This new hydroxychloroquine data point

Several people have pointed out this new preprint, a retrospective look at 568 patients in Wuhan. All of them were confirmed positive and on mechanical ventilation, median age 68, 63% male. 520 of them had standard of care (various antivirals and antibiotics), and in addition 48 patients were treated with 200mg hydroxychloroquine (b.i.d.) They measured hospital stay, mortality, and (interestingly) IL-6 levels as well. And their results were quite striking: mortality was 18.8% in the HCQ group and 45.8% in the others. That’s a much larger effect than anyone outside of Marseille has reported, I have to say. Patient IL-6 levels declined significantly in the treatment group, but not in the other cohort. The preprint’s Figure 3 also indicates that IL-6 went back up after hydroxychloroquine was discontinued.

That’s interesting indeed, and ties a possible mechanism of action to the same one that has led to HCQ’s use in rheumatoid arthritis and lupus: suppressing cytokine signaling in the immune response. 

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This is followed by several other known reports on risks...but this is not ‘settled science yet’. That effect on very sick patients is much better vs the non treated group than we saw in Remdesivir.

And given the difference in death rates those who didn’t receive hcq were hard done by.

While a worthy read, by their own admission they are speculative - and more conceptual. 

Medrxiv (pronounced "med-archive", as "med - r chi ve") is an Internet site distributing unpublished manuscripts about health sciences.[2][3][4][5] It distributes complete, but unpublished manuscripts in the areas of medicine, clinical research, and related health sciences without charge to the reader. 

Such manuscripts have yet to undergo peer review and the site notes that preliminary status and that the manuscripts should not be considered for clinical application, nor relied upon for news reporting as established information.[6] 

Articles on medRxiv are not certified by peer review, edited, or typeset before being posted online. 

The site was founded in 2019 by Cold Spring Harbor Laboratory (CSHL), BMJ (a medical publisher), and Yale University. The server is owned and operated by CSHL.

MedRxiv, and its sister site, bioRxiv, have been major sources for the dissemination of research COVID19.[7]

Well MedRxiv is just a conduit....they reproduce the data from the trials. So unless they are lying, they are more or less irrelevant. Here’s the original abstract:

‘

Abstract

Importance: Coronavirus disease 2019 (COVID-19) is a pandemic with no specific drugs and high mortality. The most urgent thing is to find effective treatments. Objective: To determine whether hydroxychloroquine application may be associated with a decreased risk of death in critically ill COVID-19 patients and what is potential mechanism. Design, Setting and Patients: This retrospective study included all 568 critically ill COVID-19 patients who were confirmed by pathogen laboratory tests despite antiviral treatment and had severe acute respiratory distress syndrome, PAO2/FIO2 00 with need of mechanical ventilation in Tongji Hospital, Wuhan, between February 1 of 2020 to April 8 of 2020. All 568 patients received comparable basic treatments including antiviral drugs and antibiotics, and 48 of them additionally received oral hydroxychloroquine (HCQ) treatment (200 mg twice a day for 7-10 days). Primary endpoint is mortality of patients, and inflammatory cytokines levels were compared between hydroxychloroquine and non-hydroxychloroquine (NHCQ) treatments. MAIN OUTCOMES AND MEASURES: In-hospital death and hospital stay time (day) were obtained, level of inflammatory cytokine (IL-6) was measured and compared between HCQ and NHCQ treatments. RESULTS: The median age of 568 critically ill patients is 68 (57, 76) years old with 37.0% being female. Mortalities are 18.8% (9/48) in HCQ group and 45.8% (238/520) in NHCQ group (p<0.001). The time of hospital stay before patient death is 15 (10-21) days and 8 (4 - 14) days for the HCQ and NHCQ groups, respectively (p<0.05). The level of inflammatory cytokine IL-6 was significantly lowered from 22.2 (8.3-118.9) pg/mL at the beginning of the treatment to 5.2 (3.0-23.4) pg/ml (p<0.05) at the end of the treatment in the HCQ group but there is no change in the NHCQ group. CONCLUSIONS AND RELEVANCE: Hydroxychloroquine treatment is significantly associated with a decreased mortality in critically ill patients with COVID-19 through attenuation of inflammatory cytokine storm. Therefore, hydroxychloroquine should be prescribed for treatment of critically ill COVID-19 patients to save lives.’

Now perhaps the selection of the hcq patients was biased, if so that should be exposed under peer review. But the raw numbers are impressive.

Many serious doctors are convinced hcq helps, the urgent media effort to bury the drug smacks of politics.

Design, Setting and Patients: This retrospective study included all 568 critically ill COVID-19 patients who were confirmed by pathogen laboratory tests despite antiviral treatment and had severe acute respiratory distress syndrome, PAO2/FIO2 00 with need of mechanical ventilation in Tongji Hospital, Wuhan, between February 1 of 2020 to April 8 of 2020. 

My biggest reservation is that it happened in Wuhan, where some of these doctors that were present may no longer exist. 

The case for HDQ cocktail is overwhelming based on evidence submitted by Beeno and others. Amazing poor sharkredvirus is still determined to make a twit of himself on the subject!