OtherGround Forums OG doc. AMA on COVID-19

13 days ago
1/1/01
Posts: 7239

Mataleo1

Check your message box please.

13 days ago
10/23/05
Posts: 3737
Dryfly - 

Mataleo1

Check your message box please.


Got it.

Weird thing though: it was labeled as "read" and I never look at my messages.

13 days ago
8/19/13
Posts: 796

Tried to stay out of these threads... Woke up this morning feeling a little congested. Had a wet cough several times today. :( Wife is due in 40 days so I went and got a test done. We are keeping our distance till Saturday when we find out the results.

13 days ago
10/20/13
Posts: 239
MyTJsuX -

Tried to stay out of these threads... Woke up this morning feeling a little congested. Had a wet cough several times today. :( Wife is due in 40 days so I went and got a test done. We are keeping our distance till Saturday when we find out the results.

Rest in peace,  brother 

13 days ago
10/20/13
Posts: 240

Also ,pics of wife ,you know the rules

12 days ago
2/4/09
Posts: 11789

Anyone see the headlines? 

 

HCQ is doing exactly what mataleo said and is making many at risk

12 days ago
1/1/01
Posts: 65851
NoNeed4aScreenName - 

Anyone see the headlines? 

 

HCQ is doing exactly what mataleo said and is making many at risk


You referring to this?

https://www.reuters.com/article/us-health-coronavirus-hydroxychloroquine/drug-touted-by-trump-as-covid-19-treatment-tied-to-increased-risk-of-death-study-idUSKBN22Y1UW
12 days ago
2/4/09
Posts: 11792
Tomato Can -
NoNeed4aScreenName - 

Anyone see the headlines? 

 

HCQ is doing exactly what mataleo said and is making many at risk


You referring to this?

https://www.reuters.com/article/us-health-coronavirus-hydroxychloroquine/drug-touted-by-trump-as-covid-19-treatment-tied-to-increased-risk-of-death-study-idUSKBN22Y1UW

That's the one. I havent read the study.but it's what mataleo has been warning about

12 days ago
10/23/05
Posts: 3738
Tomato Can - 
NoNeed4aScreenName - 

Anyone see the headlines? 

 

HCQ is doing exactly what mataleo said and is making many at risk


You referring to this?

https://www.reuters.com/article/us-health-coronavirus-hydroxychloroquine/drug-touted-by-trump-as-covid-19-treatment-tied-to-increased-risk-of-death-study-idUSKBN22Y1UW

Yeah saw this.

It really means that extreme caution is required when considering this drug (AT THESE DOSES).

At this point, with the many efficacy and safety concerns, if we don't have some data from a randomized prospective trial, we should not prescribe it blindly, and certainly not as a possible preventive therapeutic.

Edited: 12 days ago
1/13/10
Posts: 47853

Some Canadian scientist believe Cannabis can help against Covid 

http://nypost.com/2020/05/21/scientists-believe-cannabis-could-help-prevent-treat-coronavirus/

12 days ago
1/1/01
Posts: 65854
mataleo1 - 
Tomato Can - 
NoNeed4aScreenName - 

Anyone see the headlines? 

 

HCQ is doing exactly what mataleo said and is making many at risk


You referring to this?

https://www.reuters.com/article/us-health-coronavirus-hydroxychloroquine/drug-touted-by-trump-as-covid-19-treatment-tied-to-increased-risk-of-death-study-idUSKBN22Y1UW

Yeah saw this.

It really means that extreme caution is required when considering this drug (AT THESE DOSES).

At this point, with the many efficacy and safety concerns, if we don't have some data from a randomized prospective trial, we should not prescribe it blindly, and certainly not as a possible preventive therapeutic.


Just curious, how do they come up with the dosing? Like you've said that the dosage for COVID is much higher than it is when used as a malaria prophylaxis. Why is that?
12 days ago
10/23/05
Posts: 3739
Tomato Can - 
mataleo1 - 
Tomato Can - 
NoNeed4aScreenName - 

Anyone see the headlines? 

 

HCQ is doing exactly what mataleo said and is making many at risk


You referring to this?

https://www.reuters.com/article/us-health-coronavirus-hydroxychloroquine/drug-touted-by-trump-as-covid-19-treatment-tied-to-increased-risk-of-death-study-idUSKBN22Y1UW

Yeah saw this.

It really means that extreme caution is required when considering this drug (AT THESE DOSES).

At this point, with the many efficacy and safety concerns, if we don't have some data from a randomized prospective trial, we should not prescribe it blindly, and certainly not as a possible preventive therapeutic.


Just curious, how do they come up with the dosing? Like you've said that the dosage for COVID is much higher than it is when used as a malaria prophylaxis. Why is that?

Because these high doses were the ones tested in the first studies. Some (like the 1061 pt Raoult study) used 200mg 3 times per day, others tested 600mg twice a day, others 400mg twice a day. That's the dose for severe viral infections for Q-fever.

If a study comes out that smaller doses are efficient, then people will use these smaller doses.

Same as many things. For a bleeding ulcer you use pantoloc 40mg 3x/day. For ulcer prevention 40mg once a day is sufficient.

12 days ago
1/1/01
Posts: 99143
mataleo1 - 
Tomato Can - 
mataleo1 - 
Tomato Can - 
NoNeed4aScreenName - 

Anyone see the headlines? 

 

HCQ is doing exactly what mataleo said and is making many at risk


You referring to this?

https://www.reuters.com/article/us-health-coronavirus-hydroxychloroquine/drug-touted-by-trump-as-covid-19-treatment-tied-to-increased-risk-of-death-study-idUSKBN22Y1UW

Yeah saw this.

It really means that extreme caution is required when considering this drug (AT THESE DOSES).

At this point, with the many efficacy and safety concerns, if we don't have some data from a randomized prospective trial, we should not prescribe it blindly, and certainly not as a possible preventive therapeutic.


Just curious, how do they come up with the dosing? Like you've said that the dosage for COVID is much higher than it is when used as a malaria prophylaxis. Why is that?

Because these high doses were the ones tested in the first studies. Some (like the 1061 pt Raoult study) used 200mg 3 times per day, others tested 600mg twice a day, others 400mg twice a day. That's the dose for severe viral infections for Q-fever.

If a study comes out that smaller doses are efficient, then people will use these smaller doses.

Same as many things. For a bleeding ulcer you use pantoloc 40mg 3x/day. For ulcer prevention 40mg once a day is sufficient.


Any thoughts on WHEN the drug is adminstered?  I understand in most of these cases HCQ is only given when the patient requires intensive care.

Maybe I'm beating a dead horse here, but long before Trump mentioned it (without any context, btw), I saw HCQ being discussed as a *possible* early stage treatment to reduce the severity of symptoms.  More specifically, to usher zinc into cells so the zinc could suppress viral replication.   This, the hypothesis went, would have to be done long before a patient was critical. 

This article is from today:

https://www.dailymail.co.uk/health/article-8309337/Zinc-hydroxychloroquine-effective-COVID-19-patients-study.html

"Results showed that patients receiving the triple-drug combination had a 1.5 times greater likelihood of recovering enough to be discharged.

They were also 44 percent less likely to die, compared to those who were given the double-drug combination."

Far from a cure, and it's, I believe you termed it, the lowest form of evidence.  

12 days ago
7/15/11
Posts: 18201
MyTJsuX -

Tried to stay out of these threads... Woke up this morning feeling a little congested. Had a wet cough several times today. :( Wife is due in 40 days so I went and got a test done. We are keeping our distance till Saturday when we find out the results.

How old are you? I’m assuming somewhat young? No conditions? You’ll most likely be okay brotha.

Btw, you more than likely don’t have it. I did and the people that have said the same around me is unbelievable. Got tested and I was positive. Not shocking bc I had no smell for a month but the others all negative. Don’t let the BS fool you. You could absolutely be like my wife though that had at worst the muscle aches which SUCK but still it’s better than a few flu’s I’ve had as well as a couple of stomach bugs. Hope all is well!

12 days ago
1/1/01
Posts: 18409

With all these negative studies which seem to only give HCQ to critical patients as a Hail Mary, some not including zinc, how are the Drs or “experts” in the medical journalism world rectifying these apparent results with the WHO’s own massive hundreds of millions of doses study that showed zero zip nada cardiac deaths from 2017:

 

https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf

12 days ago
1/1/01
Posts: 18410

4 Conclusions and recommendations
The ERG panel addressed the following key questions and made the following recommendations for consideration:
1. What is the frequency of sudden death attributable to the cardiotoxicity of different antimalarial medicines?
Halofantrine has been associated with >30 sudden deaths attributed to cardiotoxicity. This is the only antimalarial considered to have an unacceptable risk.
Dihydroartemisinin-piperaquine and artemether-lumefantrine have been the most intensively studied antimalarial drugs. There have been no sudden deaths attributed to cardiotoxicity following artemether-lumefantrine. One possible sudden cardiac death associated with dihydroartemisinin-piperaquine was reported among ~200 000 individuals with close follow-up treated in clinical studies of malaria treatment, prevention, control and elimination. This is consistent with the risk of fatal cardiotoxicity associated with other QT/QTc interval-prolonging medicines in current use (see section 3.1.1).
Despite hundreds of millions of doses administered in the treatment of malaria, there have been no reports of sudden unexplained death associated with quinine, chloroquine or amodiaquine, although each drug causes QT/QTc interval prolongation. Unfortunately, there are relatively few prospective studies of the electrocardiographic effects of these drugs.
Intravenous chloroquine, quinine and quinidine may cause lethal hypotension if administered too rapidly. Large doses (>3.5mg base/kg) of intramuscular or subcutaneous chloroquine may also cause hypotension.

12 days ago
4/19/09
Posts: 17796
the_shrike -

With all these negative studies which seem to only give HCQ to critical patients as a Hail Mary, some not including zinc, how are the Drs or “experts” in the medical journalism world rectifying these apparent results with the WHO’s own massive hundreds of millions of doses study that showed zero zip nada cardiac deaths from 2017:

 

https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf

I’m guessing the dosage as mentioned above?

11 days ago
1/1/01
Posts: 18412

This is the dose from the NY study with good results:

 

As New York became the epicenter of the pandemic, hospitals in the area quickly adopted investigational therapies, including the use of hydroxychloroquine and azithromycin. Given this proposed synergistic effect of zinc with hydroxychloroquine, practices at NYULH changed and the addition of zinc sulfate 220 mg PO BID along with hydroxcychloroquine 400 mg once followed by 200 mg PO BID with azithromycin 500mg once daily became part of the treatment approach for patients admitted to the hospital with COVID-19.

 

 

 

11 days ago
10/23/05
Posts: 3740
Trust - 
mataleo1 - 
Tomato Can - 
mataleo1 - 
Tomato Can - 
NoNeed4aScreenName - 

Anyone see the headlines? 

 

HCQ is doing exactly what mataleo said and is making many at risk


You referring to this?

https://www.reuters.com/article/us-health-coronavirus-hydroxychloroquine/drug-touted-by-trump-as-covid-19-treatment-tied-to-increased-risk-of-death-study-idUSKBN22Y1UW

Yeah saw this.

It really means that extreme caution is required when considering this drug (AT THESE DOSES).

At this point, with the many efficacy and safety concerns, if we don't have some data from a randomized prospective trial, we should not prescribe it blindly, and certainly not as a possible preventive therapeutic.


Just curious, how do they come up with the dosing? Like you've said that the dosage for COVID is much higher than it is when used as a malaria prophylaxis. Why is that?

Because these high doses were the ones tested in the first studies. Some (like the 1061 pt Raoult study) used 200mg 3 times per day, others tested 600mg twice a day, others 400mg twice a day. That's the dose for severe viral infections for Q-fever.

If a study comes out that smaller doses are efficient, then people will use these smaller doses.

Same as many things. For a bleeding ulcer you use pantoloc 40mg 3x/day. For ulcer prevention 40mg once a day is sufficient.


Any thoughts on WHEN the drug is adminstered?  I understand in most of these cases HCQ is only given when the patient requires intensive care.

Maybe I'm beating a dead horse here, but long before Trump mentioned it (without any context, btw), I saw HCQ being discussed as a *possible* early stage treatment to reduce the severity of symptoms.  More specifically, to usher zinc into cells so the zinc could suppress viral replication.   This, the hypothesis went, would have to be done long before a patient was critical. 

This article is from today:

https://www.dailymail.co.uk/health/article-8309337/Zinc-hydroxychloroquine-effective-COVID-19-patients-study.html

"Results showed that patients receiving the triple-drug combination had a 1.5 times greater likelihood of recovering enough to be discharged.

They were also 44 percent less likely to die, compared to those who were given the double-drug combination."

Far from a cure, and it's, I believe you termed it, the lowest form of evidence.  


So, it would make SENSE to use it as an early treatment.

However, remember that most people have mild symptoms only (some are completely asymptomatic). So you're using a drug that has potential side-effects on someone who is likely to do just fine. That's problematic. For example, kids rarely need ICU care and almost never die from COVID. Would you use a treatment on kids?

It comes back again to patient selection. Ideally, you'd be able to find EARLY criteria of patients who will ultimately do poorly, and try a drug on them. Example: if a test shows that you are likely to be very sick from COVID but the patient is at an early stage, then it would make sense to study zinc + HCQ (for example) vs placebo.

In the study you quote for example, without looking at the limitations, these patients were hospitalized patients, meaning they are not "typical" patients, and meaning they are not what would be considered "early".

11 days ago
10/23/05
Posts: 3741
the_shrike - 

4 Conclusions and recommendations
The ERG panel addressed the following key questions and made the following recommendations for consideration:
1. What is the frequency of sudden death attributable to the cardiotoxicity of different antimalarial medicines?
Halofantrine has been associated with >30 sudden deaths attributed to cardiotoxicity. This is the only antimalarial considered to have an unacceptable risk.
Dihydroartemisinin-piperaquine and artemether-lumefantrine have been the most intensively studied antimalarial drugs. There have been no sudden deaths attributed to cardiotoxicity following artemether-lumefantrine. One possible sudden cardiac death associated with dihydroartemisinin-piperaquine was reported among ~200 000 individuals with close follow-up treated in clinical studies of malaria treatment, prevention, control and elimination. This is consistent with the risk of fatal cardiotoxicity associated with other QT/QTc interval-prolonging medicines in current use (see section 3.1.1).
Despite hundreds of millions of doses administered in the treatment of malaria, there have been no reports of sudden unexplained death associated with quinine, chloroquine or amodiaquine, although each drug causes QT/QTc interval prolongation. Unfortunately, there are relatively few prospective studies of the electrocardiographic effects of these drugs.
Intravenous chloroquine, quinine and quinidine may cause lethal hypotension if administered too rapidly. Large doses (>3.5mg base/kg) of intramuscular or subcutaneous chloroquine may also cause hypotension.


As Luke mentioned.

It's about dose. And it's about populations.

The recommended HCQ dose starts anywhere from 600mg to 1200mg per day. That is much higher than the 200mg daily dose for lupus/RA patients. In that study, it was 400mg, which is not as bad, but still something to think about.

Regarding populations: Aspirin for example is fairly benign in adults. In infants, it can cause Reye's syndrome.
Baclofen in healthy patients is totally fine. 1 dose in a patient with kidney disease may result in death. For some reasons, COVID patients appear more sensitive to HCQ-induced arrhythmia. And we've seen cardiac deaths related to HCQ.


11 days ago
10/23/05
Posts: 3742
the_shrike - 

This is the dose from the NY study with good results:

 

As New York became the epicenter of the pandemic, hospitals in the area quickly adopted investigational therapies, including the use of hydroxychloroquine and azithromycin. Given this proposed synergistic effect of zinc with hydroxychloroquine, practices at NYULH changed and the addition of zinc sulfate 220 mg PO BID along with hydroxcychloroquine 400 mg once followed by 200 mg PO BID with azithromycin 500mg once daily became part of the treatment approach for patients admitted to the hospital with COVID-19.

 

 

 


We commented on this earlier.

2 main points:

We're comparing
A) HCQ + AZY + ZC
B) HCQ + AZY

Comments:
-The result "appear" better for combination A, but it was done using univariate analysis (which does not take into account confounders). That's why we usually do a second phase called multivariate analysis. Guess what? On multivariate analysis, combination A wasn't shown better.
-Let's even assume that the results are significant (Combination A is better), then the only thing you can say is that zinc is the thing helping. To see if you have better outcomes with HCQ/AZY you'd need 3 arms:
A) HCQ + AZY + ZC
B) HCQ + AZY
C) Nothing

If combination B is better than C, then you have your answer: HCQ + AZY improve outcome.

In fact, ulterior studies showed a lack of effect, which is why these very NYC hospitals you mention have backed off HCQ.

11 days ago
10/23/05
Posts: 3743
Matrix - 
MyTJsuX -

Tried to stay out of these threads... Woke up this morning feeling a little congested. Had a wet cough several times today. :( Wife is due in 40 days so I went and got a test done. We are keeping our distance till Saturday when we find out the results.

How old are you? I’m assuming somewhat young? No conditions? You’ll most likely be okay brotha.

Btw, you more than likely don’t have it. I did and the people that have said the same around me is unbelievable. Got tested and I was positive. Not shocking bc I had no smell for a month but the others all negative. Don’t let the BS fool you. You could absolutely be like my wife though that had at worst the muscle aches which SUCK but still it’s better than a few flu’s I’ve had as well as a couple of stomach bugs. Hope all is well!


MyTJsuX, no need to panic. As Matrix mentioned, you both are likely to be just fine.

However, take this seriously for your wife. A pregnant woman is considered someone who is immunosuppressed.

Good luck.

11 days ago
2/4/09
Posts: 11852

Mataleo, do you think they could rushing these trial designs because of the current situation?

 

Cause like in your response to trust it makes sense to start the treatment earlier but as you also mention there additional risks associated with it. 

 

case of risk VS reward?

11 days ago
10/23/05
Posts: 3745
NoNeed4aScreenName - 

Mataleo, do you think they could rushing these trial designs because of the current situation?

 

Cause like in your response to trust it makes sense to start the treatment earlier but as you also mention there additional risks associated with it. 

 

case of risk VS reward?


There is HUGE incentive to publish these days.

Firstly, high-impact journals have said that there would be preference for COVID-type publications.

Second, journals have expedited the review process (and even are publishing papers prior to peer-review, which is weird).

As to your question, these are retrospective data, so if you have an eager ethics committee and many COVID patients (NYC), it's easy to look at past data and to analyze anything/everything.

Trials (prospective, 2 arms) are obviously more complicated and longer to do. There are many trials looking at early HCQ treatment, the results just haven't yet come out.

11 days ago
11/23/10
Posts: 261
NoNeed4aScreenName -

Mataleo, do you think they could rushing these trial designs because of the current situation?

 

Cause like in your response to trust it makes sense to start the treatment earlier but as you also mention there additional risks associated with it. 

 

case of risk VS reward?

The abundance of observational hospital data in these days of electronic medical records makes making those types of studies accessible to everybody. Also to those who aren’t competent to make good use of the data. And with the urgency of the situation, it seems people are ignoring that it’s a fundamentally invalid study design for estimating causal effects (and getting a free pass from the public, administrators and scientific journals). The Lancet study (and to some extend the VA study) on HCQ+azithomycin pull out all the statistical tricks to compensate for the design issues, so their conclusion are probably more accurate. Still, they don’t really do much more than generate a hypothesis to test in a RCT. And for better or worse,that hypothesis has been there since Ranoult made his trashcan study, and the RCTs are already underway. So those types of studies aren’t really what we need at this point.

In other news, the Remdesivir RCT study has been published:

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764?source=nejmfacebook&medium=organic-social

It looks good, and they also discuss why they changed primary/secondary outcomes (both of which ended up being significantly in favor of remdesivir, so it’s a non-issue in the end).