Hydroxychloroquine + azithromycin combination being touted as a Corona treatment

bo0li5eumx12kp

https://www.mediterranee-infection.com/hydroxychloroquine-and-azithromycin-as-a-treatment-of-covid-19/

Short and to the point

https://techcrunch.com/2020/03/19/french-study-finds-anti-malarial-and-antibiotic-combo-could-reduce-covid-19-duration/

All very preliminary but encouraging.

Wibbs

Interesting that the addition of the antibiotic really ramped up the recovery speed. I wonder does this mean in some patients opportunistic bacteria are part of the disease process?

deathbomber

a bacterial infection is quite a common to occurrence in patients with pneumonia, it is already being recommended to administer an antibiotic, however some countries (including China) don't usually do so, unsure why, perhaps they opt for another treatment etc

CIARAN_BOYLE

Wibbs wrote: »

Interesting that the addition of the antibiotic really ramped up the recovery speed. I wonder does this mean in some patients opportunistic bacteria are part of the disease process?

Interesting to note that estimates of germany's pneumonia vaccine coverage is around the 50% in persons 60 or over.

I have felt that Germany's low death rate is one of the key stories about the pandemic.

I have shared stories suggesting that it's contributed to by a higher level of testing (ie more minor cases being detected) and that there are bookkeeping differences regarding the cause of death.

It could be the case that a major killer is secondary infection and this is low in Germany.

begbysback

Pretty amazing if the virus can be eradicated in 6 days by drugs already on the shelves, probably more amazing is that theres 4 posts on this thread in 4 hours and maybe 400 in 4 hours in the coronamania thread

CIARAN_BOYLE

begbysback wrote: »

Pretty amazing if the virus can be eradicated in 6 days by drugs already on the shelves, probably more amazing is that theres 4 posts on this thread in 4 hours and maybe 400 in 4 hours in the coronamania thread

It and every other trial has been discussed in the megathread.

I think there was two sided ranting about orange oompa loompas after this was shared. I forget the details.

RoYoBo

I wonder how likely would it be to have this (Plaquinal) prescribed if diagnosed and you asked for it from your doctor? I'd be keen to try it if I got the chance in that situation.

bo0li5eumx12kp

CIARAN_BOYLE wrote: »

It and every other trial has been discussed in the megathread.

Incorrect.

Sweet.Science

These drugs are our best hope. Trump put them on notice to the world the other day suggesting they were approved for use (wrongly)

In other words he was saying hurry the **** up

Gretas Gonna Get Ya!

Sweet.Science wrote: »

These drugs are our best hope. Trump put them on notice to the world the other day suggesting they were approved for use (wrongly)

In other words he was saying hurry the **** up

He's thinking like any normal person on the street would, if they got wind of an effective treatment for this... what are you waiting for, get this thing out there!

I wonder how long the FDA needs in normal circumstances, to safely approve something like this? And can that process be fast-tracked given the urgency of this situation?

begbysback

Sweet.Science wrote: »

These drugs are our best hope. Trump put them on notice to the world the other day suggesting they were approved for use (wrongly)

In other words he was saying hurry the **** up

Tbf I kinda made the same mistake as trump, in that they are approved for use, just not for use in corona treatment - the problem here is there’s no consistency, countries seem to be selecting different drugs, so actual successes are not clear.

Still though to eradicate a virus from the body in 6 days seems to be remarkable. I guess WHO can’t recommend the successful combinations though until they are FDA approved for the treatment of corona?

thomasdylan

RoYoBo wrote: »

I wonder how likely would it be to have this (Plaquinal) prescribed if diagnosed and you asked for it from your doctor? I'd be keen to try it if I got the chance in that situation.

No chance of getting it prescribed now. I don't think GPs will be prescribing it.

It's mainly used for lupus and has lots of side effects.

CIARAN_BOYLE

Gretas Gonna Get Ya! wrote: »

He's thinking like any normal person on the street would, if they got wind of an effective treatment for this... what are you waiting for, get this thing out there!

I wonder how long the FDA needs in normal circumstances, to safely approve something like this? And can that process be fast-tracked given the urgency of this situation?

The fact that the treatment is approved for other uses means we can fast track and cut the safety portions. So we only need to verify that it actually works on a larger sample.

begbysback

CIARAN_BOYLE wrote: »

It and every other trial has been discussed in the megathread.

I think there was two sided ranting about orange oompa loompas after this was shared. I forget the details.

I’ve banned myself from the mega thread for mental health reasons, there should be a government health warning shown before entering that thread.

EDit

I work in this area (Drug approvals) and it’s a complicated and often convoluted process. In certain circumstances, just because a drug is approved in one indication (for one disease) it cannot automatically be approved in another due to different doses or dosing schedules. For example, if all your safety data for drug X in disease A is at a dose of 10mg/ml once a day for a week, but a small study shows that drug X also has efficacy in disease B at a dose of 20 mg/ml twice a day over a 3-week course, you need to make sure that the new dose and schedule is safe in a large pool of patients before you can approve the drug (totally hypothetical example).

In terms of these specifics drugs, they do appear to be promising and could really help those with severe disease, as long as they are safe* Unfortunately, hydroxychloroquine isn’t usually given to patients with heart disease (it has a moderate disease interaction meaning that the recommendation is usually to not use it) and heart disease is one of the risk factors for death with C-19... ie, this might not be the silver bullet for all patients.

*i found and read the French study that is being widely cited. It is small (36 patients) and no safety data are included. I suspect this is a primary reason for the FDA treading carefully.

EDit

As a follow up, here is the French paper: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

deathbomber

supply would also be a problem a si think it is only manufactured by 1 US company, however i am sure there are ways around it for urgency

EDit

deathbomber wrote: »

supply would also be a problem a si think it is only manufactured by 1 US company, however i am sure there are ways around it for urgency

Absolutely.

It should also be mentioned (and I really am not trying to be pessimistic, merely realistic) that widespread use of any of these drugs is highly unlikely as the costs associated with treating everyone infected would destroy most countries healthcare budget immediately. Best case scenario IMO, is that it is something that is available for the 20% who get severe infections and as a prophylaxis to protect frontline healthcare workers. Even that would make a massive difference.

Wibbs

EDit wrote: »

Absolutely.

It should also be mentioned (and I really am not trying to be pessimistic, merely realistic) that widespread use of any of these drugs is highly unlikely as the costs associated with treating everyone infected would destroy most countries healthcare budget immediately.

Set against that is it's a very cheap drug as drugs go and that's with profits attached. It certainly wouldn't destroy a country's healthcare budget. Never mind the costs of not treating people early before they get to the ICU stage. How many doses would you buy for the cost of one patient in ICU for a day.

EDit

Wibbs wrote: »

Set against that is it's a very cheap drug as drugs go and that's with profits attached. It certainly wouldn't destroy a country's healthcare budget. Never mind the costs of not treating people early before they get to the ICU stage. How many doses would you buy for the cost of one patient in ICU for a day.

Good point. Forgot both of these are generic, so should be relatively cheap. Apparently they are being tested in larger trials with results expected in ~20 days. Fingers crossed the data look good.

Gretas Gonna Get Ya!

Wibbs wrote: »

Set against that is it's a very cheap drug as drugs go and that's with profits attached. It certainly wouldn't destroy a country's healthcare budget. Never mind the costs of not treating people early before they get to the ICU stage. How many doses would you buy for the cost of one patient in ICU for a day.

If this is a malaria drug, surely it would have to cheap to produce? Most cases of malaria are in desperately poor regions of the world.

begbysback

One quote I heard was 5c per pill, think that was the hydrothingy one

bo0li5eumx12kp

EDit wrote: »

As a follow up, here is the French paper: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

Pffff

"...At day6 post-inclusion, 100% of patients treated with hydroxychloroquine and azithromycin combination were virologicaly cured comparing with 57.1% in patients treated with hydroxychloroquine only, and 12.5% in the control group...."

Early stages, small trials and that just explains what the graph demonstrates, but hell it's reassuring to see something like that in writing.

"....Of note, one patient who was still PCR-positive at day6-post inclusion under hydroxychloroquine treatment only, received azithromycin in addition to hydroxychloroquine at day8-post inclusion and cured her infection at day-9 post infection..."

Combination therapy is obviously the effective route.

"...severe QT prolongation induced by the association of the two drugs has not been established yet but should be considered..."

Prolonged heart rate vs respiratory failure.

Kind of seems like a no-brainer.

Cheers for finding the full link. I ran the original through sci-hub and couldn't get anything.

BorneTobyWilde

Would a doctor here prescribe it ? Can one go pick it up at Chemist /

begbysback

If this is the solution, then there is still an issue where a person of high risk contracts the virus, by the time symptoms start getting bad, do they really have 6 days. I haven’t read the full report as yet, does it say to what degree the symptoms improve.

I guess mass testing, in conjunction with this combination of drugs, for those who contract the virus would need to be applied together to completely eradicate from this island.

EDit

begbysback wrote: »

If this is the solution, then there is still an issue where a person of high risk contracts the virus, by the time symptoms start getting bad, do they really have 6 days. I haven’t read the full report as yet, does it say to what degree the symptoms improve.

I guess mass testing, in conjunction with this combination of drugs, for those who contract the virus would need to be applied together to completely eradicate from this island.

This part might answer your question to a degree “ A total of 26 patients received hydroxychloroquine and 16 were control patients. Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days1-2 and one transferred on day4 post-inclusion who was PCR- positive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days1-2; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days1-2-3.“

So 3 patients who received hydroxychloroquine still went into ICU (after between 1 and 3 days of treatment) and 1 patient died after 2 days of treatment even though clear of the virus.

begbysback

I guess that’s expected, and why FDA can’t just say yeah go ahead. The sample group were most likely at critical stages, and organ damage already done, Im thinking a more accurate sample would be where the symptoms aren’t critical, and a larger group of course.

Sweet.Science

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-continues-facilitate-development-treatments

CIARAN_BOYLE

begbysback wrote: »

If this is the solution, then there is still an issue where a person of high risk contracts the virus, by the time symptoms start getting bad, do they really have 6 days. I haven’t read the full report as yet, does it say to what degree the symptoms improve.

I guess mass testing, in conjunction with this combination of drugs, for those who contract the virus would need to be applied together to completely eradicate from this island.

This isn't the solution.

The drug is counter indicated for certain conditions for a reason. So it wont work on everyone.

It is however a potential solution. If the doctors find it works for some people that's great. That's 5-60% of the people in serious condition that can be whacked with it so they take up icu beds for less time.

That means icu can go further.

It's not a answer all solution that will fix the problem.

begbysback

CIARAN_BOYLE wrote: »

This isn't the solution.

The drug is counter indicated for certain conditions for a reason. So it wont work on everyone.

It is however a potential solution. If the doctors find it works for some people that's great. That's 5-60% of the people in serious condition that can be whacked with it so they take up icu beds for less time.

That means icu can go further.

It's not a answer all solution that will fix the problem.

Do you have a source that specifies which conditions this won’t work on, and why?

deathbomber

BorneTobyWilde wrote: »

Would a doctor here prescribe it ? Can one go pick it up at Chemist /

yes it is a well known drug, i was given a prescription for it before i went travelling in asia for 6 months about 12 years ago, i never took it, no need etc, from what i recall, it is not a drug you just pop as it can be quite hard on the body/possible side effects

Wibbs

Anti malarials seem to be harsh drugs as a general thing? Though better than getting a full dose of malaria so risk/benefit comes into it.

CIARAN_BOYLE

begbysback wrote: »

Do you have a source that specifies which conditions this won’t work on, and why?

I'd have to go digging for a proper answer but here's the top of my head one.

It's not that they wont work it's that it's dangerous for people.

It reacts badly with insulin so diabetics cant take it.

I believe they wont prescribe it for anyone with kidney problems or heart problems for it's current problems. Given that the proposed dose for covid 19 is higher than the current dose (anti malaria and autoimmune) I'd imagine this would be more dangerous.

bo0li5eumx12kp

Via Luke O'Neills twitter account:

"Many drugs are being carefully tested against COVID19. 4 standouts optimism high: 2 that kill the virus- Remdesivir (anti-Ebola)and combo Ritonavir/Lopinavir (anti-HIV), and 2 anti-inflammatories to protect lungs (hydroxychloroquine (anti-malaria) and tocilizumab (anti-IL6)"

Don't know about the others but that HIV drug combo makes you feel like you've been hit by a freight train.
Seriously heavy drug.

Don't know why we're not hearing more reports of their actual use.

The HIV drugs also cost well over 1000 currency for a months supply.

Montage of Feck

So your saying drinking gin and tonic will prevent the virus?

threeball

I think I heard yesterday that Novartis produced 200000 doses of hydroxy available free of charge so it must be gathering momentum.

I don't think the addition of azithromycin actually benefits recovery. It doesn't actually make sense from the data and it doesn't make sense pharmacologically.
Hydroxychloroquine is the real deal.

Also, Keletra doesn't work.

bfa1509

Wibbs wrote: »

I wonder does this mean in some patients opportunistic bacteria are part of the disease process?

This is all I could think of when you said "opportunistic bacteria"

irishgeo

Interesting reading.


Another interesting idea is plasma from cured patients.Any word what the italians did with the tonne of plasma china sent them?

begbysback

Eliezer Shrilling Grassland wrote: »

Via Luke O'Neills twitter account:

"Many drugs are being carefully tested against COVID19. 4 standouts optimism high: 2 that kill the virus- Remdesivir (anti-Ebola)and combo Ritonavir/Lopinavir (anti-HIV), and 2 anti-inflammatories to protect lungs (hydroxychloroquine (anti-malaria) and tocilizumab (anti-IL6)"

Don't know about the others but that HIV drug combo makes you feel like you've been hit by a freight train.
Seriously heavy drug.

Don't know why we're not hearing more reports of their actual use.

The HIV drugs also cost well over 1000 currency for a months supply.

Im baffled too as to why more isnt being discussed about drug treatment of COVID19 - theres no doubts its going on in countries, when I questioned the HSE consultant in the AMA thread on their exaggerated death forecast in Ireland I got the below as a source for the predictions - what I consider to be strange is this specifies non pharmaceutical intervention, as if there was nothing available - I find it bizzare to be honest that nobody as yet has produced a larger scale report than the french one about drug treatments. Ive no doubt the Chinese have such reports, but dont seem to be sharing them, or at least us public are not told about them.

I would hate to think that the large discrepancies in death numbers when comparing countries is caused by lack of shared information about a treatment.


https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

thebaz

Interferon treatment in the UK sounds promising :-
https://www.theguardian.com/science/2020/mar/19/prospects-treatment-coronavirus-drugs-vaccines

Not sure if it is adminstered directly into lungs or pill format.

bo0li5eumx12kp

Deleted User wrote: »

I don't think the addition of azithromycin actually benefits recovery. It doesn't actually make sense from the data and it doesn't make sense pharmacologically.
Hydroxychloroquine is the real deal.

Also, Keletra doesn't work.

Study clearly outlines addition of azithromycin to hydroxychloroquine monotherapy went from..... not recovering, to fully recovered.

Isn't it used specifically in treatment of pneumonia, respiratory difficulties and bacterial infections?

Bold statements.
Any updated links/studies, remotest form of evidence as to this assertions?

bo0li5eumx12kp

https://time.com/5808894/hydroxychloroquine-coronavirus/

Outlay of hydroxychlor and azithro potential use, misuse, and mechanics vs CV19.

Kaletra study - not that it doesn't work, only doesn't work if it's admin'd whilst patient is on last legs; seems to basically say.

https://www.fiercepharma.com/pharma-asia/top-covid-19-aspirants-chloroquine-abbvie-s-kaletra-and-a-flu-drug-disappoint-clinical

The Hound Gone Wild

Eliezer Shrilling Grassland wrote: »

https://time.com/5808894/hydroxychloroquine-coronavirus/

Outlay of hydroxychlor and azithro potential use, misuse, and mechanics vs CV19.

Kaletra study - not that it doesn't work, only doesn't work if it's admin'd whilst patient is on last legs; seems to basically say.

https://www.fiercepharma.com/pharma-asia/top-covid-19-aspirants-chloroquine-abbvie-s-kaletra-and-a-flu-drug-disappoint-clinical

Nearly everything is a case study. The methods are flawed, the research poor. This is not the data we need to inform clinical decisions

In normal circumstances those "papers" wouldn't get anywhere close to being published in such prestigious journals.

kevinc565

EDit wrote: »

I work in this area (Drug approvals) and it’s a complicated and often convoluted process. In certain circumstances, just because a drug is approved in one indication (for one disease) it cannot automatically be approved in another due to different doses or dosing schedules. For example, if all your safety data for drug X in disease A is at a dose of 10mg/ml once a day for a week, but a small study shows that drug X also has efficacy in disease B at a dose of 20 mg/ml twice a day over a 3-week course, you need to make sure that the new dose and schedule is safe in a large pool of patients before you can approve the drug (totally hypothetical example).

In terms of these specifics drugs, they do appear to be promising and could really help those with severe disease, as long as they are safe* Unfortunately, hydroxychloroquine isn’t usually given to patients with heart disease (it has a moderate disease interaction meaning that the recommendation is usually to not use it) and heart disease is one of the risk factors for death with C-19... ie, this might not be the silver bullet for all patients.

*i found and read the French study that is being widely cited. It is small (36 patients) and no safety data are included. I suspect this is a primary reason for the FDA treading carefully.

luckily we live in europe/eu so its the EMA that would give the nod for us,not the FDA.

Ficheall

begbysback wrote: »

Im baffled too as to why more isnt being discussed about drug treatment of COVID19

There's been at least one death in the states already (AZ?) of someone who took fish-tank cleaner because it contained some sort of chloroquinine (sp?). There are also doctors in the US prescribing hydrochloroquinine (sp?) for themselves and their families as a precaution.



You can't underestimate people's idiocy, selfishness (and perhaps eventually litigiousness), so any benefits to announcing a cure prematurely are outweighed by the negatives.

Edit: And as deathbomber pointed out - it is not a pleasant drug to take.

Raconteuse

I think it's responsible for there not to be much talk around a drug treatment. Best not to get hopes up until there is more certainty. Drug approval is a lengthy process - a lot of trials are just one aspect of it. And with good reason. How headwrecking would it be for researchers to be getting "what are ya waitin' for? Get on with it!" messages, as if they're just lolling around on Facebook. They must be run ragged.

endacl

deathbomber wrote: »

a bacterial infection is quite a common to occurrence in patients with pneumonia, it is already being recommended to administer an antibiotic, however some countries (including China) don't usually do so, unsure why, perhaps they opt for another treatment etc

Dried animal parts. The more endangered, defenceless and inoffensive the more potent, apparently.

odyssey06

Saw this on the Guardian:
Doctors in Australia have been told not to prescribe the anti-malarial drug hydroxychloroquine and the similar compound chloroquine after some physicians gave it to themselves and their family members despite potentially deadly side-effects.

begbysback

Ficheall wrote: »

There's been at least one death in the states already (AZ?) of someone who took fish-tank cleaner because it contained some sort of chloroquinine (sp?). There are also doctors in the US prescribing hydrochloroquinine (sp?) for themselves and their families as a precaution.



You can't underestimate people's idiocy, selfishness (and perhaps eventually litigiousness), so any benefits to announcing a cure prematurely are outweighed by the negatives.

Edit: And as deathbomber pointed out - it is not a pleasant drug to take.

I would disagree, the scenario put forward so far is if someone is diagnosed with COVID then they should go home and isolate, if it gets bad then you may be hospitalized and placed on a ventilator, if we have a ventilator because they are in short supply.

Given that scenario, people will naturally become desparate and seek alternative measures, so I believe the lack of clarity & consistency is the real problem. Its a global disease, yet is being handled locally, after the dust settles we can be sure this structure has increased the mortality rate of the disease.

It does seem that Czech Republic have been provisionally approved for the use of Remdesivir in serious cases, and maybe we can compare Dublin to Prague in population with regards to calculating death rate reduction if somewhat successful.

EDit

kevinc565 wrote: »

luckily we live in europe/eu so its the EMA that would give the nod for us,not the FDA.

Who follow a nearly identical process. I only mentioned the FDA as the discussion at that point was around Trump’s comments on it being fast-tracked. TBH, if anything, the EMA is often even more finicky about approvals vs the FDA