Hydroxychloroquine + azithromycin combination being touted as a Corona treatment

Wibbs

I wasn't just Trump hoping, even promoting this as a treatment. That may be a part of it with some who have an axe to grind pro or nay as far as Trump goes, but if it showed good clinical promise backed up by results, doctors around the world watching patient after patient die in front of them would be praising and using it no matter who thought it good, or bad for that matter.

LuckyLloyd

ozmo wrote: »

Im wondering if the fact its so cheap compared to the huge profits and secure patents of the alternatives (still not proven either) plus a huge desire by everyone to prove Trump wrong has put more emphasis on finding and reporting issues with this treatment.

Are you? It’s much much more likely that if isn’t effective once subjected to rigorous analysis via a clinical trial. Viruses are hard to treat, it’s nothing new.

Kermit.de.frog

Coronavirus: Chloroquine study in Brazil aborted after deaths

Too high a dose of the antimalarial agent chloroquine can cause severe cardiac arrhythmia in certain patients. Tests on COVID-19 patients in Brazil have been discontinued after 11 people died.

...

A small phase II study in Brazil, in which 11 patients died of fatal arrhythmias or heart muscle damage, shows how risky high-dose treatment of COVID-19 patients with chloroquine can be, especially in combination with the antibiotic azithromycin or other drugs.

https://www.dw.com/en/coronavirus-chloroquine-study-in-brazil-aborted-after-deaths/a-53188219

You're all welcome to give it a try as Professor Trump recommends.

jibber5000

Kermit.de.frog wrote: »

https://www.dw.com/en/coronavirus-chloroquine-study-in-brazil-aborted-after-deaths/a-53188219

You're all welcome to give it a try as Professor Trump recommends.

Mate that study's data is rubbish.

1) It was on patients in ICU ie sickest patients who may have underlying cardiac issues due to the virus.

2) Crucially the group with the cardiac side effects all received 5 times the recommended dose.
The control group who received the dose that is being given worldwide had no cardiac side effects.

You give someone with A fib 5 times their warfarin/noac dose and see how quickly they start bleeding out

odyssey06

Further trials planned in Australia and New Zealand.
The trials will test Lopinavir/ritonavir, which is currently authorised in the UK as an anti-HIV medicine, as well as hydroxychloroquine.

https://www.thejournal.ie/australian-and-new-zealand-hospitals-to-trial-coronavirus-treatment-5079630-Apr2020/

plodder

Seems like a very high dose alright, but maybe it settles the question of what happens when you give such a high dose. It seems the initial enthusiasm around this treatment is not being replicated.

jibber5000

plodder wrote: »

Seems like a very high dose alright, but maybe it settles the question of what happens when you give such a high dose. It seems the initial enthusiasm around this treatment is not being replicated.

True it does and was worth a shot.

Its not going to be a wonder drug. Equally it's not going to be useless against it. If there was any major question of it's side effects it would not be in use so widely both here and around the world.

We just have to wait for the massive trials to come out to accurately assess it's worth.

begbysback

Kermit.de.frog wrote: »

https://www.dw.com/en/coronavirus-chloroquine-study-in-brazil-aborted-after-deaths/a-53188219

You're all welcome to give it a try as Professor Trump recommends.

Good man Kermit, never let the facts get in the way of a good Trump baiting.

mvl

so, anyone looked into adding aspirin (or other blood thinners) to the treatment scheme ?

https://www.forbes.com/sites/alexandrasternlicht/2020/04/22/covid-toes-doctors-identify-newest-symptom-of-coronavirus/#5a7124401048

https://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/

so if its not the pneumonia but the thrombosis that needs care - different perspective of what we need in the hospitals (not so specialized equipment some say)

Kermit.de.frog

Trump no longer mentions this and Fox News has turned on it now.

The snake oil salesman picked up on this drug while watching Fox one day and but for that none of you would be mentioning it at all. No wonder, trying to make an unproven drug available on demand to the American public.

Don't be embarrassed, this is Trump, it's what he does - chews you up and spits you out.

Read this letter carefully

https://twitter.com/JDiamond1/status/1253056646802214912

Cronyism ahead of science

jibber5000

Kermit.de.frog wrote: »

Trump no longer mentions this and Fox News has turned on it now.

The snake oil salesman picked up on this drug while watching Fox one day and but for that none of you would be mentioning it at all. No wonder, trying to make an unproven drug available on demand to the American public.

Don't be embarrassed, this is Trump, it's what he does - chews you up and spits you out.

Read this letter carefully

https://twitter.com/JDiamond1/status/1253056646802214912

As I've said on other threads, 75% of a task force from the American Thoracic Society recommend it. For a medication without a RCT to back it up, that is very strong.

https://reachmd.com/programs/cme/covid-19-interim-guidance-management-pending-empirical-evidence-american-thoracic-society/11408/

If you come into hospital in Ireland with Covid you will get HCQ and Azithromycin for 5 days unless you've an underlying cardiac arrhythmia.

Squeaksoutloud

And it was in use in several countries long before Trump mentioned it. Most on here probably aware of it before Trump sent it global. We just need to await results of trials for the definitive answer. Certainly still interesting figures from Marseille and Dr Raoult!

Outlaw Pete

Bright's filing a whistleblower complaint. Should be interesting if nothing else.


https://twitter.com/kyledcheney/status/1253417885252255744

begbysback

Squeaksoutloud wrote: »

And it was in use in several countries long before Trump mentioned it. Most on here probably aware of it before Trump sent it global. We just need to await results of trials for the definitive answer. Certainly still interesting figures from Marseille and Dr Raoult!

Pay no attention to kermit, he's a muppet

Kermit.de.frog

Better than being a Trumptard I guess.

Hmmzis

mvl wrote: »

so, anyone looked into adding aspirin (or other blood thinners) to the treatment scheme ?

https://www.forbes.com/sites/alexandrasternlicht/2020/04/22/covid-toes-doctors-identify-newest-symptom-of-coronavirus/#5a7124401048

https://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/

so if its not the pneumonia but the thrombosis that needs care - different perspective of what we need in the hospitals (not so specialized equipment some say)

Intersting point about the anemic symptoms. It could be helped with EPO (erithropoetin) to increase red blood cell count and O2 transfer. On the other hand, given the thrombosis risk, it might make you better for a while but then make things way worse due to a blood clot (higher RBC == thicker blood). Not an easy one to manage.

Hmmzis

Some good news for a change.

https://twitter.com/mir_ocall/status/1253198967581609992?s=19

mvl

Hmmzis wrote: »

Intersting point about the anemic symptoms. It could be helped with EPO (erithropoetin) to increase red blood cell count and O2 transfer. On the other hand, given the thrombosis risk, it might make you better for a while but then make things way worse due to a blood clot (higher RBC == thicker blood). Not an easy one to manage.

Just heard that based on what they learnt from the Italian experience (autopsies finding thrombosis in all organs), in my home country they've adopted from last month adding blood thinners to the coronavirus therapy (which was antiviral + anti inflammatory before); they do that as early as they suspect someone has the virus.

Haven't found anything on HSE side from this point of view

Wibbs

mvl wrote: »

Haven't found anything on HSE side from this point of view

They'll lag behind what the doctors are doing on the frontlines. Like any profession they have their own networking jungle drums and medicine is better than most, so you can be sure they've read the current data on therapies and are trying any that look to have positive effects.

Anita Blow

mvl wrote: »

Just heard that based on what they learnt from the Italian experience (autopsies finding thrombosis in all organs), in my home country they've adopted from last month adding blood thinners to the coronavirus therapy (which was antiviral + anti inflammatory before); they do that as early as they suspect someone has the virus.

Haven't found anything on HSE side from this point of view

All COVID patients are given Clexane (blood thinner injection). Prophylactic blood thinner injections are standard of care for essentially all bed-bound medical/surgical patients.

Doc07

Anita Blow wrote: »

All COVID patients are given Clexane (blood thinner injection). Prophylactic blood thinner injections are standard of care for essentially all bed-bound medical/surgical patients.

Good point although they won’t all get that particular drug as there are some others.
But the principle is correct in that all
patients who are sick in hospital should get a drug to help prevent clotting unless they have particular bleeding risks that outweigh the benefits.

mvl

Anita Blow wrote: »

All COVID patients are given Clexane (blood thinner injection). Prophylactic blood thinner injections are standard of care for essentially all bed-bound medical/surgical patients.

- its the first time I am hearing this is standard care, I thought some pre-requisites apply (e.g. I personally have a specialist letter indicating this is needed for me)
ok, that is fine but ... are they only giving these to hospitalized patients ? - cause the point I was trying to make - the specialist driving the covid task force in my city of origin seems to indicate they treat patients at home with blood thinners too, to avoid getting to ICU stage.
(and clexane for example is not a big deal to self administer, my sister had to use it during all her pregnancies)

Anita Blow

mvl wrote: »

- its the first time I am hearing this is standard care, I thought some pre-requisites apply (e.g. I personally have a specialist letter indicating this is needed for me)
ok, that is fine but ... are they only giving these to hospitalized patients ? - cause the point I was trying to make - the specialist driving the covid task force in my city of origin seems to indicate they treat patients at home with blood thinners too, to avoid getting to ICU stage.
(and clexane for example is not a big deal to self administer, my sister had to use it during all her pregnancies)

Yes Clexane is only given to these patients in hospital.
I can't imagine there is any benefit for those in the community. Your risk of clot in COVID is proportional to severity (Eg- using D-Dimer as a marker). If you're not in hospital you're unlikely to have anything more than mild disease and so your risk of clot is probably not raised enough to warrant these injections (particularly when balanced against the risk of blood-thinning injections in such a large cohort of people). Simply walking around the house would probably be enough to reduce that risk.

mvl

Anita Blow wrote: »

Yes Clexane is only given to these patients in hospital.
I can't imagine there is any benefit for those in the community. Your risk of clot in COVID is proportional to severity (Eg- using D-Dimer as a marker). If you're not in hospital you're unlikely to have anything more than mild disease and so your risk of clot is probably not raised enough to warrant these injections (particularly when balanced against the risk of blood-thinning injections in such a large cohort of people). Simply walking around the house would probably be enough to reduce that risk.

my concern is that won't cover ppl who have higher clot risk even without COVID, only a small percentage of population are aware of genetic conditions predisposing to thrombosis (we can blame it on the screening cost I assume; lets hope things would change in this space, after coronavirus).
but could such patients get the required treatment too late, if its only done in hospital ?

Anita Blow

mvl wrote: »

my concern is that won't cover ppl who have higher clot risk even without COVID, only a small percentage of population are aware of genetic conditions predisposing to thrombosis (we can blame it on the screening cost I assume; lets hope things would change in this space, after coronavirus).
but could such patients get the required treatment too late, if its only done in hospital ?

The prevalence of clotting conditions is so low that you couldn't recommend blood-thinning injections to the general population. Such a measure would fail any risk VS benefit analysis.

mvl

Anita Blow wrote: »

The prevalence of clotting conditions is so low that you couldn't recommend blood-thinning injections to the general population. Such a measure would fail any risk VS benefit analysis.

but I am talking about predisposition for clotting, before the baseline being impacted by coronavirus. for trombophilia for example: not enough screening is done in this country for anyone to say "we've insignificant numbers"; these tests need specialized referral, they are not tests any GP would order for you ...based on the numbers published in other countries with caucasian population - e.g. australia - https://www.ncbi.nlm.nih.gov/pubmed/16028846 - trombophilia is more common (close to half the population).


do you know what type of thrombosis risk assessment is done when diagnosing patients with coronavirus ? e.g. would someone with known thrombophilia be admitted to hospital as higher risk by default ?

Anita Blow

mvl wrote: »

but I am talking about predisposition for clotting, before the baseline being impacted by coronavirus. for trombophilia for example: not enough screening is done in this country for anyone to say "we've insignificant numbers"; these tests need specialized referral, they are not tests any GP would order for you ...based on the numbers published in other countries with caucasian population - e.g. australia - https://www.ncbi.nlm.nih.gov/pubmed/16028846 - trombophilia is more common (close to half the population).


do you know what type of thrombosis risk assessment is done when diagnosing patients with coronavirus ? e.g. would someone with known thrombophilia be admitted to hospital as higher risk by default ?

The high prevalence in that study reflects heterozygotes (IE- carriers) in which the absolute risk of clot is still pretty low. Factor V Leiden is the most common thrombophilia and affects around 5% of the population, but most of those will never develop a clot in their life. The absolute risk of DVT in those with F5L is 25-50/1000.

I haven't encountered any COVID patients with inherited thrombophilias myself. In general, having a thrombophilia itself wouldn't be grounds for admission and there's been no guidance from the haematology societies that a thrombophilia screen is necessary at diagnosis.

The best advice is that those with inherited clotting disorders are a special population in COVID. We definitely need more data to guide us on how best to manage them. At present there has been no data to suggest those with mild disease in the community are at any substantial increased risk of clots. The increased clot risk arises from the cytokine storm and inflammatory cascade that gives rise to mod-severe disease. Those with moderate-severe disease will be admitted anyway due to the severity of their COVID and their coagulation markers will be monitored regularly and haematologists will guide their management on a case-by-case basis.

Hmmzis

Small improvements in critical patients.

https://www.statnews.com/2020/04/27/arthritis-drug-kevzara-disappoints-as-coronavirus-treatment/

Still, looks like it could be of some benefit if there is nothing else to throw at that damn bug.

Esel

Any comments on this post from the Farming & Forestry CV thread re famotidine?

greysides wrote: »

Your cheap heartburn medication may yet save your life.

https://www.sciencemag.org/news/2020/04/new-york-clinical-trial-quietly-tests-heartburn-remedy-against-coronavirus

Hmmzis

Esel wrote: »

Any comments on this post from the Farming & Forestry CV thread re famotidine?

Very intersting methodology they used to arrive at the drug for the virus. If it pans out well in clinical trials, then it could be an anazing technology for screening existing and new compounds for all sorts of deseases.