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Hydroxychloroquine + azithromycin combination being touted as a Corona treatment

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    #2
    Wibbs
    Moderators, Science, Health & Environment Moderators, Society & Culture Moderators Posts: 60,106 Mod ✭✭✭✭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?

    Rejoice in the awareness of feeling stupid, for that’s how you end up learning new things. If you’re not aware you’re stupid, you probably are.



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    #3
    deathbomber
    Closed Accounts Posts: 332 ✭✭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


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    #4
    CIARAN_BOYLE
    Moderators, Sports Moderators Posts: 14,599 Mod ✭✭✭✭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.


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    #5
    begbysback
    Closed Accounts Posts: 2,910 ✭✭✭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 :D


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    #6
    CIARAN_BOYLE
    Moderators, Sports Moderators Posts: 14,599 Mod ✭✭✭✭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 :D

    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.


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    #7
    RoYoBo
    Registered Users Posts: 856 ✭✭✭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.


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    #8
    bo0li5eumx12kp
    Banned (with Prison Access) Posts: 1,355 ✭✭✭bo0li5eumx12kp


    CIARAN_BOYLE wrote: »
    It and every other trial has been discussed in the megathread.

    Incorrect.


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    #9
    Sweet.Science
    Registered Users Posts: 2,837 ✭✭✭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


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    #10
    Gretas Gonna Get Ya!
    Closed Accounts Posts: 1,245 ✭✭✭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?


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    #11
    begbysback
    Closed Accounts Posts: 2,910 ✭✭✭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?


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    #12
    thomasdylan
    Closed Accounts Posts: 514 ✭✭✭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.


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    #13
    CIARAN_BOYLE
    Moderators, Sports Moderators Posts: 14,599 Mod ✭✭✭✭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.


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    #14
    begbysback
    Closed Accounts Posts: 2,910 ✭✭✭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.


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    #15
    EDit
    Registered Users Posts: 819 ✭✭✭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.


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    #16
    EDit
    Registered Users Posts: 819 ✭✭✭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


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    #17
    deathbomber
    Closed Accounts Posts: 332 ✭✭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


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    #18
    EDit
    Registered Users Posts: 819 ✭✭✭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.


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    #19
    Wibbs
    Moderators, Science, Health & Environment Moderators, Society & Culture Moderators Posts: 60,106 Mod ✭✭✭✭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.

    Rejoice in the awareness of feeling stupid, for that’s how you end up learning new things. If you’re not aware you’re stupid, you probably are.



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    #20
    EDit
    Registered Users Posts: 819 ✭✭✭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.


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    #21
    Gretas Gonna Get Ya!
    Closed Accounts Posts: 1,245 ✭✭✭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.


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    #22
    begbysback
    Closed Accounts Posts: 2,910 ✭✭✭begbysback


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


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    #23
    bo0li5eumx12kp
    Banned (with Prison Access) Posts: 1,355 ✭✭✭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.


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    #24
    BorneTobyWilde
    Registered Users Posts: 35,816 ✭✭✭✭BorneTobyWilde


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


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    #25
    begbysback
    Closed Accounts Posts: 2,910 ✭✭✭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.


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    #26
    EDit
    Registered Users Posts: 819 ✭✭✭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.


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    #27
    begbysback
    Closed Accounts Posts: 2,910 ✭✭✭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.


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    #28
    Sweet.Science
    Registered Users Posts: 2,837 ✭✭✭Sweet.Science


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


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    #29
    CIARAN_BOYLE
    Moderators, Sports Moderators Posts: 14,599 Mod ✭✭✭✭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.


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    #30
    begbysback
    Closed Accounts Posts: 2,910 ✭✭✭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?


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    #31
    deathbomber
    Closed Accounts Posts: 332 ✭✭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


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