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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.

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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.

[Deleted User]

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

[Deleted User]

Eliezer Shrilling Grassland wrote: »

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?

Read the paper

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

Mainly they haven't accounted for the fact that there is strong likelihood that the statistical difference between H+A vs H is different populations.

Also, azithromycin is an ineffectual antibiotic (mainly used as a prophylactic antibiotic.)

There's no in vitro data against any coronaviruses, let alone SARS-CoV-2. There's no clinical data. There's no animal data.

Also if the drug is ineffectual, using it can add additional harm such as QT prolongation. Just because we are in a pandemic doesn't mean we have to work by bad research/ science.

[Deleted User]

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

Neither of those are peer reviewed publications.

[Deleted User]

odyssey06 wrote: »

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.

Presume this is people using it prophylactically. There is no evidence for this at all. I do think the evidence for hydroxychloroquine at the moment is quite strong for treatment of moderate to severe COVID-19.

[Deleted User]

Science Based Medicine has a good review of the data.

"Sadly, the French study doesn’t provide us with the data needed and has muddied the waters more than clarified whether using hydroxychloroquine to treat COVID-19 is an effective intervention."

https://sciencebasedmedicine.org/are-hydroxychloroquine-and-azithromycin-an-effective-treatment-for-covid-19/

Alun

Ficheall wrote: »

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

I have a cousin in the UK who has lupus, and she takes hydroxychloroquine for this. There are no reported shortages so far, but she's naturally very concerned.

Squeaksoutloud

Hmm. I was excited by the hydroxychlorine french study initially as we as promising news from China on it. However, based on below it may not be that effective. Obviously a lot more research needed and is ongoing.

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

Hydroxychloroquine, a more tolerable form of chloroquine, didn’t top placebo at clearing the coronavirus among mild Chinese patients, or helping them reach normal temperature sooner, Evercore ISI analyst Umer Raffat noted in a Tuesday memo.

First, in a small study involving 30 patients, hydroxychloroquine, used on top of conventional treatments, cleared the virus in 13 (86.7%) cases on day 7, while 14 (93.3%) patients in the control group had the virus cleared, according to a study abstract Raffat obtained. One patient on the malaria med progressed to severe during the treatment.

The median duration from hospitalization to virus-negative testing, as well as the median time to body temperature normalization, were also similar between the two arms. The only positive signal was disease progression shown on CT scans, which five hydroxychloroquine cases showed, versus seven in the control group. But Raffat said the trial size was simply too small to draw conclusions.

The results clearly contradict an article published last week in The Lancet, in which two researchers described the study as showing “positive preliminary outcomes,” he said.

Also reported here..

https://www.google.com/amp/s/www.bloomberg.com/amp/news/articles/2020-03-25/hydroxychloroquine-no-better-than-regular-covid-19-care-in-study

The report published by the Journal of Zhejiang University in China showed that patients who got the medicine didn’t fight off the new coronavirus more often than those who did not get the medicine.

The study involved just 30 patients. Of the 15 patients given the malaria drug, 13 tested negative for the coronavirus after a week of treatment. Of the 15 patients who didn’t get hydroxychloroquine, 14 tested negative for the virus.

The results of the study weren’t statistically significant.

bo0li5eumx12kp

Bummer

thomasdylan

begbysback wrote: »

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.

Remdesivir is being used in Ireland.

thomasdylan

Deleted User wrote: »

Read the paper

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

Mainly they haven't accounted for the fact that there is strong likelihood that the statistical difference between H+A vs H is different patient populations.

Also, azithromycin is an ineffectual antibiotic (mainly used as a prophylactic antibiotic.)

There's no in vitro data against any coronaviruses, let alone SARS-CoV-2. There's no clinical data. There's no animal data.

Also if the drug is ineffectual, using it can add additional harm such as QT prolongation. Just because we are in a pandemic doesn't mean we have to work by bad research/ science.

Azithromycin is mostly used as propylaxis in Europe but in North America it's one of the most commonly prescibed antibiotics for LRTIs, sinus infections and STDs. GPs in America pump out prescriptions for the stuff. I don't get why Azithromycin was the choice here though.

thomasdylan

Alun wrote: »

I have a cousin in the UK who has lupus, and she takes hydroxychloroquine for this. There are no reported shortages so far, but she's naturally very concerned.

There could be shortages unfortunately. Kaiser Permanente in the US have told people with stable lupus that they're going to stop filling prescriptions for hydroxychloroquine to save it for very unwell COVID patients. Crazy stuff when there's little good evidence behind it.