From the last couple of days the hype over the Chloroquine (CQ) and Hydroxychloroquine (HCQ) treatment for #COVID19 has bothered me a lot. So I have decided to dig into the available & published data. What is the evidence right now for treating #COVID19 patients with CQ or HCQ?
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This is a small clinical trial (n=42 in total). Inclusion criteria in short moderate
#COVID19 infection (positive viral load). Exclusion criteria, allergy, long QT syndrome.... In total 42 enrolled, 6 drop out including 3 in ICU. Total 20 HCQ vs 16 controls.Show this thread -
Clinical presentation seemed similar between HCQ & control but sample size is so low, difficult to conclude really. Seriously underpowered. Outcome from the study is based on viral load only and not on clinical outcome and I can see a major flaw here as clinical outcome critical.pic.twitter.com/XgaDnm34bh
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So 16 patient received no treatment, 14 patients received HCQ only (200 mg/ day) and 6 patients received HCQ (200 mg/day) + Azithromycin to prevent surinfection (on clinical judgement). The treatment was for 10 days and outcome on viral load (nasopharyngeal swabs)
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The results showed a reduction of the viral load from HCQ and HCQ + Azithromycin treated patients compared to controls. Looks spectacular but wait .... No error base on these graphs. So I looked at the suppl datapic.twitter.com/UdN2y6779X
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Looking at supplementary Table 1, most of the controls had viral load qualitatively detected or the PCR was not done !!!! . Only 4 out of 16 controls had a proper measure of the viral load !!!! This is insane !pic.twitter.com/hDhKewVcTu
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In short, all this hype on the clinical trial is based on a open label, non randomized and underpowered clinical trial on HCQ treatment against
#COVID19 with viral load as an outcome that was not properly measured in 2/3 of the control cohort !!!Show this thread -
So to answer the question: What is the evidence of justifying using HCQ or CQ as a prophylactic or curative treatment against
#COVID19. The simple or short answer is NONE. To ascertain it, we need a proper and powered randomized clinical trialShow this thread -
While I understand we are in a
#COVID19 pandemic, there is no reason or whatsoever to throw away all the evidence based medicine and not doing rigorous science or a randomized clinical trial !Show this thread
End of conversation
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I am frankly surprised that this passed peer review.
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Thanks for this! You say this is “the one that interests you”—is this because it was flaunted as the best or it that it’s truly is horrible done? Are there better executed clinical trials that support CQ/HCQ other than this mess?
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