10/n The "detailed treatment" rating was similarly biased - many of the green studies in this chart had far worse descriptions of the treatment regimen than the JAMA study, which is redpic.twitter.com/0Xe8PV4UVg
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21/n In other words, not only is the figure in the meta-analysis wrong, it seems to be in entirely the opposite direction to the true result That's very worrying, and hard to explain
22/n (One thing that gives you an answer more similar to the number they've got is calculating odds based on the %s given in the KM curve rather than the crude figures, but that has its own issues)
23/n There's also no reasoning given for including multiple different outcomes from the SAME PATIENTS in a meta-analysis This is very concerning
24/n For example, they've got some studies where they included numbers on the likelihood of a "clinical cure" AND "death" from the same patients These are obviously related, so aggregating both in the same model is...problematic
25/n It's also worth noting that several of these retrospective clinical audits were from the same places at overlapping times, and so probably included some of the same patients anyway
26/n There are, somehow, even more issues to examine here For one thing, the review protocol was poorly described and hard to followpic.twitter.com/AVrJ50Kx6s
27/n Remember; this is the pre-proof version of the study In other words, the final, slightly unedited, publishable version In that context, this methodology is FAR too opaque
28/n The results show you what I'm talking about There is NO WAY that searching with those search terms gets you only 23 studies Even just plugging in the search terms to PubMed gives you >100 studiespic.twitter.com/73Qn7v1x9u
29/n It took me less than 5 minutes to find a study that matches the inclusion criteria but was not included That's...worrying
30/n On top of that, in some cases the authors have included older versions of the included studies That's less than ideal (newer versions CORRECT mistakes!)
31/n There is so much more I could look at here, but honestly you have to stop somewhere This study is riddled with flaws and almost certainly does not present an accurate estimate of the effect of HCQ or CQ
32/n If you want a decent summation of the evidence for/against HCQ, a good source is CEBM: "Current data do not support the use of hydroxychloroquine for prophylaxis or treatment of COVID-19"https://www.cebm.net/covid-19/hydroxychloroquine-for-covid-19-what-do-the-clinical-trials-tell-us/ …
33/n I forgot to mention, the paper was received, revised, and accepted within a month While not unheard of, that's very quick for academic publishing!pic.twitter.com/UgR3WO2BPB
34/n In summation, the paper: - inadequately rates risk of bias - inappropriately combines estimates... - ...that may have been miscalculated It is hard to know what to make of this, except to say that the paper itself is not very useful in any way
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