the Air Vent

Because the world needs another opinion

Good Quality Paper Demonstrates Strong Efficacy of Hydroxychloroquine. Mortality rate cut in half!

Posted by Jeff Id on July 3, 2020

Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19

A new study of over 2000 hospitalized patients reveals that Hydroxychloroquine works very well in treatment of COVID.  The reason I’m so excited about this one is because unlike the poor studies that I’ve written about already, this study controlled the dosages, use the correct levels of HCQ and Azythromycin per other studies, and matched patients to each other by their own health situations.  This matching of health condition is the proper method to control the confounding factors in a situation where testing cannot be double-blind.  The health of the patient is what the frustratingly fake studies didn’t correct for, but certain political pressures made them popular.

This is absolutely the most conclusive research produced to date by anyone, due mostly to the quality of the approach.  No one has published this quality level of work on HCQ on humans prior to this.

HCQ reduced deaths by half from the untreated patients.

Of note, this was a very large study:

The results of this study demonstrate that in a strictly monitored protocol-driven in-hospital setting, treatment with hydroxychloroquine alone and hydroxychloroquine + azithromycin was associated with a significant reduction in mortality among patients hospitalized with COVID-19. In this study, among one of the largest COVID-19 hospital patient cohorts (n = 2,541) assembled in a single institution, overall in-hospital COVID-19 associated mortality was 18.1% reflecting a high prevalence of co-morbid conditions in COVID-19 patients admitted to our institution.

And Safe:

To mitigate potential limitations associated with missing or inaccurate documentation in electronic medical records, we manually reviewed all deaths to confirm the primary mortality outcome and ascertain the cause of death. A review of our COVID-19 mortality data demonstrated no major cardiac arrhythmias; specifically, no torsades de pointes that has been observed with hydroxychloroquine treatment.

My bold of course.  That means that HCQ is still not dangerous folks!!

Look at this powerful result:

The Cox regression result for the two propensity matched groups (Table 4) indicates that treatment with hydroxychloroquine resulted in a mortality hazard ratio decrease of 51% (p = 0.009). The resulting Kaplan-Meier survival curves within the propensity matched setting displayed significantly better survival in the hydroxychloroquine treated group, with the enhanced survival persisting all the way out to 28 days from admission (Fig. 2).

Also:

 

I found it very interesting that the Azythromycin didn’t work as well in combination with HCQ but it did better by itself than no treatment.  I also found it a little overly deferential in its recognition of the bad papers which others have produced, but those who know me probably aren’t surprised by that.

I want to thank all of these researchers who did their job so well.  Saving lives the right way.

Samia Arshad, Paul Kilgore, Zohra S. Chaudhry, Gordon Jacobsen, Dee Dee Wang, Kylie Huitsing, Indira Brar, George J. Alangaden, Mayur S. Ramesh, John E. McKinnon, William O’Neill, Marcus Zervos, Henry Ford COVID-19 Task Force<ce:author-group id=”aug0010″>, Varidhi Nauriyal, Asif Abdul Hamed, Owais Nadeem, Jennifer Swiderek, Amanda Godfrey, Jeffrey Jennings, Jayna Gardner-Gray, Adam M Ackerman, Jonathan Lezotte, Joseph Ruhala, Raef Fadel, Amit Vahia, Smitha Gudipati, Tommy Parraga, Anita Shallal, Gina Maki, Zain Tariq, Geehan Suleyman, Nicholas Yared, Erica Herc, Johnathan Williams, Odaliz Abreu Lanfranco, Pallavi Bhargava, Katherine Reyes, Anne Chen

Well done!


11 Responses to “Good Quality Paper Demonstrates Strong Efficacy of Hydroxychloroquine. Mortality rate cut in half!”

  1. Anonymous said

    Just hit Fox news
    https://www.foxnews.com/politics/hydroxychloroquine-helped-save-coronavirus-study

  2. Jeff id said

    Just hit fox news
    https://www.foxnews.com/politics/hydroxychloroquine-helped-save-coronavirus-study

  3. Jeff id said

    Just hit fox news.
    https://www.foxnews.com/politics/hydroxychloroquine-helped-save-coronavirus-study

  4. […] Source: Good Quality Paper Demonstrates Strong Efficacy of Hydroxychloroquine. Mortality rate cut in half! […]

  5. […] Reposted from the Air Vent […]

  6. […] Reposted from the Air Vent […]

  7. Phil Clarke said

    Hmmm. The mean age of the no-drug cohort is 71, the mean age of the HCQ cohort was just 53. In the US population as a whole mortality amongst those in their seventies is roughly 5 times that in the fifty-somethings.

    That’s the kind of confounding factor you remove in a randomised trial, which this was not. They claim to have adjusted for age but their HR reduction of just 2.6 for age >65 seems to me both a little crude and a little small.

    • Jeff Id said

      You cannot NOT give medication to folks right now. Double blind is not possible. This is simply the finest effort you can make without harming folks and the results are stark.

      a little this or little that has little meaning when you cut deaths by half on the sickest people being hospitalized.

  8. Phil Clarke said

    ” …confounding by severity or indication (Kyriacou and Lewis, 2016) is likely. While there was a hospital
    treatment protocol in place, unmeasured clinical factors likely influenced the decision not to treat
    16.1% of patients, in a center where 78% received treatment. These factors are often difficult to
    capture in an observational study. Were the decision to withhold treatment related to poor
    prognosis (e.g. palliative intent), it stands to reason that patients receiving neither
    hydroxychloroquine nor azithromycin would have the highest mortality. Indeed, the non-treated
    group had an overall mortality that was higher than the rate of admission to the ICU (26.4% vs.
    15.2%), suggesting that many patients were not considered appropriate for critical care. Such
    being the case, their care may have differed in other substantive ways that was also associated
    with death (e.g. terminal illness or advanced directives limiting invasive care)”

    In other words, for those who were not given any treatment, it is not known WHY they were not treated, which makes the use of this subset as a ‘control group’ slighty problematic.

    • Jeff Id said

      “, which makes the use of this subset as a ‘control group’ slighty problematic.”

      See all that means is that the results might be BETTER than reported because the untreated folks were less sick. I read your comment days ago but the 4th is too much fun to hang out at blogs correcting people. Calling this ‘problematic’ is a big problem for me. There is a broken mindset in the public of eternal negativity. YOUR comment is problematic because it doesn’t make that case. It simply says problematic.

      Beyond your not explaining of ‘problematic’. I actually don’t agree with you on this at all. The whole purpose of the study was to take people with the most equivalent confounding factors and compare them. This did that and found such a strong result that we now know with incredible certainty that HCQ works the same in humans as it did in vitro. What I don’t understand is why this is a result that people don’t see.

      I put the paper right there. Linked important parts. Explained in layman’s terms and still, ‘problematic’. It is not problematic, it is absolutely the best thing you can do right now and it effing works.

      Very frustrating comment.

  9. Frank said

    Jeff: Sorry I haven’t stopped by in a long time. I read this paper carefully. The fundamental problem is that this is no a random assignment placebo-controlled clinical trial. This is a summary of the results obtained from a large hospital system where doctors chose what they though would be the most appropriate treatment for their patients. As a consequence there were many large differences between the HCQ-treated group and the non-HCQ-treated group.

    The biggest difference was that many patients also got a steroidal anti-inflammatory drug such as dexamethasone. If I remember correctly, twice as many HCQ-treated patients also got a steroidal anti-inflammatory as non-HCQ treated patients. In a random-assignment placebo controlled study, where was only one difference between groups, the steroid-treated group had a statistically significant 30% survival advantage. So in this study, the HCQ-treated group would have had a better outcome even if the HCQ had been replaced with placebo, because twice as many of them got a steroid. The authors of this study used a statistical model to correct for the many differences between groups, but the groups were so heterogeneous that the benefit from steroid was large, but not statistically significant. It was left out of their correction model, Nevertheless, the appropriate use of steroidal anti-inflammatory drugs to combat the “cytokine storm” that develops in some COVID patients was considered to be THE most important improvement in care in the early months of the pandemic and undoubtably was responsible for some of the better outcome in the HCQ-treatment group.

    If you look at the data, you’ll also see that the HCQ-treatment group was younger than the non-HCQ-treatment group. If someone had secretly replaced the HCQ with placebo, we know the outcome for the “HCQ-treatment” group would have been better than the non-HCQ treatment group. The statistical model used by the investigators tried to correct for this age difference 1 as a dummy variable for people older the average and 0 for those younger than average. This crude model can’t accurately correct for the dramatic rise in untreated COVID death rate with age.

    Finally, use of HCQ is associated with problems with heart arrhythmia and sudden death (torsade des pointes) because it and many other drugs cause a change in heart rhythm called Qt-prolongation. This is problems was discovered only in recent decades and many drugs cause Qt prolongation, including HCQ. Some of these drugs have been withdrawn from the market and other have warnings on their prescribing information. None of the patients in this study reported any problems with worsening arrhythmia – almost certainly because their doctors would have been reluctant to prescribe HCQ for patients who already had arrhythmia or heart disease. However, heart disease increases the risk of dying from COVID! When doctors decided to not give HCQ to their patients, they were sending the more patients with heart disease – the ones more likely to die from COVID – to the non-HCQ treated group.

    For all of these reasons, I’m sure that the HCQ-treated group would have been more likely to survive than the non-HCQ-treated group even if the HCQ pills had been secretly replaced with a placebo.

    For this reason, definitive clinical trials with new drugs are always performed with random assignment, placebo-controlled studies. This way you are sure that the only difference between the groups is the drug you want to evaluate. However, such trials require volunteers to give informed consent and raise ethical concerns about withholding effective treatment if early reports from China were accepted. The process is slow. Trials like the one you cite herein provide some information that may prompt running a proper random assignment placebo controlled trial, but everyone knows that only the latter provide definitive conclusions, Random assignment trials show no benefit from HCQ.

    Hope you are doing well.

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