No Evidence of Rapid Antiviral Clearance or Clinical Benefit With Combination of Hydroxychloroquine

[Celerity]

and Azithromycin in Patients with Severe COVID-19 Infection

https://www.sciencedirect.com/science/article/pii/S0399077X20300858

https://www.sciencedirect.com/science/article/pii/S0399077X20300858/pdfft?md5=6dfd30ea643276b5150c9baee103a3f3&pid=1-s2.0-S0399077X20300858-main.pdf



The COVID-19 epidemic is the worst worldwide pandemic in a century with more than 500,000 cases and 25,000 deaths so far. In France, more than 30,000 cases have been reported up to March 27, and nearly 2,000 have died. Pending the availability of a vaccine, there is a critical need to identify effective treatments and a number of clinical trials have been implemented worldwide. In France, following the results of a clinical study in Marseille, there is considerable interest for the use of hydroxychloroquine to treat COVID-19 disease, and the French Ministry of Health recently allowed the use of hydroxychloroquine to treat COVID-19 disease pending the results of ongoing clinical trials (3). In their study, Gautret et al. reported a 100% viral clearance in nasopharyngeal swabs in 6 patients after 5 and 6 days of the combination of hydroxychloroquine and azithromycin (3). This rate of viral clearance was lower with hydroxychloroquine alone (57.1%) and was only 12.5% in patients who did not receive hydroxychloroquine (p< 0.001).

Such a rapid and full viral clearance was quite unexpected and we wished to assess in a
prospective study virologic and clinical outcomes of 11 consecutive patients hospitalized in
our department who received hydroxychloroquine (600 mg/d for 10 days) and azithromycin
(500 mg Day 1 and 250 mg days 2 to 5) using the same dosing regimen reported by Gautret et
al. (3).

snip

These virologic results stand in contrast with those reported by Gautret et al. and cast doubts
about the strong antiviral efficacy of this combination. Furthermore, in their report Gautret et
al also reported one death and three transfers to the ICU among the 26 patients who received
hydroxychloroquine, also underlining the poor clinical outcome with this combination. In addition, a recent study from China in individuals with COVID-19 found no difference in the rate of virologic clearance at 7 days with or without 5 days of hydroxychloroquine, and no difference in clinical outcomes (duration of hospitalization, temperature normalization, radiological progression) (4). These results are consistent with the lack of virologic or clinical benefit of chloroquine in a number of viral infections where it was assessed for treatment or prophylaxis with sometimes a deleterious effect on viral replication (5-8).

In summary, despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we
found no evidence of a strong antiviral activity or clinical benefit of the combination of
hydroxychloroquine and azithromycin for the treatment of our hospitalized patients with
severe COVID-19. Ongoing randomized clinical trials with hydroxychloroquine should provide
a definitive answer regarding the alleged efficacy of this combination and will assess its safety.

[uponit7771]

1. That's severe cases of cv-19 have they done mild or medium cases?

[Celerity]

2. I have not found the literature on that yet

[octoberlib]

3. If it doesn't reduce viral load in critically ill

patients , it won’t in mildly ill patients , either. This confirms what Chinese doctors have been reporting .

[Rstrstx]

5. A Chinese study posted Mar 31 does suggest benefit for people with mild symptoms

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2

Many drugs (Tamiflu, for instance) are only really effective if they are started soon after symptoms appear.

[gordianot]

4. I think it would be good for Donald Trump to dose up anyway.

The potential side effects in that case would have real benefit for the entire planet.

[brewens]

6. Blood letting worked sometimes in the middle ages. The one in ten or whatever that

somehow managed to recover anyway was proof somehow. I bet a few times it was someone with hereditary hemochromatosis that really needed to lose some blood. They watched it really work real well, but had no idea why.

[Igel]

9. Or it was just chance.

Most people get better from most things most of the time.

Calomel was probably "effective" for the things it was given for, but only in the sense that it didn't kill them immediately.

Calomel is mercury chloride.

[Snake Plissken]

7. The only significant human trials conducted on this were in China, it was as effective as placebos

The only significant human trials conducted on this were in China where they can give untested experimental drugs to patients without being sued and all three trials found it no more effective than placebos, that is why it's not being used anywhere. It is only being pimped by profiteers who cite one or two people who claimed it worked for them, and never mention how ineffective it is.

[Mike 03]

8. Recommended

[Igel]

10. That's nice.

Some pro, some con. Different conditions.

One article doesn't establish truth; one article doesn't demolish a claim. When there are enough data it'll all come together and perhaps the anomalous results will be explained to everybody's satisfaction, perhaps not. But approaching it with a "I need to prove ______ right (or wrong) because he's a dick" isn't how to do science.