Study of VA’s COVID patients: Those who got hydroxychloroquine saw no benefit and died more often

Politico noticed this morning that, after weeks of hype, the president and his many friends at Fox have grown strangely quiet about hydroxychloroquine lately “for reasons that remain unclear.”

Is this why? Did Trump maybe get a heads up that a study of patients in the government’s own care was in the works that was going to prove embarrassing to him? That would have been his cue to climb off the HCQ express quickly and quietly.

This is at least the third study this month to find no clear benefit from treating coronavirus patients with hydroxychloroquine. The most encouraging thing we can say about it as a potential therapy for COVID-19 is that results are “mixed,” which doesn’t bode well for it becoming a reliable therapeutic. In fact, say the authors of today’s stay, VA patients treated with HCQ were more likely to die than patients who didn’t receive the drug.

The nationwide study was not a rigorous experiment. But with 368 patients, it’s the largest look so far of hydroxychloroquine with or without the antibiotic azithromycin for COVID-19, which has killed more than 171,000 people as of Tuesday…

About 28% who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone. About 22% of those getting the drug plus azithromycin died too, but the difference between that group and usual care was not considered large enough to rule out other factors that could have affected survival.

Hydroxychloroquine made no difference in the need for a breathing machine, either.

Researchers did not track side effects, but noted hints that hydroxychloroquine might have damaged other organs.

“I think we’re all rather underwhelmed” by the drug’s efficacy for coronavirus, said one University of Wisconsin doctor to the AP. You can read the full study here. Of note: Hydroxychloroquine was more likely to be prescribed to patients with more severe disease, which may help explain why patients who were given the drug were more likely to die. That’s one potential problem with the study, that not everyone was given the drug at the same stage of the illness. But the authors say they took that into consideration when modeling to try to control for those differences: “Nevertheless, the increased risk of overall mortality in the hydroxychloroquine-only group persisted after adjusting for the propensity of being treated with the drug.” They also considered differences among patients in “comorbidities, medications, clinical and laboratory abnormalities” before drawing their conclusions. Did the drug hasten patients’ demise?

A Twitter pal notes that, based on these results, the effective ingredient in the “HCQ + azithromycin” equation may not be HCQ:

This passage from the study is interesting, and may explain why promising results for HCQ against COVID-19 *in the lab,* as observed by Chinese doctors, might not translate into promising results in actual people:

Hydroxychloroquine could conceivably work against the virus in high doses — too high to be safely ingested by people.

John Cornyn puts the best possible result on the verdict:

Yes, clinical trials will answer the question definitively. But it takes giant stones for a top Republican to demand people reserve judgment on this drug until clinical trials are finished when Trump’s been out there for weeks encouraging people to give it a shot (“What do you have to lose?”), knowing that lupus patients who need hydroxychloroquine were destined to run into shortages as a result.

The HCQ result is depressing but this is more hopeful:

A young COVID-19 patient at the Children’s Hospital of Philadelphia is recovering after receiving donated plasma, marking a possible breakthrough in the fight against the coronavirus pandemic…

“So it took us from start to finish from when we said we wanted to use it to it actually being in the patient around 40 hours,” Dr Teachey said.

The treatment is still in an experimental stage and doctors could not say conclusively that it was the primary reason for the child’s recovery. Dr. Teachey still believes the results are encouraging however.

It’ll take clinical trials before we know if that works too, but plasma treatments have worked for ages against other diseases. Experts like Scott Gottlieb have been touting them as an obvious near-term hope for treating COVID. The sooner, the better: The one-month death toll from coronavirus has already surpassed the number of deaths from the flu across the entire 2018-19 flu season.

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