On Friday, August 7, 2020 at 4:53:50 PM UTC+2, Bruno Marchal wrote: > > > On 7 Aug 2020, at 13:09, PGC <[email protected] <javascript:>> wrote: > > > > On Friday, August 7, 2020 at 12:38:28 PM UTC+2, Bruno Marchal wrote: >> >> >> On 7 Aug 2020, at 00:52, 'Brent Meeker' via Everything List < >> [email protected]> wrote: >> >> 8 | DISCUSSION As hospitals around the globe have filled with patients >> with COVID-19, front line providers remain without effective therapeutic >> tools to directly combat the disease. The initial anecdotal reports out of >> China led to the initial wide uptake of HCQ and to a lesser extent CQ for >> many hospitalized patients with COVID-19 around the globe. As more data >> have become available, enthusiasm for these medications has been tempered. >> Well designed, large randomized controlled trials are needed to help >> determine what role, if any, these medications should have in >> treating COVID-19 moving forwards. While HCQ has in vitro activity against >> a number of viruses, it does not act like more typical nucleoside/tide >> antiviral drugs. For instance, HCQ is not thought to act on the critical >> viral enzymes including the RNA-dependent RNA polymerase, helicase, or >> proteases. Despite in vitro activity against influenza, in a large high >> quality randomized controlled trial, it showed no clinical benefit, >> suggesting that similar discordance between in vitro and in vivo >> observations is possible for SARS-CoV and SARS-CoV-273 (Table 3). >> >> >> Additionally, HCQ and especially CQ have cardiovascular and other risks, >> particularly when these agents are used at high doses or combined with >> certain other agents. While large scale studies have demonstrated that >> long-term treatment with CQ or HCQ does not increase the incidence of >> infection, caution should be exercised in extrapolating safety from the >> studies of chronic administration to largely healthy individuals to >> estimate the risk associated with short-course treatment in acutely and >> severely ill patients. Furthermore, the immunologic actions that make HCQ >> an important drug for the treatment of auto-immune diseases might have >> unintended consequences when it is used for patients with COVID-19. The >> effects of this immune modulation on patients with COVID-19 are unknown at >> this time, including a potential negative impact on antiviral innate and >> adaptive immune responses which need to be considered and studied. For all >> these reasons, and in the context of accumulating preclinical and clinical >> data, we recommend that HCQ only be used for COVID-19 in the context of a >> carefully constructed randomized clinical trial. If this agent is used >> outside of a clinical trial, the risks and benefits should be rigorously >> weighed on a case-by-case basis and reviewed in light of both the immune >> dysfunction induced by the virus and known antiviral and immune modulatory >> actions of HCQ. >> >> https://faseb.onlinelibrary.wiley.com/doi/pdfdirect/10.1096/fj.202000919 >> >> >> >> Just to be sure, I have no problem with this. My point is just that >> today, there are studies indicating that HCQ might be slightly better than >> Remdesevir, and that the Media are wrong when mocking Trump on HCQ in some >> systematic way. >> > > You're out of your field here. People out on the front lines shouldn't be > subjecting high numbers of suffering folks to medical treatment based on > some studies indicating "might be slightly better than…". > > > If serious studies shows that a medication is better than another, why > not, in case you do have confidence in those studies of course. As you say, > I am not a physician, and I have no real clue which medication I would use. > My point was just that it is hard to trust the FDA on this, and the media > is not exceptionally valid on this. > > > > > As Brent quoted, it should read "Well designed, large randomized > controlled trials are needed". You make it a point to advertise your > humility and awareness of your ignorance as a scientist. Thankfully, > Doctors around the world are not mechanists according to Bruno or Raoults > and act with *more* humility and cooler heads relative to the studies you > refer to, and interpret them as premature, until more solid evidence may > change the picture. > > > ? > > > > > > >> Most people in the virology community defending HCQ are not favorable to >> the preventive use of HCQ, and propose precise protocol to be used, and >> actually, claims that it asks for a higher doze than its usual use, >> justifying a medical prescription. Only doctors could use it. And yes, that >> can have advert effect, but according to Raoult, they are slightly less >> severe than the one accompanying Remdesevir. >> > > He doesn't provide that evidence. Not at the standards we're talking about. > > > He does, or at least he provided many references. >
Many? You're joking right? You can have a ton of references to PrEP, PEP, or alternatively conceived and designed type studies and it's everybody's right to believe in them and to take that medication if they wish. If folks want to confuse quantity with quality, that's their choice. It's you guys that are following references/names without a guiding principle/standard as you'll accept anything that goes in your discursive direction, with Christian "if they lied to us, then they are liars" type judgements embedded in the assumptions of your statements. What does that ever indicate? I'll side with the more cautious and qualitative notion of effective in terms of well designed, large randomized controlled clinical trials. It's you guys that are following references/names without a guiding principle/standard as you'll accept anything that goes in your discursive direction. PGC -- You received this message because you are subscribed to the Google Groups "Everything List" group. To unsubscribe from this group and stop receiving emails from it, send an email to [email protected]. To view this discussion on the web visit https://groups.google.com/d/msgid/everything-list/d93dc582-97f2-4903-9d5e-184f4519c903o%40googlegroups.com.
