This thread will be my last contribution in regards of #chloroquine controversy before new data are put to light. #healthNerds

Based on some data in vitro and in vivo, some virologists suggested its use, this treatment was along Keltra or remdisivir among the options used to treat covid 19 all without proper evidence because such evidence needs time

Pr Raoult from Marseille suggested based on a very tiny and methodologically controversial study to use it massively in the treatment of mild cases, he is a well known virologist with big experience in Chloroquine and his opinion thus matters

However no consensus among infectious disease doctors and virologists exists in that regard, other therapeutic options are on the table also, well how do we sort the difference among experts?

It is with robust studies methodologically, which means randomized studies comparing different therapeutic options. These studies are already starting in Europe, USA and also worldwide with WHO sponsoring one

Meanwhile, each medical team makes its choices regarding the treatments which has always been the case, many medical teams in France and elsewhere are using hydroxychloroquine, others are not using other treatments like Kelatra and remdisivir or others or even none

each medical team will weigh the evidence and decide on each case if a treatment should be used, this is how it is done when a treatment is used off label. Now some argue but why not use massively the chloroquine as Pr Raoult suggested as it is available and cheap?

well answer is that first no drug agency will issue a recommendation for a treatment without proper evidence also there are other therapeutic options on the table that need evaluation. Why would we decide to exclude those options now already?

there is a possibility for example that a treatment proves more efficient in mild cases, another one in critical ones, why would we decide to remove all the options immediately in favor of a strategy that still lacks evidence

I understand those are tense times and in such general fear people want and need fast solutions. But scientists and MDs around the world are doing their best now. It is probably complicated to understand that and easier to resort to conspiracy theories but this is the reality

I repeat Chloroquine might be or not a successful treatment and already it is widely used since no treatment has enough evidence (including chloroquine) , in parallel to the medical use, randomized studies should continue on all treatments

Those should be able in the next few weeks to give us the beginning of some answers maybe they will validate Pr Raoult strategy and i hope they do , maybe also they wont, maybe also they will validate other strategies. The important is we do the best for everyone collectively

Conspiracies, media, politicians should not be the ones dictating this, rather science. And we should all take a deep breathe and wait for it. And i ll be back when more data are available about chloroquine or others which i sincerely hope they would be positive #healthNerds

An update ,a randomized but still small chinese trial gives some positive results as opposed to another one from last week that gave negative ones. We ll have to wait for larger trials but this is the first positive sign for the treatment https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v1

Another update, a new randomized chinese trial shows no benefit of hydroxychloroquine. This trial is not yet peer reviewed , but this makes a lot of trials not giving significant benefit. https://www.medrxiv.org/content/10.1101/2020.04.10.20060558v1.full.pdf

Updating this thread because of the ongoing heated discussions about the Lancet article relating retrospectively 96000 patients and comparing those who received HCQ or CQ with or without macrolide to those who received standard of care

This clinical registry showed an excess of mortality in the chloroquine and Hydroxychloroquine groups. This registry is retrospective and shows extremely bad results for these treatments, this registry of course has bias as it is not a randomized controlled trial

So it would be dishonest to formally make the conclusion that HCQ or CQ kills while we criticized very fast conclusions from extremely biased trials that said that HCQ works or even is a miracle treatment

Reality is that if HCQ was a miracle treatment or that it kills massively then the RCTs going on would have been interrupted, so both statements are unlikely. However the lancet study is better and by far than the Raoult initial study.

So the Raoult defenders arguing that the lancet study has bias are being inconsistent, we cannot base a whole line of treatment on an extremely biased trial of 26 patients, then disregard a 96000 patients study with way better methodology albeit a retrospective one with its bias

The lancet study being way better than the Raoult study, the logic leading to its prescription in compassionate use becomes void as the lancet study sheds some doubt on a potential harm. So in all we dont know if HCQ kills or have some benefit in certain cases

But we dont have any proof that it works while having doubts it might harm now, one conclusion : HCQ or CQ should only be used in RCTs now, i am not sure it is ethical to use it in compassionate use.