Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19

Report by Joseph Magagnoli, Siddharth Narendran, Felipe Pereira, Tammy Cummings, James W Hardin, S Scott Sutton, Jayakrishna Ambati
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https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf
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This work was paid for by grants from the National Institutes of Health and the University of Virginia paid for the work.

This study showed something significantly different from other studies that showed great promise for HCQ.

This study showed:
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• 28% who were given hydroxychloroquine plus usual care died

• 22% of those getting the drug plus azithromycin died

• 11% of those getting routine care alone

Other studies showed that nearly 100% survived.
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Something in this study was done differently.

One thing to note, when added azithromycin (antibiotic) to the treatment, the death count went down.

On page 13 of the study (middle paragraph) dosage was brought up.

The author mentioned that the approved dosage regimens...
... for rheumatoid arthritis or lupus was about 1 uM (micromol/L) of HCQ concentration. The author then says the in order to inhibit COVID 19 (SARS-CoV-2) was 4.5 uM to 17 uM.

The dosage for Lupus is:

Initial: 400 mg orally 1 to 2 times a day; this dose may be ...
... continued for several weeks or months, depending on patient response

Maintenance dose: 200 to 400 mg orally daily.

The dosage for Rheumatoid Arthritis is:

Initial: 400 to 600 mg (310 to 465 mg base) orally once a day to optimum response (usually 4 to 12 weeks)
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-Maintenance dose: 200 to 400 mg orally once a day

Doses for both conditions:

Init: 400 to 600/800mg a day for several weeks.
Maintenance: 200 to 400 mg a day.

The updated recommended dosage from the Clinical Recommendations for Treatment of COVID-19 Adult Patients ...
... (March 22, 2020) was 400 mg twice daily for the first day then 200 mg twice daily for the next 4 days.

The recommendations for treating COVID-19 was essentially the same as Lupus and RA, but for a far shorter period of time (5 days).
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https://www.vumc.org/coronavirus/sites/default/files/COVID%20Documents/Weekly%20COVID-19%20Clinical%20Guidelines%20Update%20Summary%20-%203.22.2020-%20FINAL.pdf
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The study the mockingbirds are fixated on, suggested that dosage may have been 4.5 to 17 times higher than what it should have been.

Could it be possible the dosage given to these veterans was too high? Hydroxychloroquine overdosing is dangerous.
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https://www.drugs.com/cdi/hydroxychloroquine.html
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It is possible, from the understanding seen on page 13 of the report, that the veterans may have been given a much higher dose of HCQ, than is recommended.
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