So, does that make it untrue? Or affect the $1.2 million that the head of Novartis paid Michael Cohen for access to Trump?
hahaAppreciate the kind words, but I feel sheepish when someone calls me that. Just doing what any other person in my shoes would do. Nothing extraordinary
So, does that make it untrue? Or affect the $1.2 million that the head of Novartis paid Michael Cohen for access to Trump?
I'm really trying to not be political, which is why I posed the question the way I did. I believe that you, an actual doctor, can read the fine print on what we know so far and come away knowing we aren't close to giving those meds the nod.
I guess I don't understand why these meds are brought up by the President over and over if you and the rest of the medical community thinks they aren't close to being a cure.
Oh man, the way you tear that paper up is beautiful. There’s plenty of journals that are publishing garbage papers without legitimate vesting, and uninformed readers can be fooled. There is a lot more bad interpretation of data than there is bad research.hey man - really great news about your daughter. Truly. I’m 31 and don’t have kids at the moment, but I can only imagine what you were going through as a parent. It was my pleasure in helping facilitate any kind of help.
Regarding your question - I can’t go into too much detail about treatments etc. I’ll post more on the malaria drug (plaquenil) being used in other studies - I read a lot of the papers already, and yeah the data isn’t there to support it’s widespread use.
Most of the data is from in vitro studies - not in actual human beings.
There are some small studies used in humans but again there are issues with the data. I’ll
Give you this paper as an example - which has been cited by some - https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2
-Treatment arms, sample size, endpoints are all different on clinical trials registration website
- Although claims to be blinded placebo-controlled trial this is not described in manuscript
- All patients received the standard treatment (oxygen therapy, antiviral agents, antibacterial agents, and immunoglobulin, with or without corticosteroids) but no further information given
- Only moderate disease (not hypoxic), so not generalizable to hospitalized hypoxic patients
- Definition of fever different than US definition
- Did not report on what baseline temperatures were, use ofantipyretic agents
- Time from onset of symptoms to randomization not listed
- Timing of progression not defined
- Appears no deaths, not clearly stated
- Almost no demographic, comorbidity data given, so cannot assess if groups are similar at baseline. Only sex and age listed
I’ve read the other papers, and issues with the studies are peppered everywhere. Point is that there are a lot of issues with these studies, and most of them - I believe all actual - excluded the sickest patients.
other drugs are being more readily used
not enough evidence in my opinion for me to say we should use in all cases - we need to pump the breaks a bit. Randomized controlled trials are needed (which people are being enrolled into right now), before we can give the green light safely. In medicine history, there are numerous examples of drugs showing promise in small sample sizes only to either not shown to have benefit when applied to a larger sample or demonstrated to be harmful. So we have to be careful here.
Other thing is we have to be mindful of is that plaquenil is among the medications used for patients with lupus. Using it to treat a condition in which the evidence for its benefit is scant, may/will take away from use against diseases that we know the drug has clinical value.
Appreciate everything you are doing man but randomized double blind trials are for another day and I'd say there is zero chance we use enough Plaquenil in our efforts regarding Covid 19 to put any lupus patient at risk. It would be interesting to know though if those taking Plaquenil for another reason are protected in any way from Covid.
I do agree that we really have no data driven idea if this drug is effective at all at this point.
I think your last sentence is spot on. Just not enough data to determine the effectiveness yet.Appreciate everything you are doing man but randomized double blind trials are for another day and I'd say there is zero chance we use enough Plaquenil in our efforts regarding Covid 19 to put any lupus patient at risk. It would be interesting to know though if those taking Plaquenil for another reason are protected in any way from Covid.
I do agree that we really have no data driven idea if this drug is effective at all at this point.
I think your last sentence is spot on. Just not enough data to determine the effectiveness yet.
Dr. Daniel Wallace at Cedar Sinai hospital in Los Angeles has some interesting comments about Plaquenil and its effectiveness. He just talked about how safe the Drug is when used correctly and he's used it for over 40+ years and is a Lupus expert.
Evidently he is treating alot of Covid 19 patients with it.
Agree on the lack of evidence and count me out of the study if I'm on deaths door from Covid. I was merely asking wouldn't it be interesting if folks on Plaquenil were protected in some way from Covid.None of the current studies provide good evidence supporting its use for COVID. Enrollment for randomized trials are happening now, so not sure what you mean by “for another day”.
the study you should suggest brings about a whole set of issues
Agree on the lack of evidence and count me out of the study if I'm on deaths door from Covid. I was merely asking wouldn't it be interesting if folks on Plaquenil were protected in some way from Covid.
His statement was he's treating 2,000 patients now but not sure if that meant Lupus patients or Covid patients in L.A?he’s a rheumatologist. Why’s he treating COVID patients
His statement was he's treating 2,000 patients now but not sure if that meant Lupus patients or Covid patients in L.A?
If everyone used the same electronic health record system it would be really great right now. With the click of a button you could see how many people have tested positive, died, etc... that are already taking the meds for other issues. You could also see the same instantly for the ones that have received it for the virus.
they’re enrolling for that trial right now. You have to have had exposure to someone with COVID within 3 days, I think
i really can’t see a rheumatologist treating 2,000 COVID patients. I have a lot of respect for rheumatologists, but it just doesn’t make sense, and frankly it wouldn’t be appropriate.
Confident he’s referring to lupus patients
My wife,who suffers from lupus, has taken these drugs for years with little to no side affects. There, of course is no cure for lupus, but the anti-malaria drug has definitely helped her deal with the problems associated with lupus.not enough evidence in my opinion for me to say we should use in all cases - we need to pump the breaks a bit. Randomized controlled trials are needed (which people are being enrolled into right now), before we can give the green light safely. In medicine history, there are numerous examples of drugs showing promise in small sample sizes only to either not shown to have benefit when applied to a larger sample or demonstrated to be harmful. So we have to be careful here.
Other thing is we have to be mindful of is that plaquenil is among the medications used for patients with lupus. Using it to treat a condition in which the evidence for its benefit is scant, may/will take away from use against diseases that we know the drug has clinical value.
Thoughts on the new info coming out about the killing mechanism for COVID being basically attack the heme group on a red blood cell and dissociate the iron ion rendering the cell unable to bind and carry O2?
link?
curious , how would it dissociate the iron ion? Is the iron converted from ferrous to ferric ? I guess that would be like Methemoglobinemia, which would be a pretty straightforward fix
My wife,who suffers from lupus, has taken these drugs for years with little to no side affects. There, of course is no cure for lupus, but the anti-malaria drug has definitely helped her deal with the problems associated with lupus.
Multiple COVID+ patients at our institution were extubated over the last several days, including some elderly with comorbid conditions. One in particular was doing very poorly initially with ARDS. Didn’t think was going to make it - now extubated and doing well.
What % of COVID+ patients that are intubated are diagnosed with ARDS?
Just wanted to share a few “wins” with the board given the constant barrage of gloomy news.
And no I don’t have a link
Have a good day, everyone
It might be because he has a financial stake in the company that makes Plaquenil and several Trump advisors have a significant stake in Novartis. It’s always about the money
He apparently has a small stake in Sanofi through a diversified fund he has an investment in. Not a big deal.It might be because he has a financial stake in the company that makes Plaquenil and several Trump advisors have a significant stake in Novartis. It’s always about the money
He apparently has a small stake in Sanofi through a diversified fund he has an investment in. Not a big deal.
Appreciate everything you are doing man but randomized double blind trials are for another day and I'd say there is zero chance we use enough Plaquenil in our efforts regarding Covid 19 to put any lupus patient at risk. It would be interesting to know though if those taking Plaquenil for another reason are protected in any way from Covid.
I do agree that we really have no data driven idea if this drug is effective at all at this point.
Yep.
During a Pandemic, I am not one to favor listening to someone spout groupthink where folks that issue an opinion are doing so mostly based on a learned behavior during “normal” times to say what they say- until a double blind 3-phase clinical trial and FDA politics play out. Screw that.
In this case, the data that does exist would make one lean toward it being most helpful in the early stages, not as a last resort. Some say it saved thier life...who knows.
if I get the damn virus, I will take it. It should be a tool in the toolbox for now. We will get better ones soon.
Here is the most recent update from my doc, who is a close friend.
Hydroxychloroquine + Azithromycin appears to be working... although this is a small sample size and It is acknowledged this regimen has not been put through the rigor required for large scale adoption.
The key is early diagnosis and getting on meds quickly. Note symptoms common among those who have tested positive below.
———
I want to update you on our office’s work related to Covid-19 during the week of March 25 through April 3:
• My office has tested 9 additional patients for Covid-19. That brings the total patients tested to 36.
• Those tests have been administered at my office with no physical contact between my staff and patients.
• We have had a total of 15 positive Covid-19 test results.
• All positive Covid-19 patients have been treated with Hydroxychloroquine (Plaquenil) and Azithromycin. We have seen great results when using this combination of drugs to treat Covid-19.
• I have had no hospitalizations.
• The patients I have tested are from all over San Antonio, not just 78209.
• The positive test results from this week (9) have been through community spread, not travel related.
The symptoms of infection for Covid-19 that I have observed remain the same: high fever (over 101.0), fast onset, body aches, and cough. I have continued to test people with other symptoms, such as loss of smell, gastrointestinal issues, nausea, vomiting, diarrhea, and low grade fever, but I am not seeing positive results with those symptoms.
———
Hope this adds to the conversation in a positive way. Appreciate @MF123 and the entire medical community who is on the front lines of this.
When People say there’s small evidence to benefit of this drug, what studies are they referring to? Its like this thing gets perpetuated and nobody can cite the paper they are leaning on
When People say there’s small evidence to benefit of this drug, what studies are they referring to? Its like this thing gets perpetuated and nobody can cite the paper they are leaning on
At this point it’s anecdotal. I think the French doc was working on a paper. Haven’t seen a formal paper yet. But, we’re in unchartered waters and have been for several weeks. Keep in mind I’m asking this as a biology major turned financial analyst/advisor (read: I know slightly more than nothing), but if the downside risk is limited and there is a decent body of anecdotal evidence from other doctors treating a novel disease in heavily impacted areas for which there is no cure, does the potential for success outweigh the potential downside?
if the downside risk is limited and there is a decent body of anecdotal evidence from other doctors treating a novel disease in heavily impacted areas for which there is no cure, does the potential for success outweigh the potential downside?
there is no data that it helps in “early stages” or ANY stage
and clinical trial is how people get free drugs, by the way. You enroll a patient in a trial involving Kaletra, and Novartis or whoever gives the patient and the hospital free drugs.
this isn’t a trial where a NEW drug is being created. They are just giving people the drug and then a high end statistical analysis will be made later. Enrolling people in trials is how they get access to these drugs to begin with. How do you all think that patients get medications which haven’t even been approved ? It goes through insurance ?? Of course not
People don’t really get this
With the testing lag, is your doctor friend starting treatments on a patient with these drugs if they’re exhibiting the major symptoms? Or do they have faster test result turnaround?I was referring to the small sample size (which I thought spoke to the absence of studies— assuming you are talking about the double blind standard)
And, I’m also saying this is coming from one of the top docs in Texas who has had 15 positive tests with 0 hospitalizations.
Not claiming statistical significance, but a useful data point IMO.
There’s actually been a ton of good news. Most places are way over prepared. By May most of America should open business with rules. By June, even New York and New Orleans should be open. I don’t see this hitting what H1N1 did or most flu seasons.
With the testing lag, is your doctor friend starting treatments on a patient with these drugs if they’re exhibiting the major symptoms? Or do they have faster test result turnaround?