And that is why forums are problematic at times, because we are all coming at from different angles and experiences. Doesn’t make the conversation less worth while, but does lead to issues at times.
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I haven’t said or even implied anything political. As someone whose T1 and age and co-morbidities place them in a high risk group for Covid-19, I’m interested in exploring any potential treatment protocol. That’s all. Hydroxychloroquine happens to be one I am familiar with.
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I don’t think it’s meant to suppress the cytokine storm, it’s supposed to prevent the virus from replicating because it makes endosomes on the cell membrane more basic, which prevents viral replication via acidifying the endosomes. Also I guess it changes the structure of the ACE2 receptor. That’s in cell culture at least. We don’t know if those effects will pan out in the body.
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That’s what I’ve read… we could be saying the same thing, indirectly vs directly, those factors are among those that cause this response in the body aren’t they? My understanding was it also believed to reduce the immune response, which is ultimately what fills a persons lungs with liquid
So, I don’t know whether this drug’s immune modulating effect would be helpful later on in the course of the disease if there’s a cytokine storm? I mean it is a drug used against autoimmune diseases, so presumably it has some mechanism of action related to quieting inflammation or immune overreaction. I think I read that interleukin-6 levels are elevated in these patients, and so they’re trying a bunch of IL-6 inhibitors as well (like Actemra).
But the original idea for chloroquine I think came from this paper, which showed its effects in cell culture in the original SARs virus in primates.
And then another analysis in a new preprint paper identified it based on a genetic analysis that showed it binding to the receptor, which I guess would inhibit viral binding:
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You’re right, I guess chloroquine also inhibits IL-6 and others associated with cytokine storm:
https://www.aocd.org/page/Chloroquine
They’re doing a bunch of trials of this – some are prophylactic, to prevent healthcare workers from coming down with COVID-19 in the first place, some with people early on in the disease to see if it can prevent more severe course, and some in severe patients, where I guess the cytokine storm would be a really high risk…
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I completely agree with you the use of these medications at unknown dosing regimens is a risk/reward situation. Chloroquine and Hydroxychlorine are old drugs which are beneficial at their current dosing schedules. The recent fast track approval by the FDA for the use of these drugs is an effort to decrease morbidity and mortality because there is nothing else. They are essentially completing a Phase II/ Phase III trial with large numbers of people to determine efficacy and safety at various dosing regimens. This was done in the HIV/AIDS era where unproven treatments were used against the virus based on hypotheses even when they were very toxic until more was known about the virus. I hope that the results are promising for all of us. However, people need to be aware of potential side effects of these other dosing schedules. The reward significantly outweighs the risk at this time since there are no other alternatives.
So I think we all are on the same page about it’s use in the hospital setting but I would wait to treat the general population until we have some preliminary results.
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It’s nice to see that this forum and thread have been great in bringing people together to discuss this important topic coming from different perspectives and angles. We all know that we are part of a very high risk population so improving our knowledge and understanding will allow us to help each other stay healthy.
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And just stay up to date which is nice, since we have such a diverse group of really smart people.
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Hi Jan,
There may be some misunderstanding here. I am aware of the use of chloroquine and hydroxychloroquine which have been around forever and are great in treating malaria and autoimmune disease respectively. The treatment doses have already been defined. In regards to the novel coronavirus, I agree with treating seriously ill patients in the hospital setting as there is no alternative at this time but I would not recommend prophylaxis since we do not know the correct dosing and whether it is effective. I have not seen the protocols from China or S. Korea in the seriously ill and unclear if the US will follow those protocols or try varying dosing strategies. There lies the problem about dosing. These drugs are not benign potentially causing cardiac arrhythmias. I still would not recommend prophylaxis until we have preliminary data showing a benefit. If so, then we can consider broader use in the general population.
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Thanks, I only brought up use as a prophalactic for Covid-19 to try and more completely understand it’s action.
Some new info from the CDC specifically on treatment with hydroxychloroquine, chloroquine, and remdesivir updated March 30th:
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It is striking to me how we as emotional humans demand studies when we want them to tell us what we want to hear, and disregard studies that don’t.
Some studies have shown that there is no benefit in outcomes to tightly controlling diabetes. We don’t want to hear that— so we disregard.
Countless studies have shown us that controlling lipid levels improve outcomes, and even taking statins regardless of lipid levels improve outcomes in diabetics— huge movement to disregard…
Countless studies have shown that vaccinations don’t cause autism—- huge movement to disregard
I could go on. And I understand the human tendency to want to wait to hear a study confirm what one wants to hear, or to hear a study to tell you what isn’t wanted to hear so that it can be rebutted… but neither one of those human tendencies makes sense to me in this particular case
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That’s a pretty broad statement to make. Deflection perhaps? We get it… You are in support of using any drug for any reason, little or no testing or trials. Some of us aren’t and you saying things like these in a broad sweeping fashion don’t make them true.
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Except talking about some of the most widely prescribed drugs in the world… Which do not even require a prescription in many parts of the world but whatever
Save yourself from the scourge of these dangerous drugs. If you’re on deaths doorstep infected with covid and your doctor tells you this is your only hope— don’t take them. Not worth the risk. Sometimes you gotta take a stand on principle, right?
ETA… since you’re likely to be non-responsive at that point one might consider to add to your advanced directive that you don’t wish to be treated with chloroquine if not able to speak for yourself… just to be safe
Reposting my previous with editing
That type of thinking solves problems because this forum is a good sounding board. The discussion today made me research the studies in China, S. Korea, and France which provided conflicting results. The Chinese study used a lower dose for a shorter duration of therapy where they found no significant benefit. The French study was very small with a cohort of 20 patients, open label, variability of sample testing, and dropout of 5 patients…one discontinuing due to side effects, 3 just leaving the hospital, and 1 death. The results showed faster virus elimination with a combination of hydroxychloroquine and azithromycin at day 6. Azithromycin was considered more of a treatment to prevent lower respiratory tract infections. There were questions in study design which may have lead to bias and skewed data. A similar study in Paris led by infectious disease expert, Dr. Molina, using the same protocols showed no benefit.
He reiterated that, "
This should give us serious pause before we rush into widespread use of prescription medications for sars-CoV-2 and covid-19. These drugs can have serious side effects, particularly in people most vulnerable to the virus: the elderly and those with heart problems."
He may have explained things a little better than I. The conversation today pushed us to better evaluate the research and look at all possible solutions. These studies are ongoing so hopefully we get some positive preliminary data. Thank you for joining the conversation.
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I am really interested/surprised by the use of azythormycin.
I assume it was used to solely prevent the possible lung infections often developing starting around D+7/D+9? I am not quite sure I am parsing the research discussion well.
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Not sure how to embed the video, but this comment from Scott Gottlieb, former FDA head (and one of the best ones in recent memory, in my opinion) suggests so far it’s not likely to be having a strong effect:
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I was going to try and prove you wrong, but despite searching I can’t find my original article. Possibly I did not see it on the BBC but on another British paper, possibly less reliable.
I did find this in the process:
Coronavirus: China hid extent of outbreak, US intelligence reportedly says
But the discussion is is nowhere near 40x scale. Still as always, they lied. Amazing when we deal with a worldwide emergency like COVID-19.
Well, at least they dealt with it–I am waiting to see what happens to Brasil, which has to deal with two national catastrophes at the same time: COVID-19 and Bolsonaro.
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That guy is disastrous! Do Brazilians know what’s going on in Italy? Aren’t they scared to death? Health care systems all over the world are completely overwhelmed by all the Covid-19 patients and Brazilian health care certainly doesn’t belong to the top of the world. That’s going to be catastrophic. It’s a danger to the rest of the world too. What measures will we have to take against Brazil to prevent new outbreaks once we have the virus under control?