At this point, it’s getting hard to see how the idea of a hydroxychloroquine (or hydroxychloroquine/azithromycin) therapy for coronavirus infection can be taken seriously. I reviewed some of the recent studies here, but missed a May 11 preprint from France that had claimed benefit for the combination. No matter, though: this was just withdrawn by the authors, who say that they are revising the manuscript.
This morning brings this paper from The Lancet. It’s a retrospective look at registered patients across 671 hospitals around the world, and it covers four patient groups: treatment with chloroquine, chloroquine plus a macrolide antibiotic (azithromycin, doxycycline), hydroxychloroquine, or hydroxychloroquine with a macrolide. All of these patients were started on these treatment regimens within 48 hours of diagnosis. The study specifically excludes those patients whose treatment started later, anyone whose therapy was started while they were on mechanical ventilation, or anyone received remdesivir as well. Early treatment in less severe patients only, in other words.
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There are other interesting things about this paper (for example, it confirms earlier reports that ACE-directed therapies are associated with a survival benefit in coronavirus patients).
But I’m going to leave it at this. There was no evidence whatsoever of any benefit with any of these treatment regimes. There was significant evidence of harm. Here’s how it works: when something is real, you continue to see a real signal as you collect more and better data. When something is not real, it disappears.
Tell me again why anyone should be advocating such treatments. But your reasons had better stand up to 14,888 patients versus 81,144 comparators. Make it good.
