Do not expect a cure. But it would be good if this compound can slow things down.

Finally, there are some potentially very interesting results from France on hydroxychloroquine. A number of things need to be said up front: first of all, this was a small trial.

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Second, it was open-label. Third, there were significant patient drop-outs in the treatment group, making the sample even smaller. In summary, 26 patients were enrolled in the treatment group, with 16 controls. Six patients dropped out of the treatment group: 3 went to the ICU, one dropped out due to nausea, one left the hospital apparently recovered? No one left the control group. There were 15 male and 21 female patients. The treatment group got mg of hydroxychloroquine sulfate three times a day, and six of those patients were also given mg azithromycin in addition. The paper says that this was the deal with possible bacterial superinfection, and the lead author also makes mention of possible antiviral effects of the compound.

The results are shown at right. As you can see, there appears to be an effect of hydroxychloroquine although I would like to see some error bars , and a notably stronger effect down to zero virus as measured by nasal swab of the hydroxychloroquine — azithromycin combination.

I would expect this to start some larger trials, and that looks completely justified. But it points the way to something larger and more controlled. These are two inexpensive generic drugs with a long history of use in humans; if they can be repurposed in this manner we need to know as soon as possible. Chloroquine and hydroxychloroquine both can have notable side effects, but this is not a long course of treatment, either.

Update: a closer look at the data.

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Many feel they are on their own to develop treatment protocols. Federal health authorities like the Centers for Disease Control and Prevention recommend supportive care, but have said there is no evidence yet to support antiviral drugs or treatments for inflammation…For critically ill patients suffering from intense inflammatory reactions, called a cytokine storm, some centers are trying a drug called tocilizumab.

My contacts tell me that there are now 6 Indian companies starting to make favipiravir. Also, a company that was making chloroquine and had a very bad FDA inspection has now had the decision reversed and been asked to ramp up production for the US. Really not helpful in this circumstance. Pretty sure Trump routinely appears with experts of various sorts.

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Trump has fired anyone who remotely disagrees with him and has chosen instead to surround himself with sycophants and morons. Barry et al — President Donald J. Trump seeks and recruits people more competent than himself a very high standard and does not suffer incompetence in his organizations. The US Presidency is such that it it more difficult to enforce that policy within government culture inculcated with deception.

Still, he acts and acts quickly to assemble teams for success. If you really believe that Pence was a judicious choice, I think you might be letting politics override any scientific inclination you might have.

Now read this and let us know what you think on competence and decision making! In seriousness, we have here an exemplary Trumpian argument. Do this unblinkingly, immediately, with total authority: evidence is for losers. While your opponent is responding, move on to a different baldly false statement or say something rankly offensive. It disorients those of us with a scientific bent. I wonder why are you skeptical on remdesivir? To my superficial understanding the biggest problem would be insufficient PK to target a respiratory virus as it was optimized for hemorrhagic viruses. Am I missing something?

In their Nature paper from last year doi They also showed that it has a long half life in peripheral blood monocyte cells PBMCs. Human dosing is mg on d1 and then mg IV qd subsequently, again suggesting that PK is not an issue. It does have efficacy, just not enough to merit it progressing.

The two Mabs in the other arms of that trial were far superior which is still a little bit of a surprise, but the data is the data. A disappointment to be sure.

Azithromycin: antibiotic to treat bacterial infections - NHS

That said, biologists only leave std deviations off a graph when the data sucks. There can be no error bars on qualitative data. The data in the French study are incredibly problematic. Not clear what error rates are at that site and with that assay, or what the threshold is for scoring positive. Thanks for linking to twitter thread — provides crucial analysis. Red flags all over the place; this needs serious scrutiny. What about reports that Losartan may be beneficial? Still not clear to me how the virus is being distributed by asymptomatic patients but it seems to be.

Is there any reason to believe favipiravir might be just as effective in viral clearance as mono therapy without alpha interferon? So they tried this?? Please keep on being a voice for reason. People appear to have very uninformed ideas about the difference between an attractive molecule and a medicine. Most, the majority, almost all hypothetical treatments wind up not working. Some brilliant guy with shaggy hair who just thinks up a miracle drug is only found in the movies.

In real world, it is done by teams of shaggy technicians with brilliant hair, working under the inspired leadership of project manager — who is covering his butt, servile and paranoid in equal measure. The dropouts in the treatment arm are a major problem for interpreting the data. So I would be extremely cautious on the hydroxychloroquine data. At the moment it looks ambiguous to me. Also it would be much more interesting to see the actual viral titers in the patients rather than percentage of patients as the endpoint.

Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days and one transferred on day4 post-inclusion who was PCR positive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days It seems disconcerting that that 4 people in the treatment group dropped out due to progression to ICU or death, while none of that happened in the control group.

But the people in the treatment group were older Hydroxychloroquine is also used to suppress autophagy. Is that help WRT fighting a viral infection? Or would combination therapy with something that promotes autophagy, such as Ambroxol, be useful? Azithromycin also blocks autophagy!

Looking at the Gautret paper. Am I the only one that is far more interested for Pre exposure prophylaxis? This would be a gamechanger since it transforms the disease completely.

As long as you take your meds you cannot get sick. Low doses of AZ are routinely given to asthmatics for preventing exacerbations. I would like to see if mefloquine works for this — it would be an ideal pre-exposure prophylaxis agent — mg once or twice weekly maybe with azithromycin mg twice weekly the PK for mefloquine is great for this type of prescription — controlled trial in emergency medical workers would be easy to set up and fast to get results — assuming these anti malaria meds for for this virus.

Do you know of any trials planned on these targets? Azithromycin is a macrolide antibiotic with well-described anti-inflammatory properties which can be attributed, at least partially, to its action on macrophages. Most of the anti-inflammatory effect documented in studies of azithromycin is in vitro. We need to look harder at the three deaths in elderly patients receiving azithromycin in the Rouault study to affirm or rule out cytokine storm. Agree someone independent should replicate the French hydroxychloroquine results which follow earlier Chinese testing as well in a larger, much better trial.

Italian group claims they cannot find any record of the chloroquine results in the clinical trial registry. We sought for evidence of such data in the trial registries we reviewed and found none.

Zinc should be looked at more.