One step back The authors of a large study on hydroxychloroquine withdrew their work

Two weeks ago, the largest study of hydroxychloroquine in patients with covid-19 was published. According to their results, the patient survived. On Thursday, June 3, their cars withdrew their very frequently quoted work. Want more openness.

The most discussed drug with anti-SARS-CoV-2 virus in recent weeks is hydroxychloroquine, the original anti-malarial drug.

In short, it is completely rational: in a situation where there are no reliable and available anti-SARS-CoV-2 viruses, hydroxychloroquine is administered to patients around the world. Even in the Czech Republic, more than 600 patients received it, ie more than half of the hospitalized patients in whom the presence of new coronavirus was detected. It is therefore logical to ask how I really influence patients.

Graph from the press

A graph from the press conference on May 22, 2020, showing how the drugs were used in hospitalized patients with covid-19. Hydroxychloroquine is abbreviated HCQ, chloroquine abbreviated CQ. The table does not show the total number of hospitalized with covid-19 in R, according to the data presented at the same press conference, there were 1298.

The reason for the popularity of the product is undoubtedly the politicization of this professional question. We will omit this in the following text. Let us be satisfied with the fact that, first of all, hydroxychloroquine received such attention from the public and the public.

So when the largest analysis of hydroxychloroquine in patients was published in The Lancet on May 22, most copper, including Technet, reported the results. The most important result can be easily summarized: hydroxychloroquine and related chloroquine (even in combination with antibiotics) increased the risk of death in the studied patients. The difference was quite obvious, the risk of death increased by about an aunt.

The results have been so warning that some trials of this drug have been suspended around the world. For example, the WHO stopped admitting patients to its large clinical trials and tested their interim results to make sure there were no deaths. The admission patient was also suspended in two studies conducted in R.

R

Various factors affecting the death of patients included in an observational study investigating the effects of hydroxychloroquine and related substances. The results for these products are highlighted in the box at the bottom of the page. As can be seen, in all cases the result is to the right of the centers of the axis, and in all cases it is therefore a factor that increases the risk of death.

Even though the analysis had inherently some weaknesses. This is a retrospective observation of patients from different hospitals and different parts of the world. Undoubtedly, there was a number of differences between them, which cannot be captured in the data on the course of the disease. On the other hand, there was a real possibility that participants in the ongoing studies would have to die, so a number of institutions and experts preferred to be careful.

Cut data!

However, it soon began to show that the study had problems that were not so obvious at first glance. Pedevm was not got open. Today, it is common custom for authors of similar studies to be published with the text and their analysis, as well as all the data from which they were based. In this case, the patient was included in the study. Of course, the signs are modified so that the patient’s identity cannot be ascertained from them and he gives sensitive data.

In this particular case, the data was not available. The professional public noticed that they are very suspicious. The number of patients and dead patients with covid-19 mucus for Australia was not your local health ministry. The authors acknowledged this mistake: some data should have been transferred from an Asian hospital to Australia by mistake.

Only one objection out of many came out. More than 200 vdcs, for example, signed an open letter to the journal and the author of the study, which drew attention to a number of other twists and irregularities.

For example, the signatories did not gain certainty from the study that factors such as the amount of drugs administered, the severity of the course of the disease, etc. are sufficiently taken into account. Data on the course of treatment from different continents were surprisingly similar (ie the course of treatment of African, European and Asian patients was similarly known by differences in health and equal health). According to the analysis, the majority of patients received two, not recommended by the American FDA, but two-fifths should come from patients from North America, especially the first from the USA. Due to a letter and further reminders received, the Lancet added to the study a warning that the study was subject to professional criticism.

It would be relatively easy to answer most objections and questions if they could doubt the analysis of the data from which the analysis was based. The company, which was supposed to collect data from hospitals around the world and which is its own, practically unknown American Surgisphere in the field, refused to release it. According to n contracts concluded with hospitals, from which dates I do not allow data to be published. The database from which the analysis was based, data on how the treatment of patients took place, therefore remained closed.

And that was the end of the study. Under them are signed three cars. They work at various universities, the district, Span Desai, is the founder of Surgisphere. Academics refused for the results of stt. In the letter in which he downloaded the study from the journal (here in PDF), he explained that Surgisphere did not allow access to the data or to their colleagues who were to review the study before publication. This professional control (even in English, the English term peer-review is often used) is a complete foundation of any serious professional article.

The problem with Surgisphere is not just about this study. On the same day, ie on the 4th of June, the work was based on its database. It was published on May 1 in the magazine NEJM and on the basis of essentially the same work to make it clear that patients with heart problems with covid-19 die more often than not in a healthy person (here is the original article, here is a link to information about the study). The remark is not controversial in itself, the problem is again that Surgisphere did not give anyone, according to the text or any of the co-authors of the text, access to the data from which the observation is based.

We know we don’t know much

So we have a lot to say about the monoxide yield of hydroxychloroquine, we didn’t know two weeks ago. On the other hand, studies take literally hundreds. For example, on June 3, the NEJM magazine published the results of a study examining the preventive, ie prophylactic, use of hydroxychloroquine in people who drank in contact with their disease. It did not find any positive effect against the outbreak, but also no other side effects. Does this mean that hydroxychloroquine urite cannot function prophylactically? Probably not, there are too many variables (for example, dvka, as has elapsed since the virus was exposed, etc.).

It is therefore too early for a definitive evaluation, even if the dog generally does not completely encourage the results of hydroxychloroquine in smaller studies. We’ll have to repent of the data given. The vast majority of studies are still b. Including large international studies conducted by the WHO, which have re-established a group of patients; Evidently, there were no traces of mortality in their data in the patients who received it.

Of course, the political side will further complicate the situation. Hydroxychloroquine is inexpensive, readily available, due to its history of anti-malarial drugs relatively well known, and in laboratory conditions against the virus is guaranteed to work. So it is possible (but definitely not sure) that I can help sick people with the right help. Can poor countries with low health also offer their citizens a better health?