总结的很好。我一直觉得羟氯喹这事很奇怪，一个几十年的老药，居然有那么多人搞出各种奇怪的东西要证明它没用，甚至造假的临床实验，这些都是违反常识的：从来造假都是夸大药效。 然后最近还有篇文章说什么呼吸道上皮细胞没有羟氯喹受体，简直是搞笑，呼吸道上皮细胞没有受体就不管用了？可以是其它机理啊。从来都是实验室研究去解释临床结果，没有反过来的。 还有那些左派，一个个出来说这个药没用，然后自己在后面偷偷吃。 我不是说这个药一定有用，要看更多数据。我根据已经发表的数据的判断是，这个药对阻止早期感染者进入重症有作用。 2009 PhD in pharmacology & toxicology, currently serve as head of a molecular pharmacology program.
总结的很好。我一直觉得羟氯喹这事很奇怪，一个几十年的老药，居然有那么多人搞出各种奇怪的东西要证明它没用，甚至造假的临床实验，这些都是违反常识的：从来造假都是夸大药效。 然后最近还有篇文章说什么呼吸道上皮细胞没有羟氯喹受体，简直是搞笑，呼吸道上皮细胞没有受体就不管用了？可以是其它机理啊。从来都是实验室研究去解释临床结果，没有反过来的。 还有那些左派，一个个出来说这个药没用，然后自己在后面偷偷吃。 我不是说这个药一定有用，要看更多数据。我根据已经发表的数据的判断是，这个药对阻止早期感染者进入重症有作用。 2009 PhD in pharmacology & toxicology, currently serve as head of a molecular pharmacology program. htscorpion 发表于 2020-07-31 00:20
总结的很好。我一直觉得羟氯喹这事很奇怪，一个几十年的老药，居然有那么多人搞出各种奇怪的东西要证明它没用，甚至造假的临床实验，这些都是违反常识的：从来造假都是夸大药效。 然后最近还有篇文章说什么呼吸道上皮细胞没有羟氯喹受体，简直是搞笑，呼吸道上皮细胞没有受体就不管用了？可以是其它机理啊。从来都是实验室研究去解释临床结果，没有反过来的。 还有那些左派，一个个出来说这个药没用，然后自己在后面偷偷吃。 我不是说这个药一定有用，要看更多数据。我根据已经发表的数据的判断是，这个药对阻止早期感染者进入重症有作用。 2009 PhD in pharmacology & toxicology, currently serve as head of a molecular pharmacology program. htscorpion 发表于 2020-07-31 00:20
https://www.ijidonline.com/article/S1201-9712(20)30600-7/fulltext#%20 前天给International Journal of Infectious Disease的一封公开信，在意大利米兰病人里进行研究的小组得出了和Henry ford之前的研究类似的结果 We divided a subset of our cohort in three groups who started treatment a median of 1 day after admission: those receiving hydroxycholoroquine alone (N = 197), those receiving hydroxycholoroquine + azithromycin (N = 94), and those receiving neither (controls) (N = 92). Of the latter group, 10 started HIV antivirals (boosted-lopinavir or –darunavir), 1 teicoplanin, 12 immunomodulatory drugs or corticosteroids, 23 heparin and 46 remained untreated. The percent of death in the 3 groups was 27%, 23% and 51%. Mechanical ventilation was used in 4.3% of hydoxychloroquine, 14.2% of hydroxycholoroquine + azithromycin and 26.1% of controls. Unweighted and weighted relative hazards of mortality are shown in Table 1. After adjusting for a number of key confounders (see table), the use of hydroxycholoroquine + azithromycin was associated with a 66% reduction in risk of death as compared to controls; the analysis also suggested a larger effectiveness of hydroxychloroquine in patients with less severe COVID-19 disease (PO2/FiO2 > 300, interaction p-value<.0001). Our results are remarkably similar to those shown by Arshad et al.
https://www.ijidonline.com/article/S1201-9712(20)30600-7/fulltext#%20 前天给International Journal of Infectious Disease的一封公开信，在意大利米兰病人里进行研究的小组得出了和Henry ford之前的研究类似的结果 We divided a subset of our cohort in three groups who started treatment a median of 1 day after admission: those receiving hydroxycholoroquine alone (N = 197), those receiving hydroxycholoroquine + azithromycin (N = 94), and those receiving neither (controls) (N = 92). Of the latter group, 10 started HIV antivirals (boosted-lopinavir or –darunavir), 1 teicoplanin, 12 immunomodulatory drugs or corticosteroids, 23 heparin and 46 remained untreated. The percent of death in the 3 groups was 27%, 23% and 51%. Mechanical ventilation was used in 4.3% of hydoxychloroquine, 14.2% of hydroxycholoroquine + azithromycin and 26.1% of controls. Unweighted and weighted relative hazards of mortality are shown in Table 1. After adjusting for a number of key confounders (see table), the use of hydroxycholoroquine + azithromycin was associated with a 66% reduction in risk of death as compared to controls; the analysis also suggested a larger effectiveness of hydroxychloroquine in patients with less severe COVID-19 disease (PO2/FiO2 > 300, interaction p-value<.0001). Our results are remarkably similar to those shown by Arshad et al. 默雨润苗 发表于 2020-07-31 11:01
是的 这个意大利也讨论过的 结论不能conclusive 你可以看到这个study后面的解释 因为病人不是双盲分配的 control arm的里面有心脏病的更多-当然有心脏病的本来医生也会更谨慎给氯喹+阿奇霉素。 然而心脏病基础班是新冠死亡的最高risk的group 所以可以说control arm本来死亡的risk就要更高 不过这个study可以进一步去找一个都没有心脏病的病人group 双盲分两部分 看用氯喹的和没用氯喹的效果对比。这样就可以conclusive了。 我现在的观点是没有心脏病的可以在医生监督下吃 study一下 Although unmeasured confounding remains the most likely explanation for the discrepancies, a robust meta-analysis is still lacking and we question whether hydroxychloroquine should be further tested. When best to start treatment is also a question that needs to be addressed in ad-hoc randomised studies.
总结的很好。我一直觉得羟氯喹这事很奇怪，一个几十年的老药，居然有那么多人搞出各种奇怪的东西要证明它没用，甚至造假的临床实验，这些都是违反常识的：从来造假都是夸大药效。 然后最近还有篇文章说什么呼吸道上皮细胞没有羟氯喹受体，简直是搞笑，呼吸道上皮细胞没有受体就不管用了？可以是其它机理啊。从来都是实验室研究去解释临床结果，没有反过来的。 还有那些左派，一个个出来说这个药没用，然后自己在后面偷偷吃。 我不是说这个药一定有用，要看更多数据。我根据已经发表的数据的判断是，这个药对阻止早期感染者进入重症有作用。 2009 PhD in pharmacology & toxicology, currently serve as head of a molecular pharmacology program. htscorpion 发表于 2020-07-31 00:20
这是一位巴西人写的一篇长文，把HCQ在新冠中的发展过程串成了一个时间线。文章作者自认为是反川人士，对于美国川普和巴西川普他的评价是“two demented leaders”。他说他写这篇文章的目的是“to explain everything I know to my friends and relatives, so that if they get it, they are not more afraid of the medication than of the disease.” 文章挺长的，里面有不少章节是他对于巴西总统和政府的看法。我在下面把他找到的主要事件列出来，很难得的是这些事件作者基本都提供了原link。有兴趣的人可以去看原文： https://medium.com/@filiperafaeli/hydroxychloroquine-the-narrative-that-doesnt-work-is-the-biggest-hoax-in-recent-human-history-2685487ad717 在这声明，我只是个搬运工，只不过做了点翻译和删减了一些作者个人的看法。转载的目的是能让更多人中立地去看待羟氯喹这个药，不是让你去吃这个药 *** 看完觉得这个贴还不错的请帮着顶下贴，让更多人能看到。我希望这个药最终不要继续政治化下去，政府不该干扰医生的处方权。每个人都该有知道真相和选择的权利！ 默雨润苗 发表于 2020-07-30 13:20
这是一位巴西人写的一篇长文，把HCQ在新冠中的发展过程串成了一个时间线。文章作者自认为是反川人士，对于美国川普和巴西川普他的评价是“two demented leaders”。他说他写这篇文章的目的是“to explain everything I know to my friends and relatives, so that if they get it, they are not more afraid of the medication than of the disease.” 文章挺长的，里面有不少章节是他对于巴西总统和政府的看法。我在下面把他找到的主要事件列出来，很难得的是这些事件作者基本都提供了原link。有兴趣的人可以去看原文： ！！！不可思议，原link被网站封杀了，下面是新link，想看的快去看吧，别很快又被封了 http://archive.is/yfbLB 在这声明，我只是个搬运工，只不过做了点翻译和删减了一些作者个人的看法。转载的目的是能让更多人中立地去看待羟氯喹这个药，不是让你去吃这个药 *** 看完觉得这个贴还不错的请帮着顶下贴，让更多人能看到。我希望这个药最终不要继续政治化下去，政府不该干扰医生的处方权。每个人都该有知道真相和选择的权利！ 默雨润苗 发表于 2020-07-30 13:20
Fauci一直挂嘴上的HCQ RCT的trial曾经存在过，还是Fauci的NIAID sponsor的，你们听说过吗？最后trial流产了，原因你们猜是为什么？招不到病人。。。 https://www.niaid.nih.gov/news-events/bulletin-nih-clinical-trial-evaluating-hydroxychloroquine-and-azithromycin-covid-19 The study, conducted at ACTG sites across the United States, planned to rapidly enroll approximately 2,000 adults who had laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19, and were experiencing symptoms consistent with COVID-19. Participants were randomly assigned to receive either hydroxychloroquine and azithromycin or matching placebo pills to take at home for seven days. Since its launch in May, however, the study had enrolled only 20 participants, despite efforts by the study sites to enhance recruitment, raising concerns that it would not be feasible to continue the trial to full enrollment. On June 15, FDA revoked an Emergency Use Authorization that had allowed hydroxychloroquine and the related drug chloroquine to be prescribed to hospitalized adolescents and adults with COVID-19. This revocation does not apply to clinical trials and is specific to hospitalized individuals rather than outpatients. However, the decision could further dampen enthusiasm for enrollment in studies evaluating these drugs. Based on these considerations and in close consultation with the study team, NIAID determined that it is highly unlikely that the ACTG trial, known as A5395, would be able to enroll to completion and meet its intended objectives. The DSMB concurred with this assessment and agreed it would be best to close the trial. https://clinicaltrials.gov/ct2/history/NCT04358068?A=10&B=12&C=Side-by-Side#StudyPageTop
Usual Adult Dose for Malaria Prophylaxis 400 mg salt (310 mg base) orally once a week Weight-based dosing: 6.5 mg/kg salt (5 mg/kg base) orally once a week -Maximum dose: 400 mg salt (310 mg base)/dose Usual Adult Dose for Malaria 800 mg salt (620 mg base) orally as an initial dose, followed by 400 mg salt (310 mg base) at 6, 24, and 48 hours after the initial dose Total dose: 2000 mg salt (1550 mg base) Weight-based dosing: -First dose: 13 mg/kg salt (10 mg/kg base) orally -Second dose (6 hours after first dose): 6.5 mg/kg salt (5 mg/kg base) orally -Third dose (24 hours after first dose): 6.5 mg/kg salt (5 mg/kg base) orally -Fourth dose (48 hours after first dose): 6.5 mg/kg salt (5 mg/kg base) orally Maximum Dose: -First dose: 800 mg salt (620 mg base)/dose -Second, third, and fourth dose: 400 mg salt (310 mg base)/dose
HCQ在rheumatoid arthritis的用量 Adult dosing for rheumatic diseases ranges from 200 mg to 400 mg per day (typically 5 mg/kg, maximum 400 mg daily). In some cases, higher doses are used. HCQ在lupus的用量 Hydroxychloroquine is generally prescribed at a daily dose of 6.5 milligrams (or less) per kilogram of body weight. (Using this formula, the dosage for a 150-pound person would be 443 mg/day, as one kilogram equals 2.2 pounds.) Because HCQ is formulated as a 200 mg tablet, many people taking it for lupus will take two pills per day. Those who are newly diagnosed with lupus may take 400 mg once daily for several weeks while the medication builds up in their system, and then 200–400 mg daily after that.
Henry Ford 这封公开信什么意思，彭斯在4月份说在这个医院要对HCQ进行3000 人的clinical trial, 怎么会因为政治原因不再对这个药发表评论了？ https://www.henryford.com/news/2020/08/hydroxychloroquine-an-open-letter?from=groupmessage&isappinstalled=0 We believe wholeheartedly that a mission statement is more than a plaque we hang on a wall, but rather an idea we embed in our hearts and minds that unifies, empowers and enables us to do what we do every day for the people of our communities. Our mission is to improve people’s lives through excellence in the science and art of health care and healing. For more than 100 years, we have proudly pioneered clinical and scientific breakthroughs that have advanced health care here and abroad. As an early hotspot for the COVID-19 pandemic, we have seen and lived its devastating effects alongside our patients and families. Perhaps that’s what makes us even more determined to rally our researchers, frontline care team members and leaders together in boldness, participating in scientific research, including clinical trials, to find the safest care and most effective treatments. While feeling the same sense of urgency everyone else does to recognize a simple, single remedy for COVID-19, we need to be realistic in the time it takes to fully understand the optimal therapy or combination of therapies required of a new virus we are all trying to contain. The most well-accepted and definitive method to determine the efficacy of a treatment is a double-blind, randomized clinical trial. However, this type of study takes a long time to design, execute and analyze. Therefore, a whole scientific field exists in which scientists examine how a drug is working in the real world to get as best an answer as they can as soon as possible. These types of studies can be done much more rapidly with data that is already available, usually from medical records. Like all observational research, these studies are very difficult to analyze and can never completely account for the biases inherent in how doctors make different decisions to treat different patients. Furthermore, it is not unusual that results from such studies vary in different populations and at different times, and no one study can ever be considered all by itself. Our promising Henry Ford treatment study should be considered as another important contribution to the other studies of hydroxychloroquine that describes what the authors found in our patient population. We – along with all doctors and scientists – eagerly support the need for randomized clinical trials. We also want to point out that scientific debate is a common occurrence with almost every published study. In part, this is what fuels the advancement of knowledge – challenging one another on our assumptions, conclusions and applications to get to a better place for the patients we collectively serve. You can read the original study here and the senior author’s letter to the editor here. Unfortunately, the political climate that has persisted has made any objective discussion about this drug impossible, and we are deeply saddened by this turn of events. Our goal as scientists has solely been to report validated findings and allow the science to speak for itself, regardless of political considerations. To that end, we have made the heartfelt decision to have no further comment about this outside the medical community – staying focused on our core mission in the interest of our patients, our community, and our commitment to clinical and academic integrity. Thank you for your support. Sincerely, Adnan Munkarah, M.D., Executive Vice President and Chief Clinical Officer Steven Kalkanis, M.D., Senior Vice President and Chief Academic Officer
再来说说梅干菜mm一直要我说明的西班牙RCT实验 https://www.medrxiv.org/content/10.1101/2020.07.20.20157651v1 首先，这个实验再一次的只用了HCQ，没有Zinc，也没有Azithromycin。 而且，这个实验开始给HCQ的时间是expose后四天“The median length from exposure to enrollment was 4.0 (IQR 3.0-6.0) days”。如果之前NEJM的data修正后的结果是正确的，那么单独使用HCQ必须要很早，暴露后前两天用处比较明显，越往后就越没用了。 无巧不成书，这篇文章的一作Oriol Mitja又和Gilead有千丝万缕的关系。在四月份Gilead召开的关于新冠的会议，Mitja是其中一个speaker。那次会议的另一个speaker Mandeep Mehra正是那篇被撤回的Lancet文章的作者。
回复 182楼springday的帖子 这个study受到太大压力了。。。太同意下面这段话了 The most well-accepted and definitive method to determine the efficacy of a treatment is a double-blind, randomized clinical trial. However, this type of study takes a long time to design, execute and analyze. Therefore, a whole scientific field exists in which scientists examine how a drug is working in the real world to get as best an answer as they can as soon as possible. These types of studies can be done much more rapidly with data that is already available, usually from medical records. 真不知道Fauci天天强调gold standard study的目的是什么？现在我们面对的是pandemic crisis啊。。。
Henry Ford 这封公开信什么意思，彭斯在4月份说在这个医院要对HCQ进行3000 人的clinical trial, 怎么会因为政治原因不再对这个药发表评论了？ https://www.henryford.com/news/2020/08/hydroxychloroquine-an-open-letter?from=groupmessage&isappinstalled=0 We believe wholeheartedly that a mission statement is more than a plaque we hang on a wall, but rather an idea we embed in our hearts and minds that unifies, empowers and enables us to do what we do every day for the people of our communities. Our mission is to improve people’s lives through excellence in the science and art of health care and healing. For more than 100 years, we have proudly pioneered clinical and scientific breakthroughs that have advanced health care here and abroad. As an early hotspot for the COVID-19 pandemic, we have seen and lived its devastating effects alongside our patients and families. Perhaps that’s what makes us even more determined to rally our researchers, frontline care team members and leaders together in boldness, participating in scientific research, including clinical trials, to find the safest care and most effective treatments. While feeling the same sense of urgency everyone else does to recognize a simple, single remedy for COVID-19, we need to be realistic in the time it takes to fully understand the optimal therapy or combination of therapies required of a new virus we are all trying to contain. The most well-accepted and definitive method to determine the efficacy of a treatment is a double-blind, randomized clinical trial. However, this type of study takes a long time to design, execute and analyze. Therefore, a whole scientific field exists in which scientists examine how a drug is working in the real world to get as best an answer as they can as soon as possible. These types of studies can be done much more rapidly with data that is already available, usually from medical records. Like all observational research, these studies are very difficult to analyze and can never completely account for the biases inherent in how doctors make different decisions to treat different patients. Furthermore, it is not unusual that results from such studies vary in different populations and at different times, and no one study can ever be considered all by itself. Our promising Henry Ford treatment study should be considered as another important contribution to the other studies of hydroxychloroquine that describes what the authors found in our patient population. We – along with all doctors and scientists – eagerly support the need for randomized clinical trials. We also want to point out that scientific debate is a common occurrence with almost every published study. In part, this is what fuels the advancement of knowledge – challenging one another on our assumptions, conclusions and applications to get to a better place for the patients we collectively serve. You can read the original study here and the senior author’s letter to the editor here. Unfortunately, the political climate that has persisted has made any objective discussion about this drug impossible, and we are deeply saddened by this turn of events. Our goal as scientists has solely been to report validated findings and allow the science to speak for itself, regardless of political considerations. To that end, we have made the heartfelt decision to have no further comment about this outside the medical community – staying focused on our core mission in the interest of our patients, our community, and our commitment to clinical and academic integrity. Thank you for your support. Sincerely, Adnan Munkarah, M.D., Executive Vice President and Chief Clinical Officer Steven Kalkanis, M.D., Senior Vice President and Chief Academic Officer springday 发表于 2020-08-05 14:51
Henry ford 这个医院在7月份的时候还发表过文章 Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows https://www.henryford.com/news/2020/07/hydro-treatment-study 现在为什么由于政治压力不能再做评论了？ springday 发表于 2020-08-05 20:34
传递正确的消息，责不旁贷！
我不是说这个药一定有用，要看更多数据。我根据已经发表的数据的判断是，这个药对阻止早期感染者进入重症有作用。
2009 PhD in pharmacology & toxicology, currently serve as head of a molecular pharmacology program.
哇，支持层主量身份发言！
谢谢！华人上人才济济，希望能有更多人加入讨论。不管是赞成还是反对这个药在新冠上的使用，都能各抒己见。
前天给International Journal of Infectious Disease的一封公开信，在意大利米兰病人里进行研究的小组得出了和Henry ford之前的研究类似的结果
We divided a subset of our cohort in three groups who started treatment a median of 1 day after admission: those receiving hydroxycholoroquine alone (N = 197), those receiving hydroxycholoroquine + azithromycin (N = 94), and those receiving neither (controls) (N = 92). Of the latter group, 10 started HIV antivirals (boosted-lopinavir or –darunavir), 1 teicoplanin, 12 immunomodulatory drugs or corticosteroids, 23 heparin and 46 remained untreated. The percent of death in the 3 groups was 27%, 23% and 51%. Mechanical ventilation was used in 4.3% of hydoxychloroquine, 14.2% of hydroxycholoroquine + azithromycin and 26.1% of controls. Unweighted and weighted relative hazards of mortality are shown in Table 1. After adjusting for a number of key confounders (see table), the use of hydroxycholoroquine + azithromycin was associated with a 66% reduction in risk of death as compared to controls; the analysis also suggested a larger effectiveness of hydroxychloroquine in patients with less severe COVID-19 disease (PO2/FiO2 > 300, interaction p-value<.0001). Our results are remarkably similar to those shown by Arshad et al.
是的 这个意大利也讨论过的 结论不能conclusive 你可以看到这个study后面的解释 因为病人不是双盲分配的 control arm的里面有心脏病的更多-当然有心脏病的本来医生也会更谨慎给氯喹+阿奇霉素。 然而心脏病基础班是新冠死亡的最高risk的group 所以可以说control arm本来死亡的risk就要更高
不过这个study可以进一步去找一个都没有心脏病的病人group 双盲分两部分 看用氯喹的和没用氯喹的效果对比。这样就可以conclusive了。
我现在的观点是没有心脏病的可以在医生监督下吃 study一下
Although unmeasured confounding remains the most likely explanation for the discrepancies, a robust meta-analysis is still lacking and we question whether hydroxychloroquine should be further tested. When best to start treatment is also a question that needs to be addressed in ad-hoc randomised studies.
搞不懂这个层主以专业的身份的发言，立场也非常中立，还有2个人点踩。这2个人得病也不要吃羟氯喹啊！
不要政治化下去， 看看其他国家 (除了美国跟巴西总统在推以外）有没有领导人在强推这个药品！
羟氯喹不是对病毒本身，主要是调整机体免疫反应，预防轻中症机体过度反应变成重症。
不要想当然，医学界都不知道呢，你就下结论了？免疫抑制剂多了，怎么没看别的拿来治疗Covid? 除了dexamethasone
系统提示：若遇到视频无法播放请点击下方链接
https://twitter.com/i/videos/1289276211827372032
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https://twitter.com/i/videos/1289276863479549953
HCQ是敲门砖 稳定住免疫风暴 真正杀灭病毒的应该是ZINC
我还挺想看看你在medium写了啥，然后发现你已经被medium封了，估计也不用看了吧。。。。。。
还真的被封了！我昨天看还好好的。。。
我昨天也看了
你说这个事情媒体这么用力打压到底为啥？
原文被medium封了，作者在twitter解释了，换了个Link，update在一楼
不奇怪，三月份美国医生协会统一口径还要求所有医生宣传不要戴口罩呢。现在估计又开始统一口径要求批判HCQ了😂。只盼医生们不要被自己反复打脸
不奇怪。
现在什么都是要搞政治正确。
手动点赞，Mark慢慢读！
我个人理解 ，HCQ就是为了消弱免疫，防止过激反应。
这个没办法。
隔壁楼的被加了“有料”的印戳。
这个楼没有这个待遇。
信不信我昨天给版主发信要求盖戳，被无视了。。。
我现在也觉得作用是防止CRS
没有盖戳，
也这么高的楼，
很厉害了。
你没看这楼里一半以上的回帖都是两三个人发的么，包括我自己
现在各种各样的说法，
等着时间给出最终答案吧。
很好的信息，谢分享
你们一直想要隔壁楼里医生过来，这个id就是个医生，人家也反驳了。。。
他在我这帖子里反驳hcq没用了吗？他comment的是hcq如果有用是不是因为免疫抑制？
我说了这个帖子欢迎专业人士来科普，对我列的这些信息进行质疑或者纠错都欢迎，可是为什么一个都没有？
https://www.niaid.nih.gov/news-events/bulletin-nih-clinical-trial-evaluating-hydroxychloroquine-and-azithromycin-covid-19
The study, conducted at ACTG sites across the United States, planned to rapidly enroll approximately 2,000 adults who had laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19, and were experiencing symptoms consistent with COVID-19. Participants were randomly assigned to receive either hydroxychloroquine and azithromycin or matching placebo pills to take at home for seven days.
Since its launch in May, however, the study had enrolled only 20 participants, despite efforts by the study sites to enhance recruitment, raising concerns that it would not be feasible to continue the trial to full enrollment. On June 15, FDA revoked an Emergency Use Authorization that had allowed hydroxychloroquine and the related drug chloroquine to be prescribed to hospitalized adolescents and adults with COVID-19. This revocation does not apply to clinical trials and is specific to hospitalized individuals rather than outpatients. However, the decision could further dampen enthusiasm for enrollment in studies evaluating these drugs.
Based on these considerations and in close consultation with the study team, NIAID determined that it is highly unlikely that the ACTG trial, known as A5395, would be able to enroll to completion and meet its intended objectives. The DSMB concurred with this assessment and agreed it would be best to close the trial.
https://clinicaltrials.gov/ct2/history/NCT04358068?A=10&B=12&C=Side-by-Side#StudyPageTop
我在第33楼就发贴，这个楼值得加精。可惜，楼主这么多合理引用，有理有据的帖子，比如隔壁自称医生发贴就跑的噱头。隔壁楼几个自称医生的为什么不敢在这里大家摒除政治分歧，好好讨论这个话题呢？各个专业相关人士都拿出中立的态度摆事实讲道理，真理总是越变越明的！
那就给顶上去呗
支持. 决定权应该在医生
只能我们手动多定贴让帖子🔥起来
这样专业的帖子，带节奏的是不会来看的。他们来来回回就是那几句话， 1）副作用大。问他们推荐剂量+zinc短期服用的副作用是什么，遁了 2）研究表明作用不大。给他们指出目前所做的几个研究sample和剂量的选择都有问题，他们又遁了。 3）你爱用就用呗，bingo，不正是网友们一直说的要给医生/病人愿意使用的权利，那就别ban这个药啊。他们又回到副作用上，如此再循环！
疟疾预防的剂量是去疟疾带之前每周吃一两片 比新冠剂量小很多
这么说吧
剂量的大小的排名从大到小
治疗疟疾 大于 纽约医生推荐治疗新冠 大于 红斑狼疮患者 大于 预防疟疾
我在这个楼里面一直在解释这个 我建议楼主把这些解释加到第一页去 楼主只把有利于自己观点的贴在最前面 其他这么多别人提供的讨论的各种link都不加第一页 这样不好
我不是医生 但是最早杀生丸解释的时候说的氯喹应用新冠并不是免疫抑制作用
而是理论上轻症的时候抑制病毒大量分裂+抗血栓 氯喹可以让病毒分裂慢一些 这个和它治疗疟疾和红斑狼疮的原理是不一样的 只是一个化合物可以有多种功能
氯喹的免疫抑制的效果用于新冠理论是不通的 红斑狼疮患者是长期服用低剂量 而且要服用几周后才能有效果 而且要小心卫生 这个和新冠的治疗剂量和效果都是完全不是一回事的
楼主 你看 我和几个ID都在这里贡献了一些想法 如果你能把反对你的想法也贴到第一楼 互相对比 那我支持你去要求飘蓝 尤其是minjing MM的很多回复非常拨云见雾 但是埋在后面了
杀生丸是第一个推荐氯喹的
他当时也是在第一版本武汉方仓指导说明出来之后 第一个大喊指导写的不明确必须改的 因为这个还被知乎封了几天。。。
氯喹在不同的情况下有不同的应用 这是一个安全剂量非常关键的药 很多情况下你低剂量和高剂量都是帮倒忙的 这楼里反反复复多少人讨论剂量了 楼主应该贴到第一层去
谢谢你们的客观讨论，我有时间把这个楼好的讨论楼层update到首页去
对，假试验，不是愚是真坏。
很多华人川黑加朗防的监狱医生还用”是药三分毒”这个样的谬论来吓唬其他华人。
同样假设，我也不会参加双盲，我会直接吃。
我的国内亲人有在医院药房当药剂师，早已经寄给我了。
支持，顶你，希望能救更多的人
https://forums.huaren.us/showtopic.html?topicid=2580274
Dr. Zelenko也有类似推荐
Weight-based dosing: 6.5 mg/kg salt (5 mg/kg base) orally once a week -Maximum dose: 400 mg salt (310 mg base)/dose
Usual Adult Dose for Malaria 800 mg salt (620 mg base) orally as an initial dose, followed by 400 mg salt (310 mg base) at 6, 24, and 48 hours after the initial dose Total dose: 2000 mg salt (1550 mg base)
Weight-based dosing: -First dose: 13 mg/kg salt (10 mg/kg base) orally -Second dose (6 hours after first dose): 6.5 mg/kg salt (5 mg/kg base) orally -Third dose (24 hours after first dose): 6.5 mg/kg salt (5 mg/kg base) orally -Fourth dose (48 hours after first dose): 6.5 mg/kg salt (5 mg/kg base) orally
Maximum Dose: -First dose: 800 mg salt (620 mg base)/dose -Second, third, and fourth dose: 400 mg salt (310 mg base)/dose
Adult dosing for rheumatic diseases ranges from 200 mg to 400 mg per day (typically 5 mg/kg, maximum 400 mg daily). In some cases, higher doses are used.
HCQ在lupus的用量
Hydroxychloroquine is generally prescribed at a daily dose of 6.5 milligrams (or less) per kilogram of body weight. (Using this formula, the dosage for a 150-pound person would be 443 mg/day, as one kilogram equals 2.2 pounds.) Because HCQ is formulated as a 200 mg tablet, many people taking it for lupus will take two pills per day. Those who are newly diagnosed with lupus may take 400 mg once daily for several weeks while the medication builds up in their system, and then 200–400 mg daily after that.
具体看Dr. Zelenko推特下的评论。已经有医生公开站出来，也有病人提供了telemedicine的信息
https://twitter.com/zev_dr/status/1290275551568044033
这样的主题算科普总结楼么？
你应该把所有观点总结在一起 这样愿意吃药还是不吃药的网友自己评价！
这个楼里那些专业医生都不来，都没什么反面意见
我把所有楼翻了一遍，能加的都加了
来手动点赞支持你的倡议 同意楼主把可能的利害关系整理一下， 让看到的人不会盲目吃药
2bornot2b 的回复里面的两个关于预防的trial的结果你为什么不提？
这两个是我看到的认为目前为止最有价值的关于氯喹效果的trial.
你应该把它贴出去 告诉大家 加拿大和西班牙的两个trial里面证明给新冠的密切接触者吃氯喹是不能降低阳性率，和结果的。
让大家自己判断，要不要吃。 这里可以有几个判断 1.认为氯喹没用，不吃 2.认为氯喹有用，吃 3 认为氯喹需要和其他药品合用
对不对？但是你只把支持你的观点 甚至只是推特发出来 不把这些贴出去 我认为非常没有严谨的精神 这样的做法和cherry picking的MSM是一样的。
minijing的帖子我特意看的，她提的药量问题，我回答了。在我前十楼里针对毒性列出了专业文献，也有针对新冠吃hcq的安全研究，后面也列了其他病吃hcq的药量。她的帖子都是提问题，没给出个专业意见，你觉得有必要所有人的问题我都拉到前面吗？唯一有建设性意义的就是警告大家吃了这个药要预防感染，我已经放上去了。
至于你反复强调2bornot2b的那两个study，根本不能证明hcq cocktail没用。一个做的预防的，而且没加Zinc的cocktail。我找时间把最近这些study都单独一个个列出来解释，这样行吧？
以下这篇NEJM文章被很多人拿来证明早期使用HCQ对预防新冠无效。https://www.nejm.org/doi/full/10.1056/NEJMoa2016638
这个随机双盲实验是在于新冠阳性患者有接触的人群里使用HCQ，最后得到的结论是使用相对较高剂量的HCQ并没有起到防止新冠症状发生的作用。
首先要说明的是，这个实验只用了HCQ，没有Zinc也没有Azithromycin。其次，这个研究出来以后受到不少质疑，尤其是在实验设计和最后的数据分析上。https://c19study.com/watanabe.html
有研究人员根据实验数据进行了进一步分析，得到的结论是HCQ如果用的早，作用还是很明显的。https://arxiv.org/ftp/arxiv/papers/2007/2007.09477.pdf
有意思的是这篇文章的一作曾受到Gilead的资助。。。
类似结果在我首页第十楼都有提到，可惜这种非随机双盲的实验得出来的结论是入不了Fauci和咱们论坛很多专业医生的法眼的。。。
We believe wholeheartedly that a mission statement is more than a plaque we hang on a wall, but rather an idea we embed in our hearts and minds that unifies, empowers and enables us to do what we do every day for the people of our communities. Our mission is to improve people’s lives through excellence in the science and art of health care and healing. For more than 100 years, we have proudly pioneered clinical and scientific breakthroughs that have advanced health care here and abroad. As an early hotspot for the COVID-19 pandemic, we have seen and lived its devastating effects alongside our patients and families. Perhaps that’s what makes us even more determined to rally our researchers, frontline care team members and leaders together in boldness, participating in scientific research, including clinical trials, to find the safest care and most effective treatments. While feeling the same sense of urgency everyone else does to recognize a simple, single remedy for COVID-19, we need to be realistic in the time it takes to fully understand the optimal therapy or combination of therapies required of a new virus we are all trying to contain. The most well-accepted and definitive method to determine the efficacy of a treatment is a double-blind, randomized clinical trial. However, this type of study takes a long time to design, execute and analyze. Therefore, a whole scientific field exists in which scientists examine how a drug is working in the real world to get as best an answer as they can as soon as possible. These types of studies can be done much more rapidly with data that is already available, usually from medical records. Like all observational research, these studies are very difficult to analyze and can never completely account for the biases inherent in how doctors make different decisions to treat different patients. Furthermore, it is not unusual that results from such studies vary in different populations and at different times, and no one study can ever be considered all by itself. Our promising Henry Ford treatment study should be considered as another important contribution to the other studies of hydroxychloroquine that describes what the authors found in our patient population. We – along with all doctors and scientists – eagerly support the need for randomized clinical trials. We also want to point out that scientific debate is a common occurrence with almost every published study. In part, this is what fuels the advancement of knowledge – challenging one another on our assumptions, conclusions and applications to get to a better place for the patients we collectively serve. You can read the original study here and the senior author’s letter to the editor here. Unfortunately, the political climate that has persisted has made any objective discussion about this drug impossible, and we are deeply saddened by this turn of events. Our goal as scientists has solely been to report validated findings and allow the science to speak for itself, regardless of political considerations. To that end, we have made the heartfelt decision to have no further comment about this outside the medical community – staying focused on our core mission in the interest of our patients, our community, and our commitment to clinical and academic integrity. Thank you for your support. Sincerely, Adnan Munkarah, M.D., Executive Vice President and Chief Clinical Officer Steven Kalkanis, M.D., Senior Vice President and Chief Academic Officer
首先，这个实验再一次的只用了HCQ，没有Zinc，也没有Azithromycin。
而且，这个实验开始给HCQ的时间是expose后四天“The median length from exposure to enrollment was 4.0 (IQR 3.0-6.0) days”。如果之前NEJM的data修正后的结果是正确的，那么单独使用HCQ必须要很早，暴露后前两天用处比较明显，越往后就越没用了。
无巧不成书，这篇文章的一作Oriol Mitja又和Gilead有千丝万缕的关系。在四月份Gilead召开的关于新冠的会议，Mitja是其中一个speaker。那次会议的另一个speaker Mandeep Mehra正是那篇被撤回的Lancet文章的作者。
他们如果偏要双盲那倒是去做啊，又不做又不让人用，真是...
这个study受到太大压力了。。。太同意下面这段话了
The most well-accepted and definitive method to determine the efficacy of a treatment is a double-blind, randomized clinical trial. However, this type of study takes a long time to design, execute and analyze. Therefore, a whole scientific field exists in which scientists examine how a drug is working in the real world to get as best an answer as they can as soon as possible. These types of studies can be done much more rapidly with data that is already available, usually from medical records.
真不知道Fauci天天强调gold standard study的目的是什么？现在我们面对的是pandemic crisis啊。。。
预感很快就要被挪去华人医馆了。。。。。。。
希望不会 都飘蓝了
谢谢楼主。 那些医生和药学家反对永HCQ的，能不能说一下，服用HCQ安全计量以内几天，副作用到底是什么？看了那么多帖子，只说有副作用而不谈计量和天数，🈶️什么意义？
华人医馆，好有才哈哈哈
我觉得这里的水越来越深，今天看了这篇报道，其实不只是HCQ，还有其他被临床医生证明有效的新冠疗法都被媒体和所谓medical elites压制了。报道里面提到的德州医生发现用inhaled steroid+Zinc+antibiotics对他的病人很有效，可是关注很少。总结起来，这些“草根”疗法的共同点就是利润小，没有大药厂做靠山。
https://texasscorecard.com/federal/doctors-with-coronavirus-treatment-face-orwellian-suppression/
再看到刚才的Henry Ford不敌压力的公开信，细思极恐。
我很少相信阴谋论，但哪有那么多“凑巧”！
Henry ford 这个医院在7月份的时候还发表过文章 Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows https://www.henryford.com/news/2020/07/hydro-treatment-study 现在为什么由于政治压力不能再做评论了？
受到压力了呗，被潮水般反对的声音overwhelmed了。信里说的挺明白的，trial结果就是这样，虽然达不到双盲标准，也对这药在新冠的认知做出了贡献，没必要再做什么解释