Posted on 04/22/2020 6:28:32 PM PDT by Steven W.
https://twitter.com/raoult_didier/status/1253045368377561093
Didier raoult @raoult_didier
The study published in pre-print on 04/21 on Medrxiv by Maganoli et al has three major biases which invalidate its conclusions, in any case absurd and incompatible with the literature. We have detailed these biases in the letter below.
https://www.mediterranee-infection.com/response-to-magagnoli-medrxiv-2020/
Response to Magagnoli, MedRxiv, 2020 Matthieu MILLION
https://www.mediterranee-infection.com/wp-content/uploads/2020/04/Response-to-Magagnoli.pdf
In the current period, it seems that passion dominates rigorous and balanced scientific analysis and may lead to scientific misconduct. The article by Magagnoli et al. (Magagnoli, 2020) is an absolutely spectacular example of this. Indeed, in this work, it is concluded, in the end, that hydroxychloroquine (HCQ) would double the mortality in patients with COVID with a fatality rate of 28% (versus 11% in the NoHCQ group), which is extraordinarily hard to believe. The analysis of the data shows two major biases, which show a welling to be convinced before starting the work :
The first is that lymphopenia is twice as common in the HCQ groups (25% in the HCQ, 31% in the HCQ+AZ group versus 14% in the no HCQ group, p =.02) and there is an absolute correlation between lymphopenia (<0.5G/L) and fatality rate, which is well known (Tan, 2020) and confirmed here : 28% deaths, 22% and 11% in the HCQ, HCQ+AZ and No HCQ group, respectively. Lymphopenia is the most obvious criterion of patient severity (in our cohort, lymphocytes in dead individuals (n=22, mean ± standard deviation, 0.94 ± 0.45), versus in the living (n=2405, 1.79 ± 0.84, p < .0001)). As the authors acknowledge, the severity of the patients in the different groups was very different, and their analysis can only make sense if there is a selection of patients with the same degree of severity, i.e. the same percentage of lymphopenia.
The second major bias is that in an attempt to provide meaningful data, by eliminating the initial severity at the time of treatment, two tables are shown: one table where drugs are prescribed before intubation, and which shows no significant difference in the 3 different groups (9/90 (10%) in the HCQ group, 11/101 (10. 9%) HCQ+AZ, and 15/177 (8.5%) in the group without HCQ, chi-square = 0.47, ddl = 2, p = 0.79), and one table, where it is not clear when the drugs were prescribed, where there are significant differences. These differences are most likely related to the fact that the patients had been intubated for some before receiving hydroxychloroquine in desperation. It is notable that this is unreasonable at the time of the cytokine storm, as it is unlikely that hydrochloroquine alone would be able to control patients at this stage of the disease.
Moreover, incomprehensibly, the “untreated” group actually received azithromycin in 30% of cases, without this group being analyzed in any distinct way. Azithromycin is also a proposed treatment for COVID (Gautret, 2020) with in vitro efficacy (Andreani, 2020), and to mix it with patients who are supposedly untreated is something that is closer to scientific fraud than reasonable analysis.
Altogether these 3 voluntary biases are all pushing to the idea of dangerosity of hydroxychloroquine safest drug as reported on nearly 1 million people (Lane, 2020).
All in all, this is a work that shows that, in this period, it is possible to propose things that do not stand up to any methodological analysis to try to demonstrate that one is right.
Great post!
The (fraudulent) “study” conducted for VA & NIH and published yesterday + parroted by the MSM: https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf
Nice!
See the post right before yours where Dr. Martenson takes them apart too.
Original Abstract (note Author of VA / NIH study had patent pending for COVID-19)
Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19
Joseph Magagnoli, Siddharth Narendran, Felipe Pereira, Tammy Cummings, James W Hardin, S Scott Sutton, Jayakrishna Ambati
doi: https://doi.org/10.1101/2020.04.16.20065920
This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.
https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1
Abstract
BACKGROUND: Despite limited and conflicting data on the use of hydroxychloroquine in patients with Covid-19, the U.S. Food and Drug Administration has authorized the emergency use of this drug when clinical trials are unavailable or infeasible. Hydroxychloroquine, alone or in combination with azithromycin, is being widely used in Covid-19 therapy based on anecdotal and limited observational evidence. METHODS: We performed a retrospective analysis of data from patients hospitalized with confirmed SARS-CoV-2 infection in all United States Veterans Health Administration medical centers until April 11, 2020. Patients were categorized based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) as treatments in addition to standard supportive management for Covid-19. The two primary outcomes were death and the need for mechanical ventilation. We determined the association between treatment and the primary outcomes using competing risk hazard regression adjusting for clinical characteristics via propensity scores. Discharge and death were taken into account as competing risks and subdistribution hazard ratios are presented. RESULTS: A total of 368 patients were evaluated (HC, n=97; HC+AZ, n=113; no HC, n=158). Rates of death in the HC, HC+AZ, and no HC groups were 27.8%, 22.1%, 11.4%, respectively. Rates of ventilation in the HC, HC+AZ, and no HC groups were 13.3%, 6.9%, 14.1%, respectively. Compared to the no HC group, the risk of death from any cause was higher in the HC group (adjusted hazard ratio, 2.61; 95% CI, 1.10 to 6.17; P=0.03) but not in the HC+AZ group (adjusted hazard ratio, 1.14; 95% CI, 0.56 to 2.32; P=0.72). The risk of ventilation was similar in the HC group (adjusted hazard ratio, 1.43; 95% CI, 0.53 to 3.79; P=0.48) and in the HC+AZ group (adjusted hazard ratio, 0.43; 95% CI, 0.16 to 1.12; P=0.09), compared to the no HC group. CONCLUSIONS: In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.
Competing Interest Statement
Disclosure forms provided by the authors are available with the NEJM. JA is a co-founder of iVeena Holdings, iVeena Delivery Systems and Inflammasome Therapeutics, and has received consultancy fees from Allergan, Biogen, Boehringer Ingelheim, Immunovant, Janssen, Olix Pharmaceuticals, Retinal Solutions, and Saksin LifeSciences, all unrelated to this work. JA is named as an inventor on a patent application filed by the University of Virginia relating to Covid-19 but unrelated to this work. SSS has received research grants from Boehringer Ingelheim, Gilead Sciences, Portola Pharmaceuticals, and United Therapeutics, all unrelated to this work. The other authors declare no competing interests.
Funding Statement
National Institutes of Health University of Virginia
Author Declarations
All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.
thanks for the post. looks like our gov’t is trying to kill us again.
Yet a VA official acknowledged in an interview that (a) the study was an observational study, not a clinical study and it was very small, (b) all the patients in the study were older and far along in their symptoms, and (c) Hydroxychloroquine is being used by the VA with middle aged patients not far along in their symptoms, and it is successfully mitigating their symptoms.
The deep state VA branch released the “study” just to stay on the Wash. D.C. bureaucrats agenda.
just about everything works better earlier rather than later , in fighting a disease.
No argument, though some things help much better than other things. Once a Wuhan Virus infection causes illness symptoms, which is more effective, taking more vitamin D3 and Zinc, or Hydfroxychlorquine and Z-pack?
if its only in head and throat, taking immune boosters
if it gets into the chest, take antivirals and stop the immune boosters
Great analysis
Laura Ingraham just has an excellent portion of her show on this. She used this same article to refute the VA survey.
I took the anti malaria drug and an antibiotic, but also took antihistamines to stop the fluid; buildup in my lungs.
It worked great.
Laura Ingraham also did a segment on the subject of the “HCQ bad” test.
The press is giving advice that would kill people if followed.
AP included.
Outstanding rebuttal!!!! Thank you!
p
These scientists are clearly anecdotal humans and should not be listened to. They need to report immediately to the nearest scientific re-education camp where they will be programmed with settled science.
Thank you.
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