This note is about hope, but first the bad news. As we get more data, anti-malarials are turning out to have been false-positives. Two more studies show hydroxychloroquine doesn’t work (and has risks). medrxiv.org/content/10.110…
And here’s the other negative study. medrxiv.org/content/10.110…
We can quibble with these trials’ designs & say maybe these drugs still work a bit, but at very least we need to accept that they don’t work well. If they did, we would have seen a big effect by now. It’s essential to lay aside hopes for this class of drug & focus on other drugs.
Given all the other trials out there, we need patients sorted to trials that hold more promise than any involving chloroquine or hydroxychloroqine. Someone might say, “well why not just throw it on top of new drugs just in case?”.
But the risk of that is that we already know these drugs have side effects (can really screw up heart function) and kill people. So testing a new drug that might be safe and effective on top of anti-malarials risks muddying our understanding of the new drug.
Also, drugs have interactions. If two drugs are broken down by same systems in our body (typically liver enzymes), one drug could block the other drug’s disposal, causing accumulation. Some drugs do this to anti-malarials and increase the heart toxicity. apsf.org/news-updates/s…
So we can’t just throw in any drugs we hope have some bit of efficacy together. We risk real harm. We have to pick and choose which drugs to try together - which to include on a team. And I think the anti-malarials have failed tryouts. Time to focus elsewhere.
Testing new drugs for their interactions with other drugs is a standard part of all new drug development. Public is now learning how new drugs are developed typically over a decade, but all compressed into months.
The total effort we’re exerting is inspiring yet it’s distressing when even one hope is dashed (standard for biotech). Importantly, have a lot of shots on goal remaining, many of which have a much more compelling rational for why they should work than the anti-malarials ever did.
If anyone is still convinced anti-malarials work well, please link to the studies we can discuss here. Uncontrolled studies are un-interpretable. Small controlled studies can be noisy but can be analyzed together as a “meta-analysis” to see what preponderance of data show.
