Funny numbers in CoViD-19 drug tests

This study purports to find no benefit to lopinavir–ritonavir treatment:

https://www.nejm.org/doi/full/10.1056/NEJMoa2001282

But this study suggests lopinavir–ritonavir is standard practice in China and finds no benefit to hydroxychloroquine over lopinavir–ritonavir:

https://www.bloomberg.com/news/articles/2020-03-25/hydroxychloroquine-no-better-than-regular-covid-19-care-in-study

But from the latter:

The study involved just 30 patients. Of the 15 patients given the malaria drug, 13 tested negative for the coronavirus after a week of treatment. Of the 15 patients who didn’t get hydroxychloroquine [(but got lopinavir–ritonavir)], 14 tested negative for the virus.

Those are insane numbers. Are they suggesting that there’s more than a 90% cure rate with both?

The first study had a very different result:

The percentage of patients with detectable viral RNA for SARS-CoV-2 was similar in the lopinavir–ritonavir group and the standard-care group on any sampling day (day 5, 34.5% vs. 32.9%; day 10, 50.0% vs. 48.6%; day 14, 55.2% vs. 57.1%; day 21, 58.6% vs. 58.6%; and day 28, 60.3% vs. 58.6%) (Table S2).

Much lower overall improvement apparently.

But the first study did show very worthwhile benefits:

Patients in the lopinavir–ritonavir group had a shorter stay in the intensive care unit (ICU) than those in the standard-care group (median, 6 days vs. 11 days; difference, −5 days; 95% CI, −9 to 0), and the duration from randomization to hospital discharge was numerically shorter (median, 12 days vs. 14 days; difference, 1 day; 95% CI, 0 to 3). In addition, the percentage of patients with clinical improvement at day 14 was higher in the lopinavir–ritonavir group than in the standard-care group (45.5% vs. 30.0%; difference, 15.5 percentage points; 95% CI, 2.2 to 28.8) (Fig. S5). There were no significant differences for other outcomes such as duration of oxygen therapy, duration of hospitalization, and time from randomization to death.

A 40% reduction in ICU time alone is presumably worth the price of admission. That may be why the Chinese made it standard treatment.

Thus, the further question is begged of a combination of both treatments or both plus azithromycin as in the French study’s combo with hydroxychloroquine.

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2 thoughts on “Funny numbers in CoViD-19 drug tests”

  1. What does hydroxychloroquine do? Read the first paragraph here.

    The most common side effects include diarrhea. (now we know the reason for the lack of toilet tissue!)

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  2. I would disregard the 30 sample test outright.  I’m glad they did it, but it would need to be replicated closely in another test, even another scant sample test, for it to gain meaning in my eyes.

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