Talk:Hydroxychloroquine

Semi-protected edit request on 30 April 2020

Would like to add citation on mechanism of action after this line. lysosomal pH in antigen-presenting cells. In inflammatory conditions, it blocks toll-like receptors on plasmacytoid dendritic cells (PDCs). Article https://www.nature.com/articles/s41584-020-0372-x Citation : Schrezenmeier, E., Dörner, T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 16, 155–166 (2020). https://doi.org/10.1038/s41584-020-0372-x Clearly states that it does block toll-like receptors on plasmacytoid dendritic cells. DariusMD (talk) 18:22, 30 April 2020 (UTC)

 Done Interstellarity (talk) 20:31, 30 April 2020 (UTC)

Semi-protected edit request on 9 May 2020

In connection with the Covid19 pandemic, various medical publications explicitly indicated complications in patients with glucose-6-phosphate dehydrogenase deficiency. Treatment with hydroxychloroquine can lead to hemolysis and microembolism, and thus death. 2A01:C22:BC2F:F600:7DCB:453C:420B:23E1 (talk) 03:29, 9 May 2020 (UTC)

References

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. I also doubt this change would be necessary. This article is about the drug; its side effects have been known for a long time. The article already mentions the status of efficacy and risk/benefit research for its use in COVID-19. If you’re suggesting that side effects are different for this drug because a person has COVID-19 and glucose-6-phosphate dehydrogenase deficiency, then you should be more specific in your request and your references. It sounds to me, though, that you’re just pointing out existing adverse reactions to the drug in people with glucose-6-phosphate dehydrogenase deficiency, which would have nothing to do with COVID-19 and wouldn’t warrant additional mention in that section of the article. — Tartan357  ^(Talk) 09:44, 9 May 2020 (UTC)

Testing hydroxychloroquine in combination

As regards "Revision as of 07:20, 20 May 2020 (edit) (undo) (thank) Doc James (talk | contribs) (we already say it is being studied? no need for the primary source)" However I had introduced not that just it is being studied but now as part of a package which is topical. "Hydroxychloroquine and Zinc With Either Azithromycin or Doxycycline for Treatment of COVID-19 in Outpatient Setting" https://clinicaltrials.gov/ct2/show/NCT04370782Soundhill (talk) 08:57, 20 May 2020 (UTC)

Hydroxychloroquine is an ionophore which transports zinc into cells and it is the zinc which attacks the virus. I have tried several times to link studies which explain that and they have been removed and I am beginning to feel there may be an agenda to keep Trump's zinc aspect from consideration and pretend only the hydroxycholoroquine by itself happens to be valid to consider in building a picture of Trump's action. That doesn't seem scientific. Soundhill (talk) 10:23, 20 May 2020 (UTC)>

When applied in a combination with other drugs, it may actually "work" simply because other drugs work. This is known as axe porridge. I changed wording of first phrase in the paragraph to summarize better what the whole paragraph and the cited source [1] tell. And no, do not take hydroxychloroquine with zinc. Just zinc? Yes, if you have zinc defficiency. My very best wishes (talk) 15:29, 20 May 2020 (UTC)

Orange Man Bad. Hydroxychoroquine is one drug in a family of drugs that transport Zinc and other metals into the cell to suppress RNA replication of the coronavirus. In that sense, HCQ possesses an action potential that alters the concentration of Zn in the cell. So it works. Yes, HCQ works. Raoult has more than proven this treatment regime. The only times it doesn't work is after the virus has done it damage, and when Orange Man Bad. — Preceding unsigned comment added by 24.89.228.162 (talk) 04:07, 26 May 2020 (UTC)

quoting: "When applied in a combination with other drugs, it may actually "work" simply because other drugs work." That's why the combination study is needed, to see if there may be a difference when in combination.

And hydroxychloroquine being an ionophore I feel it to be wrong to have removed my reference to that and to another Wikipedia page on that.

quoting: "do not take hydroxychloroquine with zinc." Do you put yourself above the people who have approved the clinical trial doing exactly that?

quoting: "Just zinc? Yes, if you have zinc defficiency"

Your source refers to a study of zinc and vitamin C in combination.

Now presumably the clinical trial I cite may find if other hydroxychloroquine trials may have shown no result because of an underlying zinc deficiency when the drug was administered.

As we move towards the US presidential election we need to be very careful about ideological bias not affecting Wikipedia topics relating to what the current president may be doing. Soundhill (talk) 21:22, 20 May 2020 (UTC) Trump said he is taking hydroxy/zinc combo, some doctors recommend this combo for their patients claiming the 2 work very well together. See below from ABC

Dr. Cardillo with Mend Urgent Care in Sherman Oaks says using hydroxychloroquine with zinc appears to be working in the handful of patients he has prescribed it to.

"It was actually the hydroxychloroquine opening up a channel in the cellular membranes allowing zinc to come into the cells," he said, "And we do know high levels of zinc inside of the cell that's infected with the virus shuts down that viral replication machinery." https://abc7.com/health/doctors-say-caution-needed-in-drug-treatment-for-covid-19/6082485/ Berkshires (talk) 02:40, 21 May 2020 (UTC)

I have added mention of NYU study showing more favorable results when combining hydroxy with zinc. While the NYU study was retrospective, so was the study linking to higher death rates.. so to be fair, either both of them should be mentioned or neither of them. Berkshires (talk) 03:17, 21 May 2020 (UTC)

It tells: "Dr. Anthony Cardillo said he has seen ... but ...". Even if we had no WP:MEDRS, that would be an extremely weak source and undue claim. Further, "It was actually the hydroxychloroquine opening up a channel in the cellular membranes allowing zinc to come into the cells," he [Dr. Cardillo] said. What? Yes, there were publications that hydroxychloroquine can work as an ionophore. But ionophore is NOT an ion channel, but a carrier. My very best wishes (talk) 03:48, 21 May 2020 (UTC)

Why was this removed: "As of 8 May 2020, hydroxychloroquine and azithromycin plus zinc have been found to have effect against SARS-CoV-2 for patients in hospital but not yet in intensive care. "Zinc inhibits RNA dependent RNA polymerase, and has been shown to do this in vitro against SARS-CoV[13]. However, it is difficult to generate substantial intracellular concentrations of zinc, therefore prophylactic administration of zinc alone may not play a role against SarCoV-2[14]. When combined with a zinc ionophore, such as chloroquine (hydroxychloroquine), cellular uptake is increased making it more likely to achieve suitably elevated intracellular concentrations[15]. This combination is already being tested as a prophylactic regimen in a randomized clinical trial." Soundhill (talk) 05:38, 21 May 2020 (UTC)

The current paragraph is a shambles:

"On 18 May 2020, Trump publicly stated that he was taking hydroxychloroquine combined with Mineral Zinc during the COVID-19 pandemic, despite evidence indicating that it is "linked to higher rates of death in hospitalized COVID-19 patients with pre-existing conditions", and other studies that show it to be ineffective. [57] There is some counter evidence though, that when combining hydroxychloroquine with zinc the results would be more favorable than when taking hydroxychloroquine by itself. [58]"

The bolded passages are new. Now it reads as if the "despite evidence" part includes zinc. This is not how it is done. Also, the source is a primary one. I think the zinc part should be removed until we have a secondary source. --Hob Gadling (talk) 07:42, 21 May 2020 (UTC)

Hob Gabling is this what you mean by primary and secondary sources? Waiting for someone to interpret would seem to delay vital new information. As regards the passage you quote it might be useful to consider this change: "On 18 May 2020, Trump publicly stated that he was taking hydroxychloroquine combined with Mineral Zinc. Many secondary sources have sidelined Trump's reference to mineral zinc and talked of evidence indicating that hydroxychloroquine is "linked to higher rates of death in hospitalized COVID-19 patients with pre-existing conditions", and other studies that show it to be ineffective. An example: [57] To relate to what Trump actually said, the newer research including zinc supplementation should be noted and that that regime has started to be found helpful if started before any intensive care may be needed.[58]"Soundhill (talk) 09:45, 21 May 2020 (UTC)

Your main error is the assumption that it is Wikipedia's job to sideline science and gather primary sources. Read WP:SCHOLARSHIP to find out why secondary sources are what an encyclopedia should be based on.

Your second error is the assumption that anything coming from Trump can be "vital information". His doctor is not a doctor, and he himself is as far away from a reliable source as logically possible. If he jumps off a cliff, Wikipedia will not write that jumping off cliffs is healthy because he did it, and if somebody publishes preliminary findings saying that it may well be, we will wait until others confirm it. --Hob Gadling (talk) 11:41, 21 May 2020 (UTC)

I corrected language and i think its much better. Trump taking it combined with Zinc is not primary research, neither is the NYU large observational study. Both are simple facts reported by quite a few credible sources. — Preceding unsigned comment added by Berkshires (talk • contribs) 21:49, 21 May 2020 (UTC)

The fact that some prominent layman takes a medicine because he thinks it helps against some malady may be a fact, a well-reported fact even, but that does not make it WP:DUE for the article about the medicine. --Hob Gadling (talk) 06:08, 22 May 2020 (UTC)

To Hob Gadling I have suggested an edit to WP:SCHOLARSHIP that reliable secondary sources in medicine, nutrition and toxicology should include formulation dose. — Preceding unsigned comment added by Soundhill (talk • contribs) 00:27, 22 May 2020 (UTC)

There are quite a few reliable sources reporting that zinc/hydroxy/ziro combo is working differently and is alot more effective than hydroxy itself, and there seems to be some evidence backing it. (one ex. https://en.wikipedia.org/wiki/Chloroquine#Antiviral Chloroquine also seems to act as a zinc ionophore that allows extracellular zinc to enter the cell and inhibit viral RNA-dependent RNA polymerase.[4][5] )

While the NYU study is retrospective and not clinical trial so is the vetarns study. Leaving one and omitting other would be against Wiki bias policy.

The fact is that trump is taking the whole combo not just hydroxy, which make it relevant here (at least as much as the VA study which was a)on hydroxy itself b)people in late stages of corona c) people in critical conditions or ventilators). Before revereting again please explain your position here os talk page to avoid edit war. see link https://www.cnbc.com/2020/05/18/trump-says-he-takes-hydroxychloroquine-to-prevent-coronavirus-infection.html — Preceding unsigned comment added by Berkshires (talk • contribs) 20:28, 22 May 2020 (UTC)

I have also changed the language despite some evidence indicating that it is "linked to higher rates of death in hospitalized COVID-19 patients with pre-existing conditions""since there is only retrospective studies, so further research is required. Berkshires (talk) 20:48, 22 May 2020 (UTC)

Yeah right. And when scientists find out that adding zinc changes nothing, you will claim that it has to be taken at full moon, and when scientists find out that does have no consequence, you will claim that the mixture has to be stirred exactly three times. The usual response when people refuse to accept what the science tells them.

Enough of that. Wikipedia does not cluck before the egg has been laid.

I also removed the "some" because of WP:WEASEL. --Hob Gadling (talk) 06:46, 25 May 2020 (UTC)

References

Randomized trial? Where?

Where is this randomized controlled trial on 36 patients? I don't see it in the referenced source. 172.118.183.33 (talk) 01:31, 21 May 2020 (UTC)

It's on the cited John Hopkins page if you hover over where there is a citation for COVID-19 under the adult dosing section. It describes the small trial (it's actually non-randomized and I corrected this in our article) of 36 patients. I hope that helps. TylerDurden8823 (talk) 01:35, 21 May 2020 (UTC)

References

High-quality

My very best wishes, in your edit summary [2], you said "no, please read whole source. It tells:"Given the lack of evidence that HCQ is beneficial for the treatment of COVID‐19"". Please be clear-which cited source are you referring to specifically? I ask because the cited Meyerowitz source specifically says "Early anecdotal reports and limited in vitro data led to the significant uptake of hydroxychloroquine (HCQ), and to lesser extent chloroquine (CQ), for many patients with this disease. As an increasing number of patients with COVID‐19 are treated with these agents and more evidence accumulates, there continues to be no high‐quality clinical data showing a clear benefit of these agents for this disease (my bold)." Please explain why you are objecting to saying there is no high-quality evidence when the cited source says exactly that. It's not technically correct to say there is no evidence, but it is very low-quality evidence. It is certainly accurate to say there is no high-quality evidence to support chloroquine or hydroxychloroquine's use for COVID-19. Please elaborate on your objection, thanks. TylerDurden8823 (talk) 05:07, 21 May 2020 (UTC)

I refer to first ref used for in-line sourcing the phrase, that one, and it tells in conclusion of chapter 4: This finding highlights the concern that the combination of these two medications may place patients at increased health risk. Given the lack of evidence that HCQ is beneficial for the treatment of COVID‐19, these two agents should likely not be combined for COVID‐19 outside of a clinical trial.... Regardless, this and other sources tell there is simply no evidence. Also, speaking about "high-quality", what exactly does it mean? Can you explain it please? Without explanation, a reader can imagine whatever. My very best wishes (talk) 02:30, 22 May 2020 (UTC)

It means the same thing as it always has, that there is a lack of high-quality evidence (e.g., adequately powered well-done placbeo-controlled double-blind randomized controlled trials) supporting its use. The cited article uses that precise language. To be clear, I'm not in favor of HCQ use so I hope you realize that. But it's simply an inaccurate statement to say that there is no evidence. There is, it's just very low-quality in vitro and uncontrolled case series evidence. That's what stimulated more interest and study in the first place. The whole reason this received so much attention was because the aforementioned very preliminary data came out suggesting a possible role and tons of people jumped on the bandwagon, which wasn't really warranted. Nevertheless, the most accurate statement that is consistent with that cited article is that there is no high-quality supporting evidence. Please address the aforementioned bolded sentence directly from that source. We can certainly elaborate on what high-quality means though the cited article and we very commonly use this language in medical articles throughout Wikipedia without explaining in-depth what is meant by "high-quality" (we don't say, this means a lack of well-designed double-blinded RCTs every single time we say that). We reflect what high-quality sources (like the FASEB review) say, and that's what they say. TylerDurden8823 (talk) 17:37, 22 May 2020 (UTC)

Although this is true statement, the cited source under discussion [3] actually does not say "there is no strong evidence from double-blind placebo-controlled randomized controlled trials to support". Your explanation what "high-quality" means is actually a WP:OR. Besides, we must keep it simple. double-blind placebo-controlled randomized controlled trials. A typical reader does not know what that is. And once again, there is no scientific evidence (that is what we are talking about). There are only highly controversial data. This is not scientific evidence. My very best wishes (talk) 00:54, 23 May 2020 (UTC)

That's ridiculous. It's well-established. It's not OR or Synth, it's widely known. It's very clear in the paper that is what's needed "Given these facts and the growing un- certainty about these agents for the treatment of COVID-19, it is clear that at the very least thoughtful planning and data collection from randomized clinical trials are needed to understand what if any role these agents may have in this disease." And you're wrong that highly controversial data is "not evidence". It's poor-quality evidence. TylerDurden8823 (talk) 04:47, 26 May 2020 (UTC)

I think this is very simple. One questionable study tells there are might be some benefits. Another, more rigorous study tells the probability of death due to use of the drug increases, i.e. the drug is harmful (and the toxicity of this drug is generally well known). Even WHO stopped their trial. Do we have a scientific evidence this drug works for this specific disease? Of course not. My very best wishes (talk) 17:12, 26 May 2020 (UTC)

It's a semantics argument and you're mistaken. Even if it's questionable evidence, it's still evidence. To simply say "it doesn't exist", is factually untrue. I have already made my thoughts on whether it actually works abundantly clear (I certainly don't think so and the best available evidence suggests it doesn't but generally calls for more rigorous evidence). I added another high-quality source that also supports the language more explicitly. This conversation is really going nowhere. Stay well, MVBW. TylerDurden8823 (talk) 18:32, 26 May 2020 (UTC)

I see what are you talking about. According to our page, "Evidence, broadly construed, is anything presented in support of an assertion". If so, then there is definitely an "evidence" that Earth is flat. But you are right. I will stay out of it. Thanks, My very best wishes (talk) 19:07, 26 May 2020 (UTC)

Semi-protected edit request on 21 May 2020

Hello, I created an account to correct an error I found. I am new to this so please let me know if my submission is not in the proper format.

Under the article's section:

"Society and culture", "2020 COVID-19 use", "In the state of Arizona, a man died..."

Multiple news outlets have incorrectly reported Chloroquine Phosphate as a "fish-tank cleaner". It is a medicine designed to treat fish parasites and infections. Here is a source from NBC that is correct:

https://www.nbcnews.com/health/health-news/man-dies-after-ingesting-chloroquine-attempt-prevent-coronavirus-n1167166

Here is a source explaining what Chloroquine Phosphate is in the context of fish:

https://www.vin.com/apputil/content/defaultadv1.aspx?pId=20778&meta=Generic&catId=113378&id=8505022&ind=33&objTypeID=17

I would like the portion of the paragraph to be changed from:

In the state of Arizona, a man died, leaving his wife in critical condition, as a result of ingesting fish bowl cleaner, which contained chloroquine phosphate. The couple believed the chemical cleaner could prevent them from contracting COVID-19, although the chloroquine phosphate in fish bowl cleaners is not the same formulation found in the medicines chloroquine or hydroxychloroquine.

to:

In the state of Arizona, a man died, leaving his wife in critical condition, as a result of ingesting a product containing Chloroquine Phosphate designed for treating sick fish. The couple believed the fish treatment could prevent them from contracting COVID-19. Chloroquine Phosphate, used for the treatment of fish parasites and infections, has a different chemical structure than the medicines Chloroquine and Hydroxychloroquine.

 Done Eumat114 formerly TLOM (Message) 04:17, 22 May 2020 (UTC)

Diction

Hello. This suggestion has nothing whatsoever to do with the content; it's only a matter of phrasing and diction. Currently, the lead paragraph includes: "HCQ is being studied to prevent and treat coronavirus disease 2019 (COVID‑19)." The verb "studied" does not usually take an indirect object-phrase beginning with "to". This construct "[Noun] is being studied to [verb]" is poor English grammar (or, at least, awkward diction), and, its meaning is not entirely obvious. A better, clearer, less ambiguous English sentence might be: "Scientists are currently investigating the possibility that HCQ may be useful for prevention and/or treatment of coronavirus disease 2019 (COVID‑19)." This is longer, but it's grammatically impeccable (unless I'm missing something) and its meaning is quite clear.

If you like my suggestion, feel free to put it into the article, Masters of the Wikiverse! I tried to make the modification, but I am shut out by the protection.

HandsomeMrToad (talk) 05:57, 24 May 2020 (UTC)

Semi-protected edit request on 25 May 2020

Request the sentence High quality evidence of benefit for such use is lacking, with concerns of potential harms from side effects.[3][4][5]

be changed to: While reports exist to support the administration of low dose HCQ to COVID-19 patients [added reference], concerns of potential harms from side effects also exist.[3][4][5]

Basis: A study has shown that low doses of hydroxychloroquine used for COVID-19 patients with serious illness significantly reduced the mortality rate from 47.4%(258/502) to 18.8%(9/48) with p<0.001. The reference is below.

Sci China Life Sci . 2020 May 15;1-7. doi: 10.1007/s11427-020-1732-2. Online ahead of print. Low Dose of Hydroxychloroquine Reduces Fatality of Critically Ill Patients With COVID-19 Zhuhui (talk) 09:08, 25 May 2020 (UTC)

 Already done - Thanks for this suggestion, but I think the COVID-19 section in the article already makes this point pretty clearly. — Tartan357  ^(Talk) 13:43, 25 May 2020 (UTC)

I would like to second this change: it cites reliable sources, impartially assesses both the risks and benefits of using the medicine and provides specific results/rates. All these combined will improve the quality of this article. Please also add the cited rates (47% vs 19%) and the source link for the cited ref it is available here: https://pubmed.ncbi.nlm.nih.gov/32418114/ Aenchevich (talk) 21:31, 25 May 2020 (UTC)

Semi-protected edit request on 30 May 2020

Hi. I would like to edit the following paragraph on this page:

"In anticipation of product shortages, the FDA issued product-specific guidance for chloroquine phosphate and for hydroxychloroquine sulfate for generic drug manufacturers.[49] The combination of hydroxychloroquine and azithromycin is not recommended outside the context of a clinical trial due to safety concerns with this combination and no proven benefit to combining these medications.[3]"

There are some issues I noticed:

1. The second sentence implies that the FDA does not recommend using hydroxychloroquine except in clinical trials. This is false. The FDA cautioned use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial. See [77].

2. The second sentence should state who made this recommendation, given the first sentence it implies that this is a recommendation by the FDA. That is incorrect as per the source [3] provided in the current page; this is the recommendation by the authors of the study in the FASEB journal, not the FDA.

3. The second sentence says "hydroxychloroquine and azithromycin is not recommended outside the context of a clinical trial". This is incorrect because the referenced source [3] also says it can be used on a case-by-case basis:

"they should only be used with caution and in the context of carefully thought out clinical trials, or on a case‐by‐case basis after rigorous consideration of the risks and benefits

4. The [3] source provided only refers to the outcome in the FASEB journal. This journal lists a study on the medrxiv.org website as the reason for its recommendation. Below quoted from the referenced FASAB journal:

"Given the increase in the use of HCQ for COVID‐19, a group recently published their analysis of the risk for adverse events associated with this medication.[33] They included more than 950 000 HCQ users of whom more than "320 000 had combination therapy with azithromycin"

"[33] https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v1"

The study referenced by the FASEB journal has not yet been certified by peer review. The top of the [33] Medrxiv article specifically states that the study should not be used to guide clinical practice.

Also it was was a retrospective study, not a randomized controlled study so cannot conclusively prove its theories. The study itself makes note of these inherent limitations.

5. The second sentence ends with "and no clinically demonstrable benefit to combine these medications", however at least three peer reviewed French studies have shown the combination appears to show benefit. [75] [76] [79] Two of these studies were published after the [3] source was published. Referencing a source of a study that has not been peer reviewed [3] to say there is no evidence of benefit, and then not referencing studies that have been peer reviewed that show evidence of benefit is misleading.

However it is only when large randomized clinical trials have concluded that there will sufficient evidence to say whether hydroxychloroquine, or hydroxychloroquine combined with azithromycin are definitely beneficial or not. That should be mentioned.

For the above reasons I believe the current paragraph should change as per below:

From:

"In anticipation of product shortages, the FDA issued product-specific guidance for chloroquine phosphate and for hydroxychloroquine sulfate for generic drug manufacturers.[49] The combination of hydroxychloroquine and azithromycin is not recommended outside the context of a clinical trial due to safety concerns with this combination and no clinically demonstrable benefit to combining these medications.[3]"

To:

On 20 March 2020 the results of a small (24 patients), non-randomized clinical trial conducted in France were published in the "International Journal of Antimicrobial Agents" showing evidence that the combination of hydroxychloroquine and azithromycin benefited patients with COVID-19. [75] On 11 April a further observational study in France of 80 patients was published in "Travel Medicine and Infectious Disease" showing further evidence that the combination of hydroxychloroquine and azithromycin benefited patients with COVID-19.[76]

On April 14 2020 in anticipation of product shortages, the FDA issued product-specific guidance for chloroquine phosphate and for hydroxychloroquine sulfate for generic drug manufacturers.[49] Ten days later they cautioned use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial. [77].

On 29 April an article in the "Federation of American Societies for Experimental Biology" journal said that the combination of hydroxychloroquine and azithromycin is only recommended in the context of a clinical trial, or on a case‐by‐case basis after rigorous consideration of the risks and benefits. This is due to safety concerns with this combination and a lack of evidence showing benefit when combining these medications.[3] The conclusion was based on retrospective study posted 10 April 2020 involving 323,122 users of hydroxychloroquine and azithromycin from Germany, Japan, Netherlands, Spain, UK, and USA. That study has not been certified by peer review and was based on hydroxychloroquine users with Rheumatoid arthritis, not COVID-19 [78].

On 5 May 2020 a retrospective analysis of 1061 patients with COVID-19 in France was published in "Travel Medicine and Infectious Disease". The patients were given hydroxychloroquine and azithromycin early in their treatment and their analysis provided further evidence that this treatment was beneficial to patients with COVID-19. [79]

On 8 May 2020 a not yet peer reviewed, retrospective study of hospitalized patients in USA showed evidence that adding Zinc to treatments using hydroxychloroquine and azithromycin provided further benefits to COVID-19 patients. [80] A study published in the PLOS journal on 4 November 2010 showed evidence that when Zinc is inside cells it blocks Coronavirus from replicating. [81] Another study in the same journal published 1 October 2014 showed evidence that chloroquine helps Zinc enter cells. [82] Enabling Zinc to more easily enter cells could be one of the ways hydroxychloroquine stops coronavirus from replicating and becoming worse in COVID-19 patients [80].

To find out with more certainty whether hydroxychloroquine, or hydroxychloroquine combined with azithromycin are beneficial or not, large Randomized Controlled Trials are needed. For this reason a number of these trials are currently running. [83]

[75] 20 March 2020 24 patients non-randomized clinical trial https://doi.org/10.1016%2Fj.ijantimicag.2020.105949

[76] 11 April 2020 80 patients observational study https://doi.org/10.1016/j.tmaid.2020.101663

[77] https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or

[78] https://doi.org/10.1096/fj.202000919 , which references the not yet peer reviewed https://doi.org/10.1101/2020.04.08.20054551

[79] 05 May 2020 1061 patients retrospective anaylsis https://dx.doi.org/10.1016%2Fj.tmaid.2020.101738

[80] 08 May 2020 retrospective USA study with Zinc https://doi.org/10.1101/2020.05.02.20080036

[81] 04 November 2010 Zinc Ionophores blocks the replication of Coronavirus https://dx.doi.org/10.1371%2Fjournal.ppat.1001176

[82] 01 October 2014 Chloroquine Is a Zinc Ionophore https://dx.doi.org/10.1371%2Fjournal.pone.0109180

[83] Running RCTs https://doi.org/10.1136/bmj.m1626 , https://doi.org/10.1101/2020.05.19.20106997, https://clinicaltrials.gov/ct2/show/NCT04358068?term=A5395&draw=2&rank=1

— Preceding unsigned comment added by Robbymcd (talk • contribs) 16:54, 30 May 2020 (UTC)

The words “prove” and “proven” are inappropriate here, both before and after the proposed changes. Clinical research is a complex, continuous process of weighing observed risks versus observed benefits, and if new risks are subsequently found in postmarketing surveillance, medicines get pulled from sale (and sometimes from further trials) by regulatory authorities. Capewearer (talk) 19:20, 30 May 2020 (UTC)

Yes I agree. Can you suggest a better word? Robbymcd (talk) 03:15, 31 May 2020 (UTC)

I've tentatively replaced "proven benefit" with "clinically demonstrable benefit" in the article, but am open to suggestions for better wording. Capewearer (talk) 09:57, 31 May 2020 (UTC)

How about "a lack of evidence showing benefit", that is simpler and probably more accurate. I've updated the original request with this change and some other corrections/improvements. Robbymcd (talk) 16:34, 31 May 2020 (UTC)

Due to lack of any response I started with main change to the section I identified as incorrect. The studies referenced should probably go under the research section rather. — Preceding unsigned comment added by Robbymcd (talk • contribs) 18:53, 3 June 2020 (UTC)

New development -- Major study retracted

I am not sure how notable this is, but according to this Vox article (https://www.vox.com/future-perfect/2020/6/4/21280855/coronavirus-treatment-hydroxychloroquine-lancet-retraction), The Lancet has just retrated a study that suggested hydroxychloroquine increased mortality in patients. Worth adding to the article? Elvis2500 (talk) 22:58, 4 June 2020 (UTC)Elvis2500

This was also covered at BBC Coronavirus: Influential study on hydroxychloroquine withdrawn. My preference is there should be a 48-hour holding period, to allow further info and due WEIGHT to appear. Cheers Markbassett (talk) 01:04, 5 June 2020 (UTC)

Actually, the Lancet itself has published a retraction [4]

’Statement from The Lancet’

Today, three of the authors of the paper, "Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis", have retracted their study. They were unable to complete an independent audit of the data underpinning their analysis. As a result, they have concluded that they "can no longer vouch for the veracity of the primary data sources." The Lancet takes issues of scientific integrity extremely seriously, and there are many outstanding questions about Surgisphere and the data that were allegedly included in this study. Following guidelines from the Committee on Publication Ethics (COPE) and International Committee of Medical Journal Editors (ICMJE), institutional reviews of Surgisphere’s research collaborations are urgently needed.

The retraction notice is published today, June 4, 2020. The article will be updated to reflect this retraction shortly.” BoonDock (talk) 01:11, 5 June 2020 (UTC)

There has also been some further showing of the WEIGHT and responses... seems low-to-medium coverage, noting flaws of fast science and the politicisation of it.

• Vox on the retraction, WSJ, The Guardian on how could this happen, The Verge on speedy science.
• Fox commentary from Dr. Marc Siegel. (Given Minor prominence there, way down in list of stories below numerous Floyd items, then Marine flag item and SpaceX item,) mostly noting prior coverage was political not medical. “Does hydroxychloroquine actually work early in the game to help decrease the symptoms of COVID-19? It's been studied in the lab as an antiviral," Siegel said. "Medical, we don't know yet. Political, we know this is a political hit job." Fox media about that, noting The Guardian and NewsBusters and NEJM reports. (And whinging that ABC CBS NBC were silent about Lancet story). Fox science on the limit of observational data.
• NPR, Marketwatch, Discover, NY Mag, Miami Herald,
• Politico on the retraction politics and mistrust; National Review also, Bloomberg on French questions,

... side notes

• Time notes resumption of studies about using it; CNN notes U.K. stopping theirs.
• Stat preliminary study results, with FDA note ... basically no significant benefit and no major risk.
• CBS, NBC, NYT, The Guardian, Washington Post, ... top google hydroxychloroquine results this week are of the ‘does not prevent’ story and ‘retraction’ thread needs to expressly search for ‘Lancet retraction’

Cheers Markbassett (talk) 17:12, 6 June 2020 (UTC)

Split

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.

The hydroxychloroquine arm of the WHO Solidarity trial has been dropped as of 17 June. There is no consensus to split the article into its focus related to COVID-19, and no longer a reason to specify COVID-19. Vote count 9:3, oppose:support. (non-admin closure). Zefr (talk) 20:55, 17 June 2020 (UTC)

---

The section Hydroxychloroquine#COVID-19 is growing fast and overlaps widely with many similar sections in other articles (linked as see-alsos). Any opposition to splitting it into Use of chloroquine and hydrochloroquine for treatment of COVID-19? Thanks. fgnievinski (talk) 00:06, 5 June 2020 (UTC)

I disagree. The only reason that this article (Surgisphere) exists at all is because it has gained notability for the fact that they provided data for the Lancet study and further that the data’s legitimacy has been called into question. Remove that section and I would not be surprised to see a nomination for speedy deletion of the article for non notability BoonDock (talk) 00:59, 5 June 2020 (UTC)

@BoonDock: you only mentioned the article about Surgisphere; we can leave it out if you prefer. But we're in the talk page of Hydroxychloroquine#COVID-19. There's still plenty of duplication in all the other see-alsos: Chloroquine#COVID-19, COVID-19 drug development#Hydroxychloroquine, COVID-19 drug repurposing research#Hydroxychloroquine, Trump administration communication during the COVID-19 pandemic#Hydroxychloroquine. fgnievinski (talk) 06:11, 5 June 2020 (UTC)

• Oppose: The recent controversy regarding the study has pretty much come to an end as the study has been retracted. Additionally, the sections on the drugs' main articles + Surgisphere's article have sufficient information. A splitting article would overlap most of the information already stated in these asrticles, making it a redundant fork. •Shawnqual• 📚 • 💭 03:52, 5 June 2020 (UTC)

The intention is quite the opposite: to centralize in a single article the information currently dispersed and duplicated in multiple articles, which would then just contain a summary, basically the lead of the proposed article (Use of chloroquine and hydrochloroquine for treatment of COVID-19). fgnievinski (talk) 04:11, 5 June 2020 (UTC)

Still disagree I understand your intention and disagree that it will achieve that. BoonDock (talk) 04:22, 5 June 2020 (UTC)

• Support There have been campaigns including by Trump promoting Hydroxychloroquine as a measure to cure COVID-19. There is a much broader coverage and I agree to have a separate article on that. Abishe (talk) 14:32, 5 June 2020 (UTC)
• Oppose - that section fits here and just doesn’t seem large enough to be a separate article per WP:SPLIT. Plus in addition to the other articles already covering the politics..... It’s already enough places to make complexity for editing and reading, a split would be worse rather than helpful. Cheers Markbassett (talk) 18:27, 6 June 2020 (UTC)
• Oppose as this is basically the reason they are notable and it isn't large enough to fork. Dennis Brown - 2¢ 13:01, 7 June 2020 (UTC)
• Oppose under WP:MEDRS. A specialised article might be acceptable under WP:MEDRS with a title such as Irreproducible science and misinformation in relation to chloroquine and hydrochloroquine for the treatment of COVID-19, as long as it's not redundant with Misinformation related to the COVID-19 pandemic (which presently have just very brief subsections on this subtopic), but that's not the present proposal. Reproducibility in scientific research, irreproducibility in this context, and the way that misinformation has spread in this context are all interesting and valid topics. The fact that the two medicines have been used in this context is less interesting - we don't seem to have articles on the use of homeopathic pills. Boud (talk) 17:37, 7 June 2020 (UTC)
• I disagree with splitting the Surgisphere page up as the COVID19 scandal is most likely going to cause the company's demise.Mfernflower (talk) 18:48, 8 June 2020 (UTC)
• Support, as it's going to be more than Surgisphere, it has enveloped Amit Patel now. It seems like this whole topic (hydro/chloroquine and covid, this paper and retractions, other research) needs to be centralized. tedder (talk) 00:48, 9 June 2020 (UTC)
• Oppose for reasons mentioned so far: not large enough to fork, section fits here and even the fact that the company is likely going belly up.--Wuerzele (talk) 20:17, 9 June 2020 (UTC)
• Oppose too small for relevance just keep it in the section. --Cs california (talk) 07:58, 15 June 2020 (UTC)
• Oppose: With the closure today of the hydroxychloroquine arm of the WHO Solidarity trial - the world's largest trial involving hydroxychloroquine/chloroquine, this is no longer an issue concerning COVID-19. The vote count is 9-3 opposing the proposed split, indicating insufficient consensus and warrant to close the discussion. Zefr (talk) 20:55, 17 June 2020 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Adding Zinc to treatment with hydroxychloroquine

Hi I would like to add the following to the COVID-19 Timeline:

"On 12 May 2020 news outlets reported that NYU hospitals had treated 411 patients hospitalized with COVID-19 using an investigational therapy of hydroxychloroquine, azithromycin and zinc. Only low-level, in-vitro and preprint retrospective cohort study evidence suggests that the addition of zinc with hydroxychloroquine may be beneficial in the treatment of COVID-19 patients. . To obtain high-level evidence if the addition of zinc is beneficial in this combination a Randomized Controlled Trial is currently recruiting and estimated to complete 31 December 2020. "

The news articles refer to the preprint medrxiv observational study: https://doi.org/10.1101/2020.05.02.20080036

As per WP:MEDRS preprints should not be sourced as evidence. However it seems factual that NY hospitals used this treatment and at the very least the secondary news sources above as well as the the primary source preprint confirm this event happened.

This topic appears to have been discussed at length in the section https://en.wikipedia.org/wiki/Talk:Hydroxychloroquine#Testing_hydroxychloroquine_in_combination section. Hob Gadling said "I think the zinc part should be removed until we have a secondary source" . Below I think counts as a secondary source given it was published on the East Virginia Medical School website and the says:

"This is our recommended approach to COVID-19 based on the best (and most recent) literature"

https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf

It advocates the use of Zinc in addition to other treatments including Hydroxychloroquine saying:

"while there is no high-level evidence that this cocktail is effective; it is cheap, safe and widely available"

The link to the ongoing RCT for this combination is also relevant given all of the above. The fact is nothing is currently proven and very little has been disproven relating to COVID-19 treatments, so really everything to do with treatment is speculative in one way or another.

Robbymcd (talk) 16:46, 5 June 2020 (UTC)

 Not done: , this clearly fails WP:MEDRS, WP:OR, and WP:SYNTH. TylerDurden8823 (talk) 09:35, 6 June 2020 (UTC)

Ok so why the bias then to only this post when there are clearly other posts here that make the same violations. If cant provide a suitable reason will remove them too. Robbymcd (talk) 09:45, 6 June 2020 (UTC)

It's not a bias. It's simply following well-established Wikipedia procedure that is there for many good reasons. You'll have to be more specific about what other content you're suggesting is objectionable. TylerDurden8823 (talk) 10:12, 6 June 2020 (UTC)

Just looking in the last few days 961032578 (RECOVERY Trial) 960626395 ( add new study) clearly fail WP:MEDRS and WP:OR as well. So why the bias for my post? However I've managed to find an existing source in this article for my latest attempt to make mention of the possible benefit zinc might have for COVID-19 patients on this page. So if still not happy then seems we need to delete most of the covid-19 section because it follows the same methods as my most recent post. Robbymcd (talk) 12:54, 6 June 2020 (UTC)

Service: You probably mean these: [5][6]. (This way, only I had to do the work of deriving which edits you mean, everybody else can just click on the links. Next time, do that yourself please.) --Hob Gadling (talk) 17:07, 6 June 2020 (UTC)

Because I happened to be online right now and noticed you posted this and it overtly failed the aforementioned policies. Again, it's not a "bias". TylerDurden8823 (talk) 18:22, 6 June 2020 (UTC)

References

WHO resumed HCQ Testing on June 3 2020

https://time.com/5847664/who-hydroxychloroquine-covid-19/ The article says the opposite. — Preceding unsigned comment added by 24.89.228.162 (talk) 00:24, 11 June 2020 (UTC)

The timeline section already says the WHO resumed testing on 3 June. Where does it say the opposite? Capewearer (talk) 04:33, 11 June 2020 (UTC)

History of Hydroxychloroquine and Details of pharmacokinetics

Hello wiki community. I would like to add few very important missing evidences from the topic. That is history and pharmacokinetic detailing.

"When in 1638, a patient from Peru’s Viceroy’s family, countess cinchona, contracted Malaria. She was cured with a bark of a tree called Jesuit’s bark. It took 200 years to isolate its active ingredient ‘quinine’. In 1945, quinine was hydroxylated to form hydroxychloroquine, a safer derivative. The drug has continued its glorious march since then. Currently, the drug is the United States Food and Drug Administration (FDA) approved for Malaria, discoid lupus erythematosus, systemic lupus erythematosus (SLE), and rheumatoid arthritis."https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdaa074/5850534?searchresult=1

Pharmacokinetics: Hydroxychloroquine sulfate (blood half-life 537 hours or 22.4 days) attains peak blood levels 3.26 hours after administration of 200 mg salt (155-mg base) orally in healthy males. Absorption of the drug was found to be less in patients with rheumatoid arthritis with severe disease activity compared with the less severe groups. This observation may have significant importance while ascertaining the dosage recommendation in a healthy subset of the population. https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdaa074/5850534?searchresult=1 https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf

Mendellwiki (talk) 10:05, 13 June 2020 (UTC)Mendellwiki, 15:34, 13.06.2020

References

Studies favoring HQC for Covid-19 keep getting deleted

Did anyone else notcied that? Berkshires (talk) 02:36, 3 July 2020 (UTC)

How much convincing of its ineffectiveness for treating COVID-19-infected people is needed? It has been withdrawn for providing no benefit in the WHO Solidarity trial, UK Recovery trial, and the FDA EUA. My edit summary explained why, and your use of this one observational study (not an interventional trial) is primary research. If warranted, it could be included under the Timeline section. WP:BRD means a contested edit is brought here to the talk page for dispute resolution and consensus building, rather than the edit warring that you prefer. Discuss the merits and seek consensus, WP:CON. Zefr (talk) 03:07, 3 July 2020 (UTC)

You are putting a different standard for studies that are not favoring HCQ versus those favoring. Did you used the same standard to delete "the Lancet study" from Wiki pages??? The Lancet study was from the outset NOT peer reviewed and the source of data was confidential??? you are clearly biased on this and should be ashamed of your behavior. Seeing you cant win with normal conversation you got the page to barred from editing... what a wonderfull way of having accurate info on wiki. Shame.Berkshires (talk) 03:15, 3 July 2020 (UTC)

Note the general sanctions and need for high-quality sources on COVID-19 topics at the top of this talk page. Zefr (talk) 03:25, 3 July 2020 (UTC)

Zefr As mentioned before, instead of deleting peoples edits when you see an issue with them, rather correct them. In this case there is an obvious high quality source as mentioned in the news references from Berkshires

Yes, i realized and i suddenly got 3 massages from different administrators (I am sure it has nothing to with you alerting them). Great way how to avoid legit debate is by deleting and barring. Sounds more like USSR. Good luck — Preceding unsigned comment added by Berkshires (talk • contribs) 03:31, 3 July 2020 (UTC)

Zefr So what you're saying is because the WHO Solidarity trial and UK Recovery trial were cancelled and FDA removed authorization for emergency use in hospitals, you now feel that any new studies that show benefit of its use cannot be shown on this page, no matter how much they meet Wikipedia's criteria for addition? I'm sorry but unless you can provide a better argument I will need to report your continued removal of people's edits, as I am not the only person that has found your edits extremely biased. Robbymcd (talk) 13:32, 3 July 2020 (UTC)

The WHO Solidarity trial and UK Recovery trial are not 'cancelled', but rather have specifically discontinued the study of HCQ because it proved to be ineffective at reducing COVID-19 deaths. Those are multi-investigator organizations relying on expert safety review boards making that conclusion, so qualify as high-quality sources for the encyclopedia per WP:MEDASSESS - see the left pyramid classifying the evidence to which can be added the withdrawn EUA by the FDA. Concerning the disputed July report in IJID (which is not a review, but rather a preliminary report), the authors of that article stated: "our results should be interpreted with some caution and should not be applied to patients treated outside of hospital settings. Our results also require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety, and efficacy of hydroxychloroquine therapy for COVID-19 in hospitalized patients." Their conclusion indicates the preliminary nature of that limited observational study which falls within "primary" research, shown in the left pyramid of MEDASSESS. There's really no place in the article at present for such preliminary findings, which should be excluded until expert assessment with other results about HCQ and COVID-19 are published in a review that meets the standards of MEDASSESS. Zefr (talk) 14:17, 3 July 2020 (UTC)

Ok Zefr, so those two trials were discontinued but what about all the other Hydroxychloroquine trials that are ongoing? The discontinued trials were testing specific doses, combinations and timing, different to other trials. Regarding this study being preliminary and falling in the primary pyramid of MEDASSESS the same could be said for of the sources used on this page that were used to say no benefit. For example [3][4][48][49] in main article are based on much weaker sources than the one proposed here, some of these sources reference studies that have not even been peer reviewed yet, some only have a single author. Please explain your bias here to prevent this being reported.

Robbymcd (talk) 14:34, 3 July 2020 (UTC)

Extended-confirmed-protected edit request on 3 July 2020

Berkshires (talk) 03:08, 3 July 2020 (UTC)

Hi,

Would like to add the following 4 sources to the IJID study. Thanks

https://www.henryford.com/news/2020/07/hydro-treatment-study https://www.wsj.com/articles/hydroxychloroquine-given-early-helped-coronavirus-patients-study-finds-11593729664 https://www.cnn.com/2020/07/02/health/hydroxychloroquine-coronavirus-detroit-study/index.html https://www.modernhealthcare.com/safety-quality/hydroxychloroquine-may-lower-covid-19-death-rates-henry-ford-finds

 Not done - use strong review sources for medical content per WP:MEDRS, not news, WP:NOTNEWS. Zefr (talk) 03:14, 3 July 2020 (UTC)

Surely a mention of a peer reviewed study published in the International Journal of Infectious Diseases specifically about the use of Hydroxychloroquine should at least appear in the timeline section of this Wikipedia page? Zefr Please explain why the below review source does not count as a strong review source as per WP:MEDRS Robbymcd (talk) 13:22, 3 July 2020 (UTC)

https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext