Je ne peux qu’approuver cet article, il y a d’ailleurs beaucoup de choses à propos du Covid-19 en France, pour lesquelles il faudrait ouvrir le débat. Deux ans après, il serait temps de sortir des obsessions sanitaires dans lesquelles notre pays s’est enfermé
Non mais sérieusement, vous croyez qu’il y a pas des milliers de médecins, de chercheurs qui se posent la question ?
Vous pensez sérieusement qu’ils attendaient que Montebourg ou des experts de Twitter leur souffle l’idée ?
> Le candidat de la « Remontada » fait ici référence au protocole du « collectif de médecins Coordination santé libre » qui mélange, hydroxychloroquine, zinc, vitamine C et D ou encore de l’acupuncture. Le protocole soutenu par les covido-sceptiques comme la députée ex-LREM, Martine Wonner, avait suscité l’indignation de nombreux praticiens en début d’année si bien que l’Ordre des médecins avait saisi la Haute Autorité de santé (HAS) et l’Agence nationale pour la sécurité des médicaments.
Montebourg : pourquoi le gouvernement ne promeut il pas les pseudo-sciences
>Le candidat de la « Remontada » fait ici référence au protocole du « collectif de médecins Coordination santé libre » qui mélange, hydroxychloroquine, zinc, vitamine C et D ou encore de l’acupuncture.
L’HCQ ne marche peu ou pas. Combien de fois faudra-t-il le répéter ? J’ai d’ailleurs compilé une compilation de méta-analyses réalisées dans différents pays à travers le globe qui montre des effets peu ou pas concluants de celle-ci dans les traitements. Pour ceux que ça intéresse (liste non exhaustive, j’ai évité le format APA pour une meilleur lisibilité des titres) :
• [Effect of azithromycin and hydroxychloroquine in patients hospitalized with COVID-19: Network meta-analysis of randomized controlled trials (August 2021)](https://onlinelibrary.wiley.com/doi/10.1002/jmv.27259)
Evidence from this systematic review and network meta-analysis suggests that chloroquine or its derivative, HCQ, combined with or without AZ did not change the mortality or mechanical ventilation rates in hospitalized patients with COVID-19. Current evidence does not support using either of these agents alone or in combination in the management of hospitalized patients with COVID-19 infection
​
• [Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials (May 2021)](https://www.nature.com/articles/s41467-021-22446-z)
Discussion
This collaborative meta-analysis of 28 published or unpublished RCTs, including 10,319 patients, shows that treatment with HCQ was associated with increased mortality in COVID-19 patients, and there was no benefit from treatment with CQ. No differences were seen across subgroup analyses on patient setting, diagnosis confirmation, control type, publication status, or dose and the between-study heterogeneity was low. For CQ, the number of studies was too small to draw clear conclusions.
​
• [Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis (March-May 2021)](https://www.mdpi.com/2308-3425/8/5/55/htm)
Conclusions
This systematic review and metanalysis revealed that the use of hydroxychloroquine alone or in conjunction with azithromycin was linked to an increase in the QTc interval of hospitalized patients with SARS-CoV-2 infection that received these agents. The effects of this prolongation in respect to life-threatening arrhythmias and mortality was outside the scope of this study, thus further studies are needed to answer this clinically pressing question. While the limitations of our study are clear, we hope that the results of our study can add to the accumulating knowledge in the field of therapeutics for patients with SARS-CoV-2 infection.
These results suggest that the use of HCQ or CQ is not associated with decreased viral load, faster clinical recovery, improved survival, decreased need for mechanical ventilation, and decreased hospitalization time for patients with COVID-19. However, it suggests that the use of HCQ or CQ can be associated with an increased risk of adverse effects.
​
• [Systematic review and meta-analysis of the effectiveness and safety of hydroxychloroquine in treating COVID-19 patients (February 2021)](https://pubmed.ncbi.nlm.nih.gov/32947506/)
Conclusion
Our results indicated that HCQ-AZI combination treatment increased mortality rate in patients with COVID-19, but it also showed benefits associated with viral clearance in patients. HCQ-alone used for treatment has revealed benefits in decreasing the mortality rate among severely infected COVID-19 group and showed potential to be used for COVID-19 treatment in long-term follow-up period group. Accordingly, more rigorous, large-scale, and long follow-up period studies in patients with COVID-19 are needed.
Although pharmacologic prophylaxis is an attractive preventive strategy against COVID-19, the current body of evidence failed to show clinical benefit for prophylactic hydroxychloroquine and showed a higher risk of adverse events when compared to placebo or no prophylaxis.
​
• [A systematic review and meta-analysis on chloroquine and hydroxychloroquine as monotherapy or combined with azithromycin in COVID-19 treatment (December 2020)](https://www.nature.com/articles/s41598-020-77748-x)
Conclusion
Treating COVID-19 patients with CQ/HCQ did not decrease mortality. even it was increased if AZM was added. Besides, CQ/HCQ alone or in combination with AZM increased the duration of hospital stay. Overall virological cure rate and that on days 4, 10, or 14 were not affected by receiving HCQ. Adding AZM to HCQ/CQ did not show any benefit in terms of virological cure as well. The Need for MV was not improved by exposure to CQ/HCQ alone or in combination with AZM. Moreover, CQ/HCQ, did not neither shorten the duration till conversion to negative PCR, prevent radiological progression, nor affect clinical worsening of the disease. Future randomized clinical trials are needed to confirm these conclusions.
There is high evidence of the efficacy of HCQ/CQ in the rheumatologic field. The lack of evidence for efficacy and the risk of death associated with the use of HCQ/CQ for COVID-19 indicate the inappropriateness of their inclusion in recent COVID-19 therapy guidelines and the urgent need for RCTs to determine eventual appropriateness as a COVID-19 therapy.
HCQ use was not associated with either increased or decreased mortality in COVID-19 patients when 4 RCTs only were evaluated, while a 7% to 33% reduced mortality was observed when observational studies were also included. The association was mainly apparent when pooling studies using lower doses of HCQ. These findings can help disentangling the debate on HCQ use in COVID-19.
Moderate certainty evidence suggests that HCQ, with or without azithromycin, lacks efficacy in reducing short-term mortality in patients hospitalized with COVID-19 or risk of hospitalization in outpatients with COVID-19.
Décidément les candidats à gauche rivalisent en postures antiscientifiques. Va bientôt plus rester que le PCF d’un peu sérieux.
5 comments
Je ne peux qu’approuver cet article, il y a d’ailleurs beaucoup de choses à propos du Covid-19 en France, pour lesquelles il faudrait ouvrir le débat. Deux ans après, il serait temps de sortir des obsessions sanitaires dans lesquelles notre pays s’est enfermé
Non mais sérieusement, vous croyez qu’il y a pas des milliers de médecins, de chercheurs qui se posent la question ?
Vous pensez sérieusement qu’ils attendaient que Montebourg ou des experts de Twitter leur souffle l’idée ?
> Le candidat de la « Remontada » fait ici référence au protocole du « collectif de médecins Coordination santé libre » qui mélange, hydroxychloroquine, zinc, vitamine C et D ou encore de l’acupuncture. Le protocole soutenu par les covido-sceptiques comme la députée ex-LREM, Martine Wonner, avait suscité l’indignation de nombreux praticiens en début d’année si bien que l’Ordre des médecins avait saisi la Haute Autorité de santé (HAS) et l’Agence nationale pour la sécurité des médicaments.
Montebourg : pourquoi le gouvernement ne promeut il pas les pseudo-sciences
>Le candidat de la « Remontada » fait ici référence au protocole du « collectif de médecins Coordination santé libre » qui mélange, hydroxychloroquine, zinc, vitamine C et D ou encore de l’acupuncture.
L’HCQ ne marche peu ou pas. Combien de fois faudra-t-il le répéter ? J’ai d’ailleurs compilé une compilation de méta-analyses réalisées dans différents pays à travers le globe qui montre des effets peu ou pas concluants de celle-ci dans les traitements. Pour ceux que ça intéresse (liste non exhaustive, j’ai évité le format APA pour une meilleur lisibilité des titres) :
• [Effect of azithromycin and hydroxychloroquine in patients hospitalized with COVID-19: Network meta-analysis of randomized controlled trials (August 2021)](https://onlinelibrary.wiley.com/doi/10.1002/jmv.27259)
Evidence from this systematic review and network meta-analysis suggests that chloroquine or its derivative, HCQ, combined with or without AZ did not change the mortality or mechanical ventilation rates in hospitalized patients with COVID-19. Current evidence does not support using either of these agents alone or in combination in the management of hospitalized patients with COVID-19 infection
​
• [Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials (May 2021)](https://www.nature.com/articles/s41467-021-22446-z)
Discussion
This collaborative meta-analysis of 28 published or unpublished RCTs, including 10,319 patients, shows that treatment with HCQ was associated with increased mortality in COVID-19 patients, and there was no benefit from treatment with CQ. No differences were seen across subgroup analyses on patient setting, diagnosis confirmation, control type, publication status, or dose and the between-study heterogeneity was low. For CQ, the number of studies was too small to draw clear conclusions.
​
• [Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis (March-May 2021)](https://www.mdpi.com/2308-3425/8/5/55/htm)
Conclusions
This systematic review and metanalysis revealed that the use of hydroxychloroquine alone or in conjunction with azithromycin was linked to an increase in the QTc interval of hospitalized patients with SARS-CoV-2 infection that received these agents. The effects of this prolongation in respect to life-threatening arrhythmias and mortality was outside the scope of this study, thus further studies are needed to answer this clinically pressing question. While the limitations of our study are clear, we hope that the results of our study can add to the accumulating knowledge in the field of therapeutics for patients with SARS-CoV-2 infection.
​
• [Use of hydroxychloroquine and chloroquine in patients with COVID-19: a meta-analysis of randomized clinical trials (February 2021)](https://www.tandfonline.com/doi/full/10.1080/20477724.2021.1884807)
Conclusion
These results suggest that the use of HCQ or CQ is not associated with decreased viral load, faster clinical recovery, improved survival, decreased need for mechanical ventilation, and decreased hospitalization time for patients with COVID-19. However, it suggests that the use of HCQ or CQ can be associated with an increased risk of adverse effects.
​
• [Systematic review and meta-analysis of the effectiveness and safety of hydroxychloroquine in treating COVID-19 patients (February 2021)](https://pubmed.ncbi.nlm.nih.gov/32947506/)
Conclusion
Our results indicated that HCQ-AZI combination treatment increased mortality rate in patients with COVID-19, but it also showed benefits associated with viral clearance in patients. HCQ-alone used for treatment has revealed benefits in decreasing the mortality rate among severely infected COVID-19 group and showed potential to be used for COVID-19 treatment in long-term follow-up period group. Accordingly, more rigorous, large-scale, and long follow-up period studies in patients with COVID-19 are needed.
​
• [The efficacy and safety of hydroxychloroquine for COVID-19 prophylaxis: A systematic review and meta-analysis of randomized trials (January 2021)](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244778)
Conclusion
Although pharmacologic prophylaxis is an attractive preventive strategy against COVID-19, the current body of evidence failed to show clinical benefit for prophylactic hydroxychloroquine and showed a higher risk of adverse events when compared to placebo or no prophylaxis.
​
• [A systematic review and meta-analysis on chloroquine and hydroxychloroquine as monotherapy or combined with azithromycin in COVID-19 treatment (December 2020)](https://www.nature.com/articles/s41598-020-77748-x)
Conclusion
Treating COVID-19 patients with CQ/HCQ did not decrease mortality. even it was increased if AZM was added. Besides, CQ/HCQ alone or in combination with AZM increased the duration of hospital stay. Overall virological cure rate and that on days 4, 10, or 14 were not affected by receiving HCQ. Adding AZM to HCQ/CQ did not show any benefit in terms of virological cure as well. The Need for MV was not improved by exposure to CQ/HCQ alone or in combination with AZM. Moreover, CQ/HCQ, did not neither shorten the duration till conversion to negative PCR, prevent radiological progression, nor affect clinical worsening of the disease. Future randomized clinical trials are needed to confirm these conclusions.
​
• [An umbrella review of systematic reviews with meta-analyses evaluating positive and negative outcomes of Hydroxychloroquine and chloroquine therapy (December 2020)](https://www.ijidonline.com/article/S1201-9712(20)32541-8/fulltext)
Conclusions
There is high evidence of the efficacy of HCQ/CQ in the rheumatologic field. The lack of evidence for efficacy and the risk of death associated with the use of HCQ/CQ for COVID-19 indicate the inappropriateness of their inclusion in recent COVID-19 therapy guidelines and the urgent need for RCTs to determine eventual appropriateness as a COVID-19 therapy.
​
• [Low dose hydroxychloroquine is associated with lower mortality in COVID-19: a meta-analysis of 26 studies and 44,521 patients (November 2020)](https://www.researchsquare.com/article/rs-107101/v1)
Conclusions
HCQ use was not associated with either increased or decreased mortality in COVID-19 patients when 4 RCTs only were evaluated, while a 7% to 33% reduced mortality was observed when observational studies were also included. The association was mainly apparent when pooling studies using lower doses of HCQ. These findings can help disentangling the debate on HCQ use in COVID-19.
​
• [Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis (October 2020)](https://academic.oup.com/jac/article/76/1/30/5919602)
Conclusions
Moderate certainty evidence suggests that HCQ, with or without azithromycin, lacks efficacy in reducing short-term mortality in patients hospitalized with COVID-19 or risk of hospitalization in outpatients with COVID-19.
Décidément les candidats à gauche rivalisent en postures antiscientifiques. Va bientôt plus rester que le PCF d’un peu sérieux.