Certains de mes proches me
font remarquer avec tristesse (semble-t-il) que je n’ai pas publié de billet
depuis lundi dernier. C’est que j’ai par ailleurs beaucoup de travail. Tout de
même, je me suis penché sur la littérature relative au traitement de la Covid-19 ;
elle est en train d’exploser. Je note tout de même un changement de ton dans la
manière d’envisager la question. La plupart des articles d’intérêt sont des
méta-analyses des résultats observationnels et des essais cliniques publiés
(SINGH et al. ; GBINIGIE and FRIE K.). Ils
se prêtent donc à la critique de ce type de travail. Néanmoins, ils donnent une
vue nettement plus nuancée (LITTLEJOHN) que celle claironnée dans le Lancet.
Tous les auteurs ou presque
commencent par dire avec une sorte de pudique et touchante unanimité qu’il n’y a aucun
traitement qui se soit montré efficace lors d’essais cliniques randomisés en
double aveugle et que tout de même, bon, en fait, ce serait bien d’en faire avec
l’hydroxychloroquine, pour essayer, quoi (Voir MACK). Quand on a un peu
l’habitude de lire la littérature scientifique, on voit ce que cela signifie
vraiment. Il est tout à fait symptomatique de constater que les Indiens (SINGH et al.)
ne s’embarrassent pas de vaines précautions et recommandent l’usage de
l’hydroxychloroquine pour le traitement de la Covid-9. Plus important encore
est l'analyse faite par SHITTU et AFOLAMI, de l’Université du Michigan, qui
indique que l’adjonction de zinc au traitement en augmente l’efficacité dont,
eux, ne doutent pas. Il s’agit d’une étude théorique et non clinique
J’écoutais
ce matin le cours d’épistémologie de Didier RAOULT. Il faisait allusion à de
grands chercheurs en théorie des sciences (POPPER, KUHN, FEYERABEND) et à un
autre dont j’ai oublié le nom. Le recours obligatoire à l’essai clinique
randomisé en double aveugle relève de la croyance et non de la science, dit-il.
Et en effet, il s’agit d’une « méthode » qui stérilise l’imagination
et nie la valeur de l’observation, de l’empirisme et de ce que les anglais appellent
la serendipity.
Voici
une liste de quelques articles. Je les commente quand cela est nécessaire.
A. K.
SINGH, A. SINGH, A. SHAIKH, R. SINGH, A. MISRA
Chloroquine and hydroxychloroquine in the treatment
of COVID-19 with or without diabetes: A systematic search and a narrative review with a
special reference to India and other developing countries
Diabetes & Metabolic Syndrome:
Clinical Research & Reviews, 14, 2020,
241e246.
Background and aims: No drugs are currently approved
for Coronavirus Disease-2019 (COVID-19), although some have been tried. In view
of recent studies and discussion on chloroquine and hydroxychloroquine (HCQ),
we aimed to review existing literature and relevant websites regarding these
drugs and COVID-19, adverse effects related to drugs, and related guidelines. Aims
and methods: We
systematically searched the PubMed database up till March 21, 2020 and retrieved
all the articles published on chloroquine and HCQ and COVID-19. Results: Two
small human studies have been conducted with both these drugs in COVID-19, and
have shown significant improvement in some parameters in patients with
COVID-19.
Conclusion: Considering minimal risk upon use, a long experience of use in other
diseases, cost effectiveness and easy availability across India, we propose
that both these drugs are worthy of fast track clinical trial for treatment,
and may be carefully considered for clinical use as experimental drugs. Since
HCQ has been approved for treatment of diabetes in India, it should be further
researched in diabetes and COVID-19, a subgroup where significant mortality has
been shown.
(Voici un extrait de la conclusion :
Although evidence of chloroquine and HCQ is limited (based on the
experimental data and only two small human trials), consideringthe potentially
favorable benefit-risk balance of chloroquine and HCQ in absence of any other
valid treatment option, we believethat such treatment could be useful in the
current context ofpandemic COVID-19 outbreak. We have summarized current consideration
and proposed line of management in Table 3. The lowcost of chloroquine and HCQ
could also be an effective strategy to counter COVID-19 (especially in patients
with diabetes and other co-morbidities in whom mortality is high) in resource
constrained and COVID-19 overburdened heath care systems in middle- and low-income
counties including India.
MACK HG.
Aust J Gen Pract. 2020 Apr
14;49. doi: 10.31128/AJGP-COVID-08. Online ahead of print.PMID: 32294807
At present, there are no studies demonstrating the clinical efficacy of hydroxychloroquine for
the prophylaxis or treatment of COVID-19 infection....
D'où la nécessité d'essais randomisés.
LITTLEJOHN E.C.
Clin J Med. 2020 May 5.
Abstract
Hydroxychloroquine
(HCQ) has multiple potential antiviral mechanisms of action that differ
according to the pathogen studied (eg, Chikungunya, Dengue virus, human
immunodeficiency virus, poliovirus, Zika virus). Data on HCQ for treatment of
coronavirus disease 2019 (COVID-19) are rapidly evolving. To date there is no evidence
from randomized controlled trials that any single therapy improves
outcomes in patients infected with COVID-19. There are also no clinical trial
data supporting prophylactic HCQ therapy in COVID-19. Hydroxychloroquine (HCQ)
use in patients with COVID-19 is being investigated examining prophylaxis,
postexposure prophylaxis, and treatment regimens.…
Il faut revoir votre bibliographie, Emily...
GBINIGIE K, FRIE K.
BJGP Open. 2020 Apr
7:bjgpopen20X101069.
doi:
10.3399/bjgpopen20X101069. Online ahead of print.PMID: 32265182
BACKGROUND: On the 11 March
2020, the World Health Organization (WHO) declared that COVID-19 was a pandemic.
Abstract
Background: On the 11 March
2020, the World Health Organization (WHO) declared that COVID-19 was a
pandemic. To date, there
are no medical treatments for COVID-19 with proven effectiveness. Novel
treatments and/or vaccines will take time to be developed and distributed to
patients. In light of this, there has been growing interest in the use of
existing medications, such as chloroquine (CQ) and hydroxychloroquine (HCQ), as
potential treatments of this disease.
Aim: To establish the current
evidence for the effectiveness of CQ and HCQ in treating COVID-19.
Design & setting: A rapid review
of the literature was conducted.
Method: Electronic searches in PubMed and Google Scholar were
conducted on 21 March 2020. A further
search was conducted in Google for relevant literature on 28 March 2020.
Results: There is limited
evidence of in vitro activity of CQ/HCQ against SARS-CoV-2. A number of in vivo
clinical trials are underway. The empirical data available from two of these
trials reveal conflicting results. Both trials are characterised by small
numbers of participants (n
= 30 and n = 36) and suffer methodological limitations. No medium
or long-term follow-up data is available.
Conclusion: At
present, there is insufficient evidence to determine whether CQ/HCQ are safe
and effective treatments for COVID-19. High quality, adequately powered
randomised clinical trials in primary and secondary care settings are urgently
required to guide policymakers and clinicians. These studies should report
medium- and long-term follow-up results, and safety data.
C’est
faux, ou alors les auteurs font mal leur bibliographie. L’équipe marseillaise a
publié sur une série de plus de 1000 patients. Elle a soumis au Lancet (qui l’a refusé) ses observations
portant sur plus de 3000 patients… Ne parlons pas de la série de DAVIDO qui a
été accessible sur MedRxiv et a été retirée pour éviter d’ajouter de la
polémique à la polémique, mais porte sur plus de 150 patients. J’ai été en
correspondance avec DAVIDO (équipe du Pr PERRONNE) en lui faisant savoir que je
regrettais ce retrait (non pas qu’il retire l’article, mais il le soumet
directement sans passer par MedRxiv). Les résultats sont spectaculaires. L’article
est soumis. Nous verrons bien s’il paraît.
PS. Je viens de voir la critique très argumentée de Julien HERNANDEZ sur cette étude. Mais HERNANDEZ adopte le point de vue des algorithmiques. La question qui se pose ici est la suivante : mauvaise statistique ou non, les gens traités par l'hydroxychloroquine ont-ils mieux traversé la maladie que les non traités. Les résultats de DAVIDO disent : oui !
M. O. SHITTU, O. I. AFOLAMI.
Improving the
efficacy of chloroquine and hydroxychloroquine against SARS-CoV-2 may require
zinc additives - A better synergy for future COVID-19 clinical trials
Le Infezioni in Medicina,
n. 2, 192-197, 2020
Biological Science Department, Michigan Technological
University, Houghton, Michigan, United States of America
The recent outbreak of coronavirus disease 2019
(COVID-19), has now been officially declared as a pandemic by the World Health
Organization. As of now, there is no known effective pharmaceutical agent
against the SARS-CoV-2 virus. However, several precautionary measures have been
prescribed to prevent further spread of the virus, which include avoidance of
social gatherings, proper handwashing, frequently disinfecting of used items
and surfaces and so on. More recent studies have highlighted the possibility of
treating patients infected with the novel SARS-CoV-2 virus with chloroquine and
hydroxychloroquine, of which mechanism of action is not completely understood. We seek to draw the attention
of the scientific community to the possibility of drastically reducing the
effects of the virus on the affected patients and improving clinical trials outcome
through the synergistic action of zinc and chloroquine in patients suffering
from the coronavirus disease.
Le vent tourne mes amis, le vent tourne. La vérité finira bien par sortir toute nue du puits. Et enfin la médecine sera pilotée par des cliniciens et non par des algorithmes.
