Dueling Meta-Studies

Published April 27, 2020

As data roll in, we are learning a lot. For example, we are learning that the so-called news media is only interested in fear and panic. Most recently, taking issue with the sun because President Trump promoted a finding that coronavirus is destroyed by sunlight.
A variety of information indicate that hydroxychloroquine offers no benefit to coronavirus patients who have progressed to severe symptomology. This information now includes clinical trials as well as retrospective studies. At the same time, a variety of information indicate that the drug is effective in quickening recovery in cases ranging up to moderate symptoms.
Hydroxychloroquine is supposed to work by inhibiting virus. It is not a cure and it does not reverse the damage to vital tissues such as the lungs. What is the purpose, then, of administering it to somebody with severe symptoms? A big part of the answer is because there is no approved treatment.
Another part of the answer is that, with some exceptions, hydroxychloroquine is not indicated to have negative side-effects. As to the exceptions, in the dosages typically prescribed to coronavirus patients, there are some counter indications. Given that a good number of patients with symptoms severe enough to warrant hospitalization recover with standard of care treatment, you wouldn’t want to prescribe a drug not proven effective when there are counter indications.
Clinical trials do more than inform us whether a drug is effective. They inform us when a drug is effective, in what combinations, in what dosages, and what are the counter indications.
A few days ago, I discussed some results from clinical trials. At this time, with the results of additional clinical trials being reported, I can speak of meta-studies (these being studies of studies). Meta-studies typically use digital search to identify previously-reported studies. Presumably, meta-studies can abstract the totality of what we have learned from prior studies and, therefore, are objective. Unfortunately, in a fast-developing situation, meta-studies are often slanted one way or the other.
One meta-study uncovered eleven underlying studies. One of the eleven underlying studies examined the use of hydroxychloroquine against coronavirus and the other ten its use against other viral diseases. The meta-study found no evidence that hydroxychloroquine has an effect (although three of the underlying studies found that it has an effect); and, attributed its finding to the heterogeneity of patients in these studies.
A second meta-study uncovered seven articles for systematic review, including three studies for meta-analysis, of the use of hydroxychloroquine against coronavirus. This meta-study found that hydroxychloroquine appears to be effective when administered to patients with moderate symptoms but doesn’t appear to be effective with respect to outcomes such as death.
A third meta-study focused on Chinese experience with patients with severe symptomology. It found hydroxychloroquine to be ineffective.
It is curious how differently the meta-studies characterize their findings.