Analgesics
Antiandrogens
Antihistamines
Bromhexine
Budesonide
Colchicine
Conv. Plasma
Curcumin
Fluvoxamine
Hydroxychlor..
Ivermectin
Lifestyle
Melatonin
Metformin
Minerals
Monoclonals
Mpro inhibitors
Naso/orophar..
Nigella Sativa
Nitazoxanide
PPIs
Quercetin
RdRp inhibitors
Thermotherapy
Vitamins
More

Other
Feedback
Home
 
next
study
previous
study
c19hcq.org COVID-19 treatment researchHCQHCQ (more..)
Metformin Meta
Bromhexine Meta
Budesonide Meta
Colchicine Meta Nigella Sativa Meta
Conv. Plasma Meta Nitazoxanide Meta
Curcumin Meta PPIs Meta
Fluvoxamine Meta Quercetin Meta
Hydroxychlor.. Meta
Ivermectin Meta Thermotherapy Meta
Melatonin Meta

All Studies   Meta Analysis       

Hydroxychloroquine with or without azithromycin and in-hospital mortality or discharge in patients hospitalized for COVID-19 infection: a cohort study of 4,642 in-patients in France

Sbidian et al., medRxiv, doi:10.1101/2020.06.16.20132597
Jun 2020  
  Post
  Facebook
Share
  Source   PDF   All Studies   Meta AnalysisMeta
Mortality -5% Improvement Relative Risk Discharge 20% HCQ for COVID-19  Sbidian et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 4,642 patients in France Higher discharge with HCQ (p=0.002) c19hcq.org Sbidian et al., medRxiv, June 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 423 studies, used in 59 countries.
No treatment is 100% effective. Protocols combine treatments.
5,500+ studies for 119 treatments. c19hcq.org
Retrospective of 4,642 hospitalized patients in France showing significantly faster discharge with HCQ and HCQ+AZ. No significant effect is seen on 28-day mortality, however many more control patients are still in hospital at 28 days. Other studies show faster resolution for HCQ, suggesting there will be a significant improvement when extending past 28 days. Hopefully authors will extend the analysis. Note that the median age is higher in the group not treated with HCQ or AZ.
For other issues with the adjustments see1. Also see the analysis here2.
This study is excluded in the after exclusion results of meta analysis: significant issues found with adjustments.
risk of death, 5.0% higher, RR 1.05, p = 0.74, treatment 111 of 623 (17.8%), control 830 of 3,792 (21.9%), adjusted per study, whole population HCQ AIPTW adjusted.
risk of no hospital discharge, 20.0% lower, RR 0.80, p = 0.002, treatment 623, control 3,792, adjusted per study, inverted to make RR<1 favor treatment, whole population HCQ AIPTW adjusted.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sbidian et al., 19 Jun 2020, retrospective, database analysis, France, preprint, 21 authors.
This PaperHCQAll
Hydroxychloroquine with or without azithromycin and in-hospital mortality or discharge in patients hospitalized for COVID-19 infection: a cohort study of 4,642 in-patients in France
Emilie Sbidian, Julie Josse, Guillaume Lemaitre, Imke Meyer, Mélodie Bernaux, Alexandre Gramfort, Nathanaël Lapidus, Nicolas Paris, Antoine Neuraz, Ivan Lerner, Nicolas Garcelon, Bastien Rance, Olivier Grisel, Thomas Moreau, Ali Bellamine, Pierre Wolkenstein, Gaël Varoquaux, Eric Caumes, Marc Lavielle, Armand Mekontso Dessap, Etienne Audureau
doi:10.1101/2020.06.16.20132597
Data sharing The data are available on request. Transparency The manuscript's guarantors (ES) affirm that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Abbreviations: SD, Standard deviation; HCQ:hydroxychloroquine, IQR : interquartile 25
References
Aluvaala, Collins, Maina, Competing risk survival analysis of time to inhospital death or discharge in a large urban neonatal unit in Kenya, Wellcome Open Res, doi:10.12688/wellcomeopenres.15302.1
Athey, Tibshirani, Wager, Generalized random forests, Ann Stat, doi:10.1214/18-AOS1709
Austin, An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies, Multivar Behav Res, doi:10.1080/00273171.2011.568786
Austin, Stuart, Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies, Stat Med, doi:10.1002/sim.6607
Beigel, Tomashek, Dodd, Remdesivir for the Treatment of Covid-19 -Preliminary Report, N Engl J Med, doi:10.1056/NEJMoa2007764
Benichou, Gail, Estimates of absolute cause-specific risk in cohort studies, Biometrics
Camprubí-Rimblas, Tantinyà, Bringué, Guillamat-Prats, Artigas, Anticoagulant therapy in acute respiratory distress syndrome, Ann Transl Med, doi:10.21037/atm.2018.01.08
Chen, Hu, Zhang, Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. medRxiv, doi:10.1101/2020.03.22.20040758
Delvecchio, Higa, Pezzuto, Chloroquine, an Endocytosis Blocking Agent, Inhibits Zika Virus Infection in Different Cell Models, Viruses, doi:10.3390/v8120322
Dm, Drug-induced Prolongation of the QT Interval, The New England journal of medicine, doi:10.1056/NEJMra032426
Funk, Westreich, Wiesen, Stürmer, Brookhart et al., Doubly robust estimation of causal effects, Am J Epidemiol, doi:10.1093/aje/kwq439
Gautret, Lagier, Parola, Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study, Travel Med Infect Dis. Published online, doi:10.1016/j.tmaid.2020.101663
Gautret, Lagier, Parola, Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents, doi:10.1016/j.ijantimicag.2020.105949
Geleris, Sun, Platt, Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19, N Engl J Med. Published online, doi:10.1056/NEJMoa2012410
Goyal, Choi, Pinheiro, Clinical Characteristics of Covid-19 in New York City, N Engl J Med. Published online, doi:10.1056/NEJMc2010419
Guan, Ni, Hu, Clinical Characteristics of Coronavirus Disease 2019 in China, N Engl J Med. Published online, doi:10.1056/NEJMoa2002032
Hamon, Grabar, Linguistic approach for identification of medication names and related information in clinical narratives, J Am Med Inform Assoc JAMIA, doi:10.1136/jamia.2010.004036
Lacticodeshydrogenase, None, median
Magagnoli, Narendran, Pereira, Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. medRxiv, doi:10.1101/2020.04.16.20065920
Mahévas, Tran, Roumier, Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data, The BMJ, doi:10.1136/bmj.m1844
Mehra, Desai, Ruschitzka, Patel, Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis, The Lancet, doi:10.1016/S0140-6736(20)31180-6
Mercuro, Yen, Shim, Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19), JAMA Cardiol. Published online, doi:10.1001/jamacardio.2020.1834
Million, Lagier, Gautret, Full-length title: Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France, Travel Med Infect Dis. Published online, doi:10.1016/j.tmaid.2020.101738
Ozenne, Scheike, Staerk, Gerds, On the estimation of average treatment effects with right-censored time to event outcome and competing risks, Published online, doi:10.1002/bimj.201800298
Resche-Rigon, Azoulay, Chevret, Evaluating mortality in intensive care units: contribution of competing risks analyses, Crit Care, doi:10.1186/cc3921
Rosenbaum, Db, Reducing Bias in Observational Studies Using Subclassification on the Propensity Score, J Am Stat Assoc, doi:10.2307/2288398
Rosenbaum, Db, The Central Role of the Propensity Score in Observational Studies for Causal Effects, Biometrika, doi:10.2307/2335942
Rosenberg, Dufort, Udo, Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State, JAMA. Published online, doi:10.1001/jama.2020.8630
Textor, Hardt, Knüppel, DAGitty: a graphical tool for analyzing causal diagrams
Villar, Ferrando, Martínez, Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial, Lancet Respir Med, doi:10.1016/S2213-2600(19)30417-5
Wendling, Jung, Callahan, Schuler, Shah et al., Comparing methods for estimation of heterogeneous treatment effects using observational data from health care databases, Stat Med, doi:10.1002/sim.7820
Yao, Ye, Zhang, Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clin Infect Dis Off Publ Infect Dis Soc Am, doi:10.1093/cid/ciaa237
DOI record: { "DOI": "10.1101/2020.06.16.20132597", "URL": "http://dx.doi.org/10.1101/2020.06.16.20132597", "abstract": "<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To assess the clinical effectiveness of oral hydroxychloroquine (HCQ) with or without azithromycin (AZI) in preventing death or leading to hospital discharge.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective cohort study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>An analysis of data from electronic medical records and administrative claim data from the French Assistance Publique - Hôpitaux de Paris (AP-HP) data warehouse, in 39 public hospitals, Ile-de-France, France.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>All adult inpatients with at least one PCR-documented SARS-CoV-2 RNA from a nasopharyngeal sample between February 1<jats:sup>st</jats:sup>, 2020 and April 6<jats:sup>th</jats:sup>, 2020 were eligible for analysis. The study population was restricted to patients who did not receive COVID-19 treatments assessed in ongoing trials, including antivirals and immunosuppressive drugs. End of follow-up was defined as the date of death, discharge home, day 28 after admission, whichever occurred first, or administrative censoring on May 4, 2020.</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p>Patients were further classified into 3 groups: (i) receiving HCQ alone, (ii) receiving HCQ together with AZI, and (iii) receiving neither HCQ nor AZI. Exposure to a HCQ/AZI combination was defined as a simultaneous prescription of the 2 treatments (more or less one day).</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>The primary outcome was all-cause 28-day mortality as a time-to-event endpoint under a competing risks survival analysis framework. The secondary outcome was 28-day discharge home. Augmented inverse probability of treatment weighted (AIPTW) estimates of the average treatment effect (ATE) were computed to account for confounding.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 4,642 patients (mean age: 66.1 ± 18; males: 2,738 (59%)) were included, of whom 623 (13.4%) received HCQ alone, 227 (5.9%) received HCQ plus AZI, and 3,792 (81.7%) neither drug. Patients receiving ‘HCQ alone’ or ‘HCQ plus AZI’ were more likely younger, males, current smokers and overall presented with slightly more co-morbidities (obesity, diabetes, any chronic pulmonary diseases, liver diseases), while no major difference was apparent in biological parameters. After accounting for confounding, no statistically significant difference was observed between the ‘HCQ’ and ‘Neither drug’ groups for 28-day mortality: AIPTW absolute difference in ATE was +1.24% (−5.63 to 8.12), ratio in ATE 1.05 (0.77 to 1.33). 28-day discharge rates were statistically significantly higher in the ‘HCQ’ group: AIPTW absolute difference in ATE (+11.1% [3.30 to 18.9]), ratio in ATE (1.25 [1.07 to 1.42]). As for the ‘HCQ+AZI’ vs neither drug, trends for significant differences and ratios in AIPTW ATE were found suggesting higher mortality rates in the former group (difference in ATE +9.83% [-0.51 to 20.17], ratio in ATE 1.40 [0.98 to 1.81];p=0.062).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Using a large non-selected population of inpatients hospitalized for COVID-19 infection in 39 hospitals in France and robust methodological approaches, we found no evidence for efficacy of HCQ or HCQ combined with AZI on 28-day mortality. Our results suggested a possible excess risk of mortality associated with HCQ combined with AZI, but not with HCQ alone. Significantly higher rates of discharge home were observed in patients treated by HCQ, a novel finding warranting further confirmation in replicative studies. Altogether, our findings further support the need to complete currently undergoing randomized clinical trials.</jats:p></jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS?</jats:title><jats:sec><jats:title>What is already known on this subject</jats:title><jats:list list-type=\"simple\"><jats:list-item><jats:label>-</jats:label><jats:p>The use of Hydroxychloroquine (HCQ) or HCQ with azithromycin (AZI) has been associated with viral load reduction at 6 days in COVID-19 infected patients</jats:p></jats:list-item><jats:list-item><jats:label>-</jats:label><jats:p>No difference between HCQ and no-HCQ groups in terms of risk of death or need for mechanical ventilation was found in two large cohorts of hospitalized COVID-19 infected patients</jats:p></jats:list-item></jats:list></jats:sec><jats:sec><jats:title>What this study adds</jats:title><jats:list list-type=\"simple\"><jats:list-item><jats:label>-</jats:label><jats:p>Using a large non-selected population of inpatients hospitalized for COVID-19 infection in 39 hospitals in France and robust methodological approaches, we found no evidence for efficacy of HCQ on 28-day mortality</jats:p></jats:list-item><jats:list-item><jats:label>-</jats:label><jats:p>Our results suggest an excess risk of mortality in patients treated by a combination of HCQ and AZI, but not with HCQ alone</jats:p></jats:list-item><jats:list-item><jats:label>-</jats:label><jats:p>Significantly higher rates of discharge home were observed in patients treated by HCQ, a novel finding warranting further confirmation in replicative studies</jats:p></jats:list-item></jats:list></jats:sec></jats:sec>", "accepted": { "date-parts": [ [ 2020, 6, 19 ] ] }, "author": [ { "ORCID": "http://orcid.org/0000-0002-1267-5270", "affiliation": [], "authenticated-orcid": false, "family": "Sbidian", "given": "Emilie", "sequence": "first" }, { "affiliation": [], "family": "Josse", "given": "Julie", "sequence": "additional" }, { "affiliation": [], "family": "Lemaitre", "given": "Guillaume", "sequence": "additional" }, { "affiliation": [], "family": "Meyer", "given": "Imke", "sequence": "additional" }, { "affiliation": [], "family": "Bernaux", "given": "Mélodie", "sequence": "additional" }, { "affiliation": [], "family": "Gramfort", "given": "Alexandre", "sequence": "additional" }, { "affiliation": [], "family": "Lapidus", "given": "Nathanaël", "sequence": "additional" }, { "affiliation": [], "family": "Paris", "given": "Nicolas", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-7142-6728", "affiliation": [], "authenticated-orcid": false, "family": "Neuraz", "given": "Antoine", "sequence": "additional" }, { "affiliation": [], "family": "Lerner", "given": "Ivan", "sequence": "additional" }, { "affiliation": [], "family": "Garcelon", "given": "Nicolas", "sequence": "additional" }, { "affiliation": [], "family": "Rance", "given": "Bastien", "sequence": "additional" }, { "affiliation": [], "family": "Grisel", "given": "Olivier", "sequence": "additional" }, { "affiliation": [], "family": "Moreau", "given": "Thomas", "sequence": "additional" }, { "affiliation": [], "family": "Bellamine", "given": "Ali", "sequence": "additional" }, { "affiliation": [], "family": "Wolkenstein", "given": "Pierre", "sequence": "additional" }, { "affiliation": [], "family": "Varoquaux", "given": "Gaël", "sequence": "additional" }, { "affiliation": [], "family": "Caumes", "given": "Eric", "sequence": "additional" }, { "affiliation": [], "family": "Lavielle", "given": "Marc", "sequence": "additional" }, { "affiliation": [], "family": "Dessap", "given": "Armand Mekontso", "sequence": "additional" }, { "affiliation": [], "family": "Audureau", "given": "Etienne", "sequence": "additional" }, { "affiliation": [], "name": "AP-HP Covid CDR Initiative and ‘Entrepôt de Données de Santé’ AP-HP consortium", "sequence": "additional" } ], "container-title": [], "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2020, 6, 19 ] ], "date-time": "2020-06-19T18:25:13Z", "timestamp": 1592591113000 }, "deposited": { "date-parts": [ [ 2021, 1, 5 ] ], "date-time": "2021-01-05T21:20:10Z", "timestamp": 1609881610000 }, "group-title": "Pharmacology and Therapeutics", "indexed": { "date-parts": [ [ 2024, 2, 8 ] ], "date-time": "2024-02-08T18:04:24Z", "timestamp": 1707415464202 }, "institution": [ { "name": "medRxiv" } ], "is-referenced-by-count": 18, "issued": { "date-parts": [ [ 2020, 6, 19 ] ] }, "link": [ { "URL": "https://syndication.highwire.org/content/doi/10.1101/2020.06.16.20132597", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "246", "original-title": [], "posted": { "date-parts": [ [ 2020, 6, 19 ] ] }, "prefix": "10.1101", "published": { "date-parts": [ [ 2020, 6, 19 ] ] }, "publisher": "Cold Spring Harbor Laboratory", "reference": [ { "DOI": "10.1056/NEJMoa2002032", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.1" }, { "DOI": "10.3390/v8120322", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.2" }, { "DOI": "10.1093/cid/ciaa237", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.3" }, { "DOI": "10.1101/2020.03.22.20040758", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.4" }, { "DOI": "10.1016/j.ijantimicag.2020.105949", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.5" }, { "DOI": "10.1016/j.tmaid.2020.101663", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.6" }, { "DOI": "10.1016/j.tmaid.2020.101738", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.7" }, { "DOI": "10.1136/bmj.m1844", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.8" }, { "DOI": "10.1101/2020.04.16.20065920", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.9" }, { "DOI": "10.1056/NEJMoa2012410", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.10" }, { "DOI": "10.1001/jama.2020.8630", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.11" }, { "DOI": "10.1016/S0140-6736(20)31180-6", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.12" }, { "DOI": "10.1136/jamia.2010.004036", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.13" }, { "DOI": "10.1016/S2213-2600(19)30417-5", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.14" }, { "DOI": "10.21037/atm.2018.01.08", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.15" }, { "DOI": "10.1080/00273171.2011.568786", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.16" }, { "DOI": "10.1093/biomet/70.1.41", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.17" }, { "DOI": "10.2307/2288398", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.18" }, { "DOI": "10.1002/sim.7820", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.19" }, { "DOI": "10.1093/aje/kwq439", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.20" }, { "DOI": "10.1056/NEJMc2010419", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.21" }, { "DOI": "10.1097/EDE.0b013e318225c2be", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.22" }, { "DOI": "10.1214/18-AOS1709", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.23" }, { "DOI": "10.1002/bimj.201800298", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.24" }, { "DOI": "10.2307/2532098", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.25" }, { "DOI": "10.1002/sim.6607", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.26" }, { "DOI": "10.1001/jamacardio.2020.1834", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.27" }, { "DOI": "10.1056/NEJMra032426", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.28" }, { "DOI": "10.1056/NEJMoa2007764", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.29" }, { "DOI": "10.12688/wellcomeopenres.15302.1", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.30" }, { "DOI": "10.1186/cc3921", "doi-asserted-by": "publisher", "key": "2021010506351222000_2020.06.16.20132597v1.31" } ], "reference-count": 31, "references-count": 31, "relation": {}, "resource": { "primary": { "URL": "http://medrxiv.org/lookup/doi/10.1101/2020.06.16.20132597" } }, "score": 1, "short-title": [], "source": "Crossref", "subtitle": [], "subtype": "preprint", "title": "Hydroxychloroquine with or without azithromycin and in-hospital mortality or discharge in patients hospitalized for COVID-19 infection: a cohort study of 4,642 in-patients in France", "type": "posted-content" }
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
  or use drag and drop   
Submit