ISAC shares concerns about the Hydroxychloroquine and Azithromycin paper

The International Society of Antimicrobial Chemotherapy (ISAC) has shared concerns about the Gautret et al. paper published in its own journal. This paper, published under senior authorship of Didier Raoult from the IHU-Méditerranée Infection in Marseille, describes a small study that showed remarkable effects of Hydroxychloroquine and Azithromycin treatment in COVID-19 patients.

After world leaders and politicians started to tweet and endorse this study, many people pressured health officials to start treating COVID-19 patients with this regime, although the study was small and not yet confirmed by independent, larger, and better randomized other studies.

Several scientists and medical professionals, including myself, had concerns about how patients were assigned to each treatment group, how PCR results were reported, why patients with a poor outcome had been left out of the final results, and how this treatment could potentially result in serious side effects. I wrote about my concerns in this blogpost and on PubPeer.

Now, ISAC, who is overseeing the International Journal of Antimicrobial Agents, the journal that published this study, has joined in those concerns.

Here is the ISAC statement, which was issued yesterday, 3 April 2020.

ISAC statement on the Gautret et al. paper, as posted on https://www.isac.world/news-and-publications/official-isac-statement

In the statement, the Society shares concerns about the inclusion criteria and patient safety. They do state, however, that the peer review process was handled according to peer review rules. One of the authors of this paper, Dr. Rolain, also is the Editor in Chief of this journal, and the paper was accepted within 24 hours. Usually, peer review takes weeks, so this raised a big red flag on whether proper peer review was conducted.

While it is reassuring to hear that the manuscript was not handled by one of the authors, but by a different Editor, the ISAC statement does not take away all my concerns about the editorial handling.

First, even if the paper was handled by a different editor, the peer review process remains unbelievably short, less than a day.

Second, the paper appears to have been published without a lot of changes compared to the preprint version. Some PCR data that were first listed as ‘not available’ were filled out, but there were not a lot of other changes. Any critical peer reviewer should have shared concerns about leaving out treated patients who did not recover, or the non-randomized assignment of patients to each of the treatment arms. Instead, the paper was published almost as-is.

Thirdly, an associate editor, might handle a paper differently if one of the authors was their boss. In this case, Dr. Rolain was not only one of the authors on the paper but also the Editor in Chief. How likely is an associate editor going to be critical of their boss’ paper? The power differential is a conflict of interest.

With almost no changes between preprint and peer-reviewed versions, a very short time between submission and acceptance, a conflict of interest in the handling of this manuscript, there are many concerns left about the peer review process, even if the paper was not handled by one of the authors himself.

With the whole world implementing new policies and treatment plans based on this sub-standard scientific paper, the world deserves to have a better insight in the peer-review process of this paper and to see the full peer review reports.

4 thoughts on “ISAC shares concerns about the Hydroxychloroquine and Azithromycin paper”

  1. ISAC did not retract the paper! Retraction should be a decision of the editorial board, or of the authors, but the chief editor is one of the authors…!!!
    Is retraction considered by the journal?

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    1. I completely agree that we can’t make any conclusion about HCQ efficacy currently. However, some of these studies might not even be useful for comparison. From my colleagues as well as a COVID youtube video update from USCF, patients need 600 mg HCQ twice a day to achieve potentially active plasma levels. If current studies are using lower doses, their ineffectiveness is almost expected. Hopefully, the current clinical trials are testing the higher HCQ dose. Only then can we know if HCQ has any effect on the virus.

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  2. Two different results from the same country on HCQ. One feels that at this time of crisis , this hype-r-competitiveness is not good. Here is quote which can inspire for working towards a common goal, defeating COVID -19

    “It is amazing what you can accomplish if you do not care who gets the credit”.

    Harry S Truman

    Like

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