Pandemic Perspective #29 October 10, 2020
Hydroxychloroquine: on again, off again, on again???
Well, it’s another head-spinner! Hydroxychloroquine (allow me to abbreviate it to HC), a medication that has been used by physicians to prevent and to treat malaria and in the treatment of several other diseases since 1955, fell victim to politics and the media with the arrival of SARS-CoV-2.
In 2003 an article in Lancet, a respected (until recently) British medical journal, described the drug’s antiviral and immune-boosting properties and suggested that it should be considered in the treatment of AIDS and SARS. A section of the paper entitled Safety considerations noted its “low incidence of adverse events during chronic administration” and “the safety of a high dosage of the drug even during pregnancy.” It can cause damage to the retina of the eye in persons who have been taking the drug over five years. The WHO placed it on its List of Essential Medicines, the safest and most effective medicines needed in the health system.
Early in the pandemic several groups published their experience with HC in coronavirus patients, especially when given with Azithromycin and reported a significant decrease in viral load and earlier discharge of ill patients from the intensive care unit.
But then the HC hit the fan when Donald Trump sang its praises and reports emerged of its cardiac toxicity and ineffectiveness in the treatment of COVID-19. Rheumatologists, who have had decades of experience in treating patients with lupus, rheumatoid arthritis and other autoimmune diseases, were aware of its potential to cause abnormal heart rhythms and noted the importance of monitoring patients with known heart disease. Like every other prescription drug, by the time millions of doses had been given for malaria and the diseases mentioned, other side effects emerged but when given for a short time these were usually limited to abdominal cramps, nausea, vomiting, diarrhea and headache.
Goodbye HC. But wait! In a report from the David Geffen School of Medicine at UCLA, although individual trials of HC did not show a “statistically significant impact on prevention or treatment,” when these trials were pooled into a meta-analysis, early use of the drug yielded a “significant 24% reduction in risk of infection, hospitalization or death.”
One of the authors of the study noted that when the results of this meta-analysis are combined with the results of seven nonrandomized controlled trials “This is extremely strong evidence of benefit.”
Stay tuned. Who knows what next week will bring?