Blog | Monday, March 30, 2020

Facts about hydroxychloroquine and COVID-19


Thanks to a shout out by President Trump that hydroxychloroquine would be a “game changer” this drug is all over TV and web as the possible treatment for COVID-19. Because this virus has no known treatment, the FDA is fast-tracking pharmaceuticals and vaccines. There are at least 22 known studies ongoing to test the effectiveness in humans and COVID-19. Here's what we know (today, March 28, 2020) about hydroxychloroquine:
• As a drug used to treat rheumatoid arthritis and lupus, hydroxychloroquine works in a complex manner on cells and proteins to down regulate the immune response.
• It is also used to treat uncomplicated plasmodium malaria but is not effective against all malaria strains.
• The brand name for rheumatology use is Plaquenil and it can be found in the urine three months after taking. It has a very long half-life.
The Journal of Antimicrobial Agents reported a study of 26 patients receiving hydroxychloroquine. Six patients were lost to follow up, but of the 20 who remained there was significant effectiveness in clearing the virus, even in patients who were asymptomatic. Azithromycin was added to six of the patients and they showed a greater response than hydroxychloroquine alone.
• Some studies are showing that the drug can work in cell cultures against COVID-19.
• Two clinical trials in the U.S. are looking at whether hydroxychloroquine can prevent COVID-19 in health professionals exposed to the disease.
• In past studies, hydroxychloroquine was found to be not effective for treating dengue, chikungunya and influenza viruses.
• Serious adverse effects include cardiac arrhythmias due to prolongation of Q-wave, blurred vision due to changes in the retina, nausea, vomiting, and headache. As with any medication, the list of side effects is long but the most worrisome is the change in the heart rhythm, which can be fatal.
• Millions of Americans currently take drugs that can interfere with hydroxychloroquine and cause side effects, liver dysfunction and prolonged Q-T syndrome.
• Patients who are dependent upon this drug are finding shortages because of stockpiling and hoarding. Nevada governor, Steve Sisolak, has blocked the use against coronavirus to protect the patients who need it. Pharmacies are directed to fill only one month at a time for patients with “legitimate medical purposes”.
• The run on hydroxychloroquine is driven by fear as patients are experiencing a pandemic and want hope.
• Doctors are being overrun with messages to prescribe this medication to patients and to tell the CDC to “cut the red tape and make it available to everyone.” According to the LA Times, these messages are sponsored by a conservative organization founded and funded by wealthy supporters of Donald Trump.
• Health professionals and experts are saying “hydroxychloroquine is not a harmless panacea for COVID-19.”

When doctors do not have a treatment for patients that are in critical condition, we often use therapies that are not yet “evidence-based” with controlled studies, but may have some benefit based on smaller studies, anecdotal reports, or laboratory evidence. This is happening with COVID-19 patients that are in ICUs as we attempt to save lives. We try everything!

This is very different from prescribing untested drugs to healthy or mildly ill patients.

It is my strong hope that hydroxychloroquine, azithromycin, and other therapies will be effective. We will find out very soon.

This post originally appeared at Everything Health. Toni Brayer, MD, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.