Is Taking Hydroxychloroquine More Harmful Than Helpful?

New research suggests that people taking hydroxychloroquine on coronaviruses are more likely to die. But that doesn’t mean the drug is killing them.

Ah Paper published in Lancet There is fresh controversy over the use of the malaria drug hydroxychloroquine as a potential treatment for COVID-19.

The authors of the study reported that they could “not confirm the benefits” of using the drug, whereas hospital COVID-19 patients treated with hydroxychloroquine had a life-threatening heart rhythm. There was a high probability of complications.

The publication called for the World Health Organization to suspend trials for hydroxychloroquine to treat COVID-19, but similar Australian trials have suspended recruitment.

A little background

Hydroxychloroquine has been used for the treatment of malaria since the 1940s, but it is attracting attention as a potential treatment for COVID-19. US President Donald Trump recently declared that he is taking it daily, and Australian businessman and politician Clive Palmer has promised to make a national stockpile of drugs.

This drug alters the human immune system (an immunomodulator rather than an immunosuppressant) and plays an important role in helping people with rheumatoid arthritis and lupus.

It has a series of potentially serious side effects, including eye damage and changes in the heart rhythm that require monitoring.

Laboratory studies suggest that hydroxychloroquine may interfere with the replication of the SARS-CoV-2 virus that causes COVID-19. Hydroxychloroquine may also reduce the “cytokine storm,” a devastating immune system overreaction that occurs in some individuals with severe COVID-19.

A great deal of work is being done worldwide to investigate whether hydroxychloroquine is safe and effective in preventing or treating COVID-19, especially to improve recovery and reduce the risk of death. .. Previous studies were inconclusive because they were case studies, observations, or small randomized trials.

There is increasing doubt about the efficacy of hydroxychloroquine, and a large observational study in New York shows that it is ineffective in treating COVID-19.

New Lancet The study, published last week, found that it could increase the risk of death in hospitalized COVID-19 patients. But there is more to the story.

What did the new study do?

of Lancet The study collected more than 96,000 actual COVID-19 inpatient data from more than 600 hospitals on six continents.

About 15,000 patients were treated with hydroxychloroquine (or the closely related drug chloroquine) alone or in combination with antibiotics.

The researchers used a global registry to investigate the safety of these treatments. They examined whether people died while in the hospital and the risk of developing life-threatening rhythm problems (called ventricular arrhythmias).

What did the research find?

Treatment with hydroxychloroquine mortality in people with COVID-19, even after researchers adjusted for other factors (age, other health conditions, immune system suppression, smoking, severity of COVID-19 infection) Risk of death that was associated with an increase in.

Approximately 18% of those who received hydroxychloroquine died in hospital, while 9% of those who did not receive COVID-19 did not receive these treatments. People who received hydroxychloroquine in combination with either the antibiotic azithromycin or clarithromycin had an even higher risk of death (24%).

Treatment with hydroxychloroquine (6%) and chloroquine (4%) was also associated with many cases of dangerous cardiac rhythm problems when compared to untreated COVID-19 (0.3%).

Although not the focus of this study, evidence of benefit was unclear.

How can you interpret the results?

Since this was an observational study, it could only explore the link between treatment and death, rather than telling that hydroxychloroquine died these patients.

Because no cause of death was reported in this study, it is unclear why mortality in patients treated with hydroxychloroquine and chloroquine doubled that of untreated patients.

Importantly, this study cannot explain all of the factors that can contribute to the deaths of these hospitalized patients and how these factors interact with each other. However, researchers have been successful at “matching” the characteristics of those who received hydroxychloroquine and those who did not, and made the results more reliable.

However, there may still be other factors or medications that contributed to these discoveries. Therefore, whether hydroxychloroquine is the cause, death Of people with COVID-19.

In addition, it was not possible to carefully control the doses of hydroxychloroquine that people received, or such as antiviral drugs or other drugs for heart disease (potentially interacting with sick inpatients), etc. You may be taking other medicines.

The average dose of hydroxychloroquine in this study was the upper limit of the usual recommended dose range for rheumatoid arthritis and lupus. However, the wide range of doses of hydroxychloroquine (and chloroquine) in this study made it difficult to interpret the results, especially if the adverse effects were found to be associated with higher doses. I will.

Broad meaning

This study provides important information on the safety of hydroxychloroquine in the treatment of COVID-19 vulnerable people undergoing hospitalization.

The effects of using hydroxychloroquine to treat COVID-19 in the community or to prevent COVID-19 remain unknown, but nothing else in this study is receiving the drug It is necessary to monitor people carefully.

A few Hydroxychloroquine Trials are ongoing, including a large RECOVERY trial in the UK.

This new information needs to be considered when balancing the harms and potential benefits of these trials, and could lead to new safety monitoring.

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