The sacred oath that doctors graduated from medical science, the first word of Hippocrates’ oath, “do no harm first,” is a strong stimulus to the published commentary. American Journal of Medicine..
Researchers at the Schmidt College of Medicine at the University of Florida Atlantic and collaborators at the University of Wisconsin’s School of Medicine and Public Health urge all providers to always prioritize credible evidence and compassion. efficacy And safe.
They suspend the prescription of chloroquine or hydroxychloroquine with or without azithromycin to treat or prevent COVID-19, except for obtaining the necessary evidence and caring use in randomized trials. We recommend that you do.
Despite the facts, or perhaps in part, deaths due to the fact that there are no curative or preventive measures in the United States for the COVID-19 pandemic, which accounts for less than 5% of the world population and about 30% of cases, these. Extensive prescriptions for medicines are 9 times the prescriptions of the last few years.
This widespread use has led to a national shortage of patients with lupus and rheumatoid arthritis, and hydroxychloroquine has been an approved indication for decades. These patients cannot refill their prescription.
On March 28, the US Food and Drug Administration (FDA) issued an emergency use permit for chloroquine and hydroxychloroquine for the treatment of COVID-19. However, by April 24th, the FDA had issued a drug safety warning about hydroxychloroquine and cardiac rhythm disorders that could lead to sudden cardiac death.
If COVID-19 patients need to be prescribed these drugs, baseline evaluation and continuous monitoring are absolutely necessary. “
Richard D. C., MD, Florida Atlantic University, First Author and Professor of Emergency Medicine
Shih is also the Division Director and Founding Program Director of the Emergency Medical Residency Program at Schmidt Medical School in FAU.
In addition, the authors point out that the reassuring safety profile of hydroxychloroquine may be clearer than it really is.
Safety data are derived from decades of prescriptions by health care providers, primarily for patients with lupus and rheumatoid arthritis. Low.
In contrast, the risk of hydroxychloroquine in COVID-19 patients is higher in those with older fatal cardiovascular complications from these drugs and those with preexisting heart disease or its risk factors (both mainly men). It is extremely high, so it will be significantly higher.
In basic research, hydroxychloroquine and chloroquine are structurally related and have a similar mechanism of inhibiting the virus that causes COVID-19. Despite their structural similarity, hydroxychloroquine appears to be more effective in vitro.
In addition, when used for lupus and rheumatoid arthritis, hydroxychloroquine has fewer side effects, fewer drug interactions, and less toxicity from overdose.
The authors state that currently available evidence is limited to five published studies involving hydroxychloroquine only. Hydroxychloroquine and azithromycin. Use both in combination or alone.
Only three of these are randomized trials enrolling 225, 62, and 30 patients, which are too small to provide credible evidence. In China, all three tested hydroxychloroquine alone compared to standard care.
One had no significant difference in viral clearance at 28 days, the second had no difference in viral clearance at 7 days, and the third had some improvement in fever, cough, or chest computed tomography findings. It was
“For hypothesis testing, only large randomized trials of sufficient size, dose, and duration ensure that the most relevant small to moderate impacts that can have a significant impact on clinical and public health are detected.” You can,” said Charles H. Hennekens. MD, Ph.D., PH, Senior Author, First Professor Richard Dough, and Senior Academic Advisor to Schmidt Medical School in FAU.
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