Hydroxychloroquine does not improve COVID-19 condition significantly
Two new studies have brought into question the widespread use of hydroxychloroquine in COVID-19 patients. One is French in origin while the other is Chinese.
According to the French study, which appeared in the British Medical Journal, hydroxychloroquine does not significantly reduce the risk of progression to intensive care or death in patients hospitalized with COVID-19 associated pneumonia. [BMJ 2020;369:m1844]
Researchers in the French study looked at the effectiveness and safety of hydroxychloroquine compared with standard care in adults admitted to hospital with pneumonia due to COVID-19, and requiring oxygen.
The study divided 181 patients into two groups—84 received hydroxychloroquine within 48 hours of admission and 89 did not (control group). When the outcomes were observed, they found no meaningful differences between the groups for survival rate without transfer to the intensive care unit, overall survival or survival without acute respiratory distress syndrome on day 21.
The researchers did call for caution in the interpretation of their results but suggested that their findings do not support the use of hydroxychloroquine in patients hospitalized with COVID-19 pneumonia requiring oxygen.
The findings of the French study isn’t the first to demonstrate hydroxychloroquine’s lack of positive effect on COVID-19 patients—a randomized clinical trial from China also came to the same conclusion that hydroxychloroquine given to patients with mild-to-moderate COVID-19 disease severity did nothing to speed up recovery of patients or reduce the risk of progressing to intensive care. [BMJ 2020;369:m1849]
The Chinese study looked at the safety and efficacy of hydroxychloroquine in 150 patients equally separated into two arms ie, hydroxychloroquine and standard of care, and standard of care alone. Patients were randomly placed in the groups and it was found that by day 28 of treatment, hydroxychloroquine-treated patients were no more likely to have negative conversion [of disease state] compared with those on standard of care alone. In fact, they found that the patients on hydroxychloroquine were more likely to suffer from adverse events.
The Chinese authors noted that the patients mostly complained of gastrointestinal events at a higher rate than those in standard care and, thus concluded that their findings “do not support the addition of hydroxychloroquine to the current standard of care in patients with persistent mild-to-moderate COVID-19 for eliminating the virus.”
Hydroxychloroquine is used as a therapeutic agent in rheumatic diseases as it can reduce inflammation, swelling and pain. It is also an antimalarial agent. It was initially believed that hydroxychloroquine would be effective in treating COVID-19 patients as in vitro studies showed potent antiviral properties, plus ongoing trials seemed to point to its efficacy in treating COVID-19. [Cell Res. 2020;30:269–271, Clin Infect Dis. 2020 Mar 9. doi:10.1093/cid/ciaa237]
[Suggest concluding statement: At present however (as of 25 April 2020) there are no drugs or other therapeutics approved by the U.S. Food and Drug Administration (FDA) to prevent or treat COVID-19. Additionally the FDA does not approve the use of chloroquine phosphate or hydroxychloroquine sulfate to treat COVID-19 and cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems.