President Donald Trump has time and again touted hydroxychloroquine, thinking that drug showed “tremendous promise” against the coronavirus, reported Elizabeth Cohen of American news channel CNN. The drug was used to treat malaria, rheumatoid arthritis, and lupus, but President Trump made it seem like hydroxychloroquine was harmless. In reality, the drug can have deadly side effects.
Survey Tackles the Experiences and Perceptions of Doctors In Using Hydroxychloroquine
Sermo, a healthcare data collection company, published a report (Wave 1 – March 23, 2020) about hydroxychloroquine efficacy and rise in prophylaxis involving over 6,200 physicians in 30 countries. Sermo found that the three most commonly prescribed treatments among COVID-19 treaters were analgesics (56%), azithromycin (41%), and hydroxychloroquine (33%). Hydroxychloroquine usage among those who treat COVID-19 varied between countries, with 72% using it in Spain, followed by Italy (41%), Brazil (39%), Mexico (28%), France (23%), the U.S.(17%), Germany (16%), Canada (13%), the UK and Japan (7%).
The most common treatment regimens for hydroxychloroquine were 400mg twice daily on day one; 400 mg daily for five days (38%) and 400mg twice daily on day one; 200mg twice daily for four days (26%). Worldwide, 19% of physicians have prescribed or have seen hydroxychloroquine prophylactically used for high risk patients. 8% have prescribed or have seen it used for low risk patients.
In Sermo’s survey conducted from March 30 to April 2 (Wave 2), the most commonly used treatments that doctors reported prescribing were azithromycin (50%), hydroxychloroquine (44%), and bronchodilators (36%), and none (36%). Other treatments they used included anti-HIV drugs (19%), drugs used to treat flu (17%), high dose steroids (13%), and non-approved drugs (10%).
When asked about the efficacy of medications respondents have used or have seen used to treat the coronavirus, 52% rated plasma from patients who have recovered from COVID-19 as effective (respondents who answered 4 or five where five is “extremely effective”), followed by hydroxychloroquine or chloroquine (38%), non-approved drugs (37%), interferon-beta (36%), and traditional Chinese medicine (34%).
In China, 63% rated hydroxychloroquine as “very or extremely effective” versus 33% of the rest of the world.” 54% of respondents in Italy and Spain rated it as effective and 51% of those in France rate it as such (versus 33%). In the US, 33% said hydroxychloroquine was effective, with the number falling to 19% in New York. With regard to the specific uses of hydroxychloroquine, 65% of doctors said they use it to treat patients who have been diagnosed and are “experiencing severe symptoms.” On the other hand, 49% use the drug on patients who have not been diagnosed but have severe symptoms, cited Stephen Silver of The National Interest, a national security publication.
Readers should remember that the survey is not a scientific trial of hydroxychloroquine’s (as well as other treatment options) efficacy, but it is more of a report of the opinions and experiences of medical professionals.
Studies That Focus on Hydroxychloroquine As A Treatment Option
A small French study involving 20 patients suggested that the combination of the drug and azithromycin was effective, stated Cohen and Dr. Minali Nigam of CNN. But the study had flaws and the International Journal of Antimicrobial Agents (IJAA), the medical journal that published the research, said it was reviewing the study again. Dr. Kevin Tracey, president and CEO of the Feinstein Institutes for Medical Research in New York City, said it was a “complete failure.” Art Caplan, head of the division of medical ethics at the New York University School of Medicine, added, “It was pathetic.”
Dr. Tracey and Caplan said that several of the patients that took the drug fared poorly and withdrew from the trial. They noted that the patients’ outcomes were not taken into account in the research’s final conclusions.
A larger French study of 84 patients concluded that hydroxychloroquine did not help coronavirus patients in hospitals. In fact, 20.2% were admitted to the ICU or died within a week of taking hydroxychloroquine, mentioned Dr. Nigam and Cohen. Of 97 patients who did not take the drug, 22.1% died or ended up in the ICU. The difference was not statistically significant. When looking at the death rates, 2.8% of those who took the drug died while 4.6% of those who did not take it died. Again, the difference was not found to be statistically significant. This study was not peer-reviewed as it was only published in a pre-print server founded by BMJ, Cold Spring Harbor Laboratory, and Yale University.
In another study, the University of Albany involved about 600 patients, with about 300 taking the combination of hydroxychloroquine and azithromycin, about 200 taking either of the two drugs, and some 100 who took neither of the drugs. The study was sponsored by the New York state Department of Health.
The researchers found that doctors were more likely to prescribe said drugs to patients who were already very sick. For instance, some were more likely to have shortness of breath and underlying diabetes and coronary disease upon admission. Given that, they had higher death rates and heart complications. The authors did a statistical adjustment but found no statistical difference in the rates of complication or death between patients who took the drugs and those that did not. David Holtgrave, dean of the University at Albany School of Public Health, who conducted the study, said researchers should focus on studying whether the drugs would work against patients who are mildly ill.
He noted that the drugs did not look like they were effective for treating very sick patients. Researchers should also study these drugs as a way to prevent people from getting sick. The results from the Albany study were also not peer-reviewed.
More Studies Need to be Done About Hydroxychloroquine
The Albany research also has inherent flaws. Dr. William Schaffner, a Vanderbilt University infectious disease expert who was not involved in the study, explained, “You never know what the biases were that persuaded physicians to use the drug in some patients rather than others and these biases often cannot be measured."
A double-blind randomized clinical trial is deemed to be the gold standard in medicine. The trials are ongoing, which involves a large group of COVID-19 patients randomly assigned to take the drug or a placebo. “We know what the limitations of observational studies are, and so I look forward to the results of the prospective control trials,” Schaffner said.
Researchers should aim to tackle more studies that aim to gauge the efficacy of hydroxychloroquine to treat COVID-19, as well as its possible side effects. A double-blind randomized clinical trial might help determine how effective hydroxychloroquine is when treating COVID-19.