Why Hydroxychloroquine Isn’t a Pandemic Panacea

Hydroxychloroquine for coronavirus
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As the numbers of those infected by COVID-19 continue to mount, there are growing calls to use untested treatments. Doctors are using existing drugs and “repurposing” them to treat coronavirus patients in the hope it will heal them. This is known as repurposing.

In the coming days and weeks, MedShadow will publish articles on trials for drugs that are being examined for repurposed use for coronavirus, as well as vaccine trials. We will interview infectious disease and other medical experts who are involved in the trials directly or have knowledge on how those drugs and vaccines work for their expertise.

The first drug we will examine is hydroxychloroquine, approved to treat malaria, lupus and rheumatoid arthritis. President Trump touts it as a potential “game-changer” for COVID-19. He has also stated, “What do we have to lose?” by using hydroxychloroquine as a COVID-19 treatment. As it turns out, plenty.

Trump is basing his optimism on anecdotal reports. And as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases has repeatedly stated, the scientific evidence supporting hydroxychloroquine in COVID-19 isn’t there yet.

A drug that’s effective in one disease does not mean it will be efficacious for COVID-19. That is precisely why many trials testing hydroxychloroquine for COVID-19 are ongoing. But until we see results from at least several clinical trials involving a significant number of patients, we won’t know for sure. 

What about the safety of hydroxychloroquine? Drugs can and do act differently in people depending on the conditions they are being treated for. In the case of hydroxychloroquine, it actually reduces the activity of the body’s immune system. That could be problematic as the body needs a strong immune system to fight off infection. As Derek Lowe points out in an excellent recent blog, this suppression of the body’s immune system is why it is used for autoimmune conditions like lupus and arthritis.  

Irregular heart rhythm: Lowe’s blog also talks about a new study out of France examining a combination of hydroxychloroquine and the antibiotic azithromycin (Z-Pak) in 11 COVID-19 patients, the majority of which had other health issues. The combination showed no benefit. But even more concerning was that one patient had to stop taking the combo on day 4 because of QT prolongation, a heart rhythm disorder, that can lead to fatal irregular heart rhythms (arrhythmias). These arrhythmias are a known side effect of hydroxychloroquine 

In another study, Lowe cites that has yet to go through peer review, about 30% of 84 COVID-19 patients given hydroxychloroquine/azithromycin combo showed significant QT prolongation. (You can find out a complete list of side effects associated with hydroxychloroquine here.)

What we do know is hydroxychloroquine does work for lupus, malaria and RA. Diverting hydroxychloroquine from people who depend on it to people for whom it might, or might not, work, could cause a shortage of the drug. And that is cruel to those who need it. 

Stockpiling hydroxychloroquine by hospitals and pharmacies has been condemned by the American Medical Association, American Pharmacists Association and American Society of Health-System Pharmacies issued a joint statement voicing their opposition to actions taken by many hospitals and pharmacies to stockpile drugs such as hydroxychloroquine and azithromycin for use in COVID-19 patients.

Of course, we all want a pandemic pill for use as soon as possible to stem the tide of people dying from COVID-19. Unfortunately, it will likely take time until we have found one. In the meantime, trying a drug like hydroxychloroquine is a gamble, and perhaps one with severe consequences.

UPDATE (4/24/2020): In reviewing hydroxychloroquine and chloroquine in our article about the drugs being tested for COVID-19, MedShadow reported that heart arhythmia is a known side effect risk of both drugs (see MedShadow’s Do We Already Have the Cure for COVID?).

So it’s not a surprise that on April 24th, the FDA issued a drug safety communication following reports of serious heart rhythm problems in patients with COVID-19 treated with hydroxychloroquine or chloroquine. The agency reiterated that neither drug has been shown to be safe or effective in treating COVID-19. The FDA also notes that the risk of an abnormal heartbeat is increased when the two medications are used in combination with Z-pak (azithromycin).

The same day, a study published in JAMA found that there was a high rate of abnormal heart rhythms in patients given either a low or high dose of chloroquine. Even more troubling, 22 of the 81 patients in the trial died, prompting investigators to end the trial early.