HCQ — the Good, the Bad, & the Ugly

There has been a lot of controversy about the use of Hydroxychloroquine (HCQ) as a treatment of COVID-19. This is an old antiviral medication, in use for more than 60 years, and considered safe for daily use even during pregnancy, yet doctors have risked their careers to use it for patients with COVID-19.

Today, in many parts of the US, pharmacies refuse to fill prescriptions; claims have been made that it is safe, unsafe, deadly, wonderful, terrible, or useless. The reasons for all this go deep into politics and the problem that an emergency vaccine can only be approved if no acceptable treatment or prevention is available.

The Food & Drug Administration (FDA) has issued warnings to doctors and pharmacies.   In June and July, 2020, the FDA decided that HCQ  should no longer be used to treat patients with Covid 19 because it is too dangerous.    It is not considered too dangerous, however, for treatment of lupus, rheumatoid arthritis, or malaria.

The American Medical Association issued a statement in April 2020 that I would find insulting if I were a doctor.  After noting that doctors are at the forefront of any emergency medical situation, they complain that doctors have been buying up HCQ and azithromycin (specifically) and hoarding them for their own families and patients.  They suggest that pharmacists should question or even refuse such prescriptions, complaining that this may deplete the market; there is no suggestion that perhaps production of these drugs could be increased to meet the perceived need.

All this controversy, however, is a topic for another day. Here, we will let the research itself talk about the urgent topic of its use for treatment and/or prevention of COVID-19.

Shah et al (March 2020)

A systematic review of the prophylactic role of chloroquine & hydroxychloroquine in coronavirus disease-19 (COVID-19)

This is a review of the few studies on the use of HCQ and the similar CQ for COVID-19 published by March, 2020.  In spite of  acknowledging that HCQ has a good safety profile, the authors conclude that the drug should NOT be used against COVID-19, claiming it might cause a “false sense of protection among the common masses.”   More . . .

Singh et al (March 2020)

Chloroquine & hydroxychloroquine in the treatment of COVID-19 with or without diabetes: A systematic search & a narrative review with a special reference to India & other developing countries.

Reviewing 2 studies, the authors concluded that HCQ and the related CQ are worth fast-tracking clinical trials for treatment of Covid-19.

They also noted that (in India) HCQ is approved for diabetes — and diabetics are at high-risk for COVID-19 mortality.  More . . .

Garcia-Cremades et al (August 2020) 

Optimizing hydroxychloroquine dosing for patients with COVID-19: An integrative modeling approach for effective drug repurposing

The authors attempt to define the best dose for HCQ both for treatment and for clinical trials, while avoiding the heart QT problem of higher doses.

The least viral load after treatment appears to be 600 mg HCQ twice a day for 10 days, but even 200 mg HCQ twice a day for 5 days is better than nothing.   More . . .

Marmor (May 2020)

COVID-19 and Chloroquine/Hydroxychloro-quine: Is there ophthalmological concern?

Marmor says that “the evidence to date indicates that extreme doses do accelerate retinal toxicity, but with a probable time course of many months rather than days.”

During this time of crisis, he concludes, ophthalmologists should be reassuring physicians and the public that retinopathy is not a serious concern in CQ or HCQ usage for COVID-19.  Several other papers about this connection are also linked.  More . . .

Gbinigie & Frie (April 2020)

Should chloroquine & hydroxychloroquine be used to treat COVID-19? A rapid review

Three studies were reviewed – two from China and one from France.  Based on the first, China included HCQ as treatment. The French study showed that 70% of the treatment group recovered in 6 days, while only 12% of the “control” group recovered. The other Chinese study (of only 30 people) could not show a difference between treatment and control groups, but they were using a very small dosage of HCQ. 

Gbinigie et al conclude there is insufficient evidence to support the use of CQ or HCQ for treatment of Covid-19.   More . . .

Giammaria & Pajewski (June 2020)

Can early treatment of patients with risk factors contribute to managing the COVID-19 pandemic?

Basically, their answer is YES.

Only about 20% of patients with COVID-19 develop serious symptoms, which seem to take about a week to come on, giving time to identify those at risk and treat them with antiviral medications.    More . . .

Mahevas et al (May 2020)

Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: Observational comparative study using routing care data

All the patients in this study were in various hospitals. They all needed oxygen and had developed pneumonia. 

The dose of HCQ used was 600 mg per day, without zinc or antibiotic.  The authors concluded that for patients in a hospital and needing oxygen, HCQ doesn’t do much to improve their condition. 

The authors claimed no conflicts of interest, but when the BMJ investigated, there were quite a few..   More . . .


Meo et al (April 2020) 

Efficacy of chloroquine and hydroxychloroquine in the treatment o f COVID-19

The authors concluded their findings support the hypothesis that HCQ has efficacy in treatment and prevention of Covid-19. 
More . . .

Catteau et al, 2020  

Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: A nationwide observational study of 8075 participants

In Belgium, HCQ is used for hospitalized patients with Covid-19.  The authors compared patients receiving HCQ for 5 days to patients receiving only supportive care.

As can be seen in Fig. 1, those patients receiving HCQ were less likely to die.   The recommended dose of HCQ was 2400 mg over 5 days, or about 480 mg per day. More . . .

To be continued …


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