Hydroxychloroquine has had a bit of a notorious reputation since the drug was first proposed as a treatment for COVID-19. Without much experience to go on, researchers and doctors jumped into trials in the hopes that the medicine would be able to combat the novel virus, and politicians, including President Trump, publicly touted its potential benefits. Now, things seem to be turning in the opposite direction.
This week, after growing concerns over the safety of the drug, France, Italy, and Belgium banned its use as a treatment for COVID-19 and the World Health Organization halted a large worldwide trial studying its effects on coronavirus patients. The decision to stop the trial came after a large study published last week in the journal The Lancet found both a higher mortality rate and a higher incidence of cardiac arrhythmia among people who took hydroxychloroquine.
At its core, hydroxychloroquine, along with its close cousin chloroquine, is an antimalarial medication that primarily treats and prevents the mosquito-borne infection by killing the microorganism (a plasmodium parasite) that causes it. But it also influences the way the immune system works in a few unique ways that have made the pair of drugs useful in treating certain autoimmune conditions like lupus and, occasionally, rheumatoid arthritis.
In March, in the relatively early stages of the pandemic, when researchers were grasping at straws to identify drugs that would help patients with COVID-19 fare better, anecdotal evidence and small studies suggested hydroxychloroquine could help. The thinking was that the small bits of positive evidence from early, small trials could be on to something, and that more experience and larger studies would lead to a better understanding of the drug’s effect on the novel coronavirus.
Unfortunately, these additional studies and experience with the medicine haven’t led to promising results. The paper in The Lancet looked at 96,032 people worldwide with COVID-19 of whom almost 15,000 took hydroxychloroquine. Overall, people who took the drug had a higher mortality rate than those with COVID-19 who didn’t take the medication. Hydroxychloroquine-treated patients also had a higher incidence of cardiac arrhythmias (a known side effect of the drug) than those that didn’t take it. The gist of the study was therefore that the drug had no benefit—and potentially caused harm.
In the United States, use of hydroxychloroquine for COVID-19 is allowed under the FDA’s emergency-use authorization. According to Reuters, however, the agency warned that because of known safety issues (noting specifically the potential for cardiac problems), the drug should be limited to clinical trials and hospitalized patients only.
Despite the consistent underwhelming evidence for hydroxychloroquine’s ability to help COVID-19 patients, President Trump has continually praised the drug’s supposed benefits since March. On May 18th, in a coronavirus press conference, he announced he was taking the drug as a preventative measure; on May 25th, he announced he had just wrapped up his two week course.
Unfortunately, though, it now seems that hydroxychloroquine is not as beneficial as we hoped it would be. All of this shows the importance of clinical trials and evidence-based decisions—especially given all the unknowns surrounding this new virus.
