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01-06-2020 | Rheumatology | News | Article

This news item has been updated from a previous item published on 1 June 2020

‘Weak and conflicting’ evidence on hydroxychloroquine benefits and harms for COVID-19

Claire Barnard

medwireNews: The use of hydroxychloroquine for the prevention and treatment of SARS-CoV-2 infection remains controversial; this report rounds up some of the most recent research and expert opinion on hydroxychloroquine and COVID-19.

Study retraction: The Lancet

A research article published in The Lancet on 22 May 2020, reporting that hydroxychloroquine and chloroquine are associated with an increased risk for in-hospital mortality and ventricular arrhythmias, has been retracted by the authors after they were unable to complete an independent audit of the data underpinning their analysis. The authors state that they could "no longer vouch for the veracity of the primary data sources.”

Systematic review finds unclear evidence for benefits and harms

Researchers from the USA and Peru have synthesized the current evidence on the benefits and harms of hydroxychloroquine and chloroquine for the treatment and prevention of COVID-19 in a “living systematic review.”

C Michael White (University of Connecticut, Storrs, USA) and team identified four randomized controlled trials, 10 cohort studies, and nine case series evaluating these agents as potential treatments, but found no studies assessing their prophylactic use.

They report in the Annals of Internal Medicine that evidence on the effect of hydroxychloroquine or chloroquine on the risk for mortality, severe respiratory complications, symptom resolution, and viral clearance “is very weak and conflicting” at present, with “very few controlled studies” conducted to date.

White and team plan to re-review the literature on a monthly basis, and say that “a major update will be performed if new evidence changes the nature or strength of the conclusions.”

Increased demand for hydroxychloroquine

Despite the lack of evidence supporting the use of hydroxychloroquine or chloroquine for COVID-19, there have been reports of increased demands for these drugs, with potential shortages for patients who need them.

In an exploratory analysis of prescription filling in the USA, Haider Warraich (VA Boston Healthcare System, Massachusetts, USA) and colleagues estimated that the absolute volume of national weekly prescription fills for hydroxychloroquine and chloroquine increased from 121,865 during 16–22 February 2020 to 367,297 during 15–21 March 2020. Moreover, there were 483,425 excess fills of hydroxychloroquine/chloroquine prescriptions between February and April 2020 compared with the same time period in 2019.

Writing in a correspondence to JAMA, Warraich et al say that this “surge” in prescription fills for hydroxychloroquine and chloroquine was “likely due to off-label prescriptions for COVID-19,” and highlight the need for “[m]echanisms to safeguard patients against both overprescription and drug shortages.”

The author of a correspondence article published in The Lancet Rheumatology stresses that hydroxychloroquine shortages would pose a particular problem for people with autoimmune rheumatic diseases in low- and middle-income countries (LMICs).

“Without protection from their own governments and international agencies, these patients are at risk of losing access to their medication” if “high-income countries call for additional supplies of hydroxychloroquine for potential COVID-19 prophylaxis,” says Soumya Banerjee (University of Cambridge, UK).

And he calls for “[a] balanced and staged approach that considers the needs of both high-income countries and LMICs […] towards hydroxychloroquine during the COVID-19 crisis.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

5 June 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Ann Intern Med 2020; doi:10.7326/M20-2496
JAMA 2020; doi:10.1001/jama.2020.9184
Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30162-4

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