Use of Hydroxychloroquine and Chloroquine During the COVID-19 Disease
In the desperate search for effective treatments for the coronavirus 2019 (COVID-19), generics used by rheumatologists and dermatologists to treat immune-mediated diseases have come under the spotlight. Hydroxychloroquine Antimalarial (HCQ) and Chloroquine (CQ) showed antiviral activity against severe acute respiratory syndrome coronavirus 2 (SRAS-CoV-2) in vitro and in small, poorly controlled or uncontrolled clinical trials.
Normally, such research would be considered hypotheses at best. A March 21, 2020 tweet from President Trump claiming that the combination of HCQ and azithromycin “has a real chance of being one of the biggest game changers in the history of medicine” has accelerated a global drug race, with pharmacies reporting a super aging within 24 hours. Here we try to provide advice on clinical decision-making and strategies to mitigate further harm to these patients, both patients with COVID-19 and patients with immune-mediated diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
Data that supports the use of HCQ and CQ for COVID-19 is limited and inconclusive. The drugs have some in vitro activity against several viruses, including coronaviruses and influenza, but previous randomized trials in influenza patients have been negative. In COVID-19, a small, uncoated study in France showed benefits but had serious methodological defects, and a follow-up study still did not have a control group. Another very small randomized study of China in patients with mild to moderate COVID-19 found no difference in recovery rates.
Finally, protective measures should be taken to prevent overuse by healthcare professionals who use up the supply of antimalarials for pre-exposure prophylaxis. The hoarding of health professionals for themselves and their friends or family is already in place, but state and pharmacy governments have begun to implement strict usage guidelines to prevent HCQ overuse. In the meantime, several manufacturers have already made a critical commitment to initiate or increase HCQ production.
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