Hydroxychloroquine: should we use it based on available evidence?
In the wake of President Trump declaring that he was on the drug, the FDA is now saying on Tuesday (05/19/2020) that the decision to take hydroxychloroquine (HCQ) prophylactically is “ultimately a decision between the patient and their doctor,” even though in April the agency advised patients not to try the drug because it could cause an abnormal heart rhythm.
May 22, 2020: Another observational study of more than 96,000 coronavirus patients in hospitals around the world found those treated with chloroquine or HCQ had a considerably higher risk of death and higher risk of serious heart arrhythmias than those who did not receive the antimalarial drugs. It is not a randomized controlled trial (RCT) which is higher in quality of evidence, but it is indeed the largest study of HCQ treatment in sick, hospitalized patients MORE THAN 10 DAYS after symptom onset. Authors admit data does NOT apply to HCQ treatment in an ambulatory or outpatient setting. There's so much we don't know, one thing is clear to me that it shows how underlying health conditions make COVID more deadly for some.
So many RCTs are already ongoing. All of us eagerly awaiting these data so we can either retire this possibly harmful treatment and/or apply it to those for whom it would help.
However, it might not be enough to convince HCQ supporters. Some RCTs has published mixed results, both positive and negative. And people have debated endlessly about this, questioning about reliability and flaws of some studies conducted outside of the US. That was one of the main reasons why NIH began its own clinical trial of HCQ.
“Although there is anecdotal evidence that hydroxychloroquine and azithromycin may benefit people with COVID-19, we need solid data from a large randomized, controlled clinical trial to determine whether this experimental treatment is safe and can improve clinical outcomes.” said NIAID Director Anthony S. Fauci, M.D.
Bottom line
Personally, I would not take HCQ for COVID-19, concerned about adverse effects, growing of negative evidence and not so clear about its potential antiviral activity. Many drugs have in vitro activity for different kinds of infections, and yet do nothing when given to people.
I do understand the opposite view. Repurposing existing cheap drugs is a very attractive option because these medications have undergone extensive testing and survive the test of time. With limited evidences on our hands, it is hard to make a decision about to do good or to do no harm. It is reasonable to listen carefully to a patient who strongly wanted treatment and go forward with it, provided they understood all the risks and there were no contraindications.
We don’t have to wait for higher quality evidence like RCTs to make decisions while dealing with the pandemic everyday. In sum, I want to share my favorite quote.
“Evidence-based medicine is not just about randomized trials; it’s about appreciating the strengths and weaknesses of all data, and allowing the data to inch us closer and closer toward truth.”
You can watch the YouTube video below for more details.
