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Corona Episode: Hydroxychloroquine. Politics, and the Media

hydroxychloroquine covid19

It’s bizarre when politics enter medicine, especially when
they enter into the debate over which treatments are best for
COVID-19. No medical treatment on earth has become more
politicalized in the last few weeks than the drug
hydroxychloroquine. So let’s try to push aside all of the red vs.
blue stuff and see if doctors on the front-line should be using
this drug or not.

Red, Blue, or Purple?

First, the novel coronavirus doesn’t know if you’re a
Democrat, Republican, or Independent. It doesn’t care that you
watch Fox News or MSNBC or read The Blaze or The Atlantic. If
you’ve got the wrong genes or are the wrong age or have a
preexisting condition, it will take you just the same long before
you can vote in November. In addition, everyone is for more
clinical trials until it’s a loved one who is dying from COVID
and then it’s “pull out all the stops†doc. I’ve had that
conversation with families more times than I can count.

What is Hydroxychloroquine?

This is a drug called Plaquenil. It’s been around for decades
and is a cheap generic drug first used for malaria in 1955 and also
more recently used to treat rheumatoid arthritis and lupus
patients. The generic version of the drug should run about $15
here. In Africa, to treat Malaria, it’s 8 cents a dose. Compare
that to the expensive antiviral drugs being used now to treat
COVID-19 that are thousands of dollars for a course of
treatment.

The Trump Pump?

President Trump discussed hydroxychloroquine a few weeks back as
a possible treatment for COVID-19 that was showing good results.
Since then the FDA has provided an Emergency Use Authorization
(EUA) for the drug to treat the novel coronavirus (5). However,
because this advice was uttered by the President, whether you love
or hate the guy, it’s clear that the use of this drug for COVID
patients has become political. That furor has lead to academics
writing in the British Medical Journal to claim that there just
isn’t enough evidence and attack the idea that this old and cheap
drug should be used (6). In addition, Michigan like other states
had threatened regulatory action against doctors using this drug
for COVID-19 patients until that order was later rescinded
(10).

Does This Stuff Work?

The answer is that we have some evidence. Viewing this as a
physician and without politics, it sure looks interesting. In
addition, not caring whether a pharma company will make big bucks
off of COVID-19 or not, let’s review what we know.

A group of French doctors published a small uncontrolled trial
looking at whether hydroxychloroquine would work for coronavirus
patients with early and mild disease (2). The study showed good
clearance of the virus.

The same group has now conducted a similar trial on 1,061 mild
COVID-19 patients who were treated for at least three days with
hydroxychloroquine and azithromycin (HCQ-AZ) (1). This was a
retrospective case review and not the gold standard randomized
trial. The mean age of patients was 44 years old and 92{5912a45c745f63b4e1319b77c6fdb181e25bf63cf770b3223e3f1fdb974c7356} of the
patients recovered by 10 days. 4{5912a45c745f63b4e1319b77c6fdb181e25bf63cf770b3223e3f1fdb974c7356} of the patients needed to go to
the ICU and half a percent died. Fewer patients died when treated
with HCQ-AZ versus other regimens. There were no serious side
effects of the medications. Interestingly, poor outcomes were
observed in patients who were on two different types of blood
pressure medications. One of these I have reported on before, which
are
ACE inhibitors
. However, the other medication, beta-blockers,
was a surprise.

A small randomized controlled trial of 61 patients using
Hydroxycholorquine was placed on a prepublication site by Chinese
physicians just a few days ago (4). The results were impressive
after 5 days of hydroxychloroquine treatment (HCQ). There was a
better resolution of high temperatures and cough in the HCQ group
and more patients showed imaging findings of improved pneumonia. In
addition, only those patients who didn’t get HCQ progressed to
severe disease. There were two patients out of 31 who had mild
adverse reactions to the drug.

The NIH has just begun a trial here in the US using
hydroxychloroquine (3). Hence, hopefully, we’ll have some data in
the next 2 months or so. However, this trial won’t be completed
when physicians on the front-line are treating the most COVID-19
patients.

Why the Push Back by Academics?

While I get that more high-level research is always better than
less, in a scenario like this one, to try to save lives,
decisions about efficacy can ONLY be made by doctors on the
frontlines
. If they see that Hydroxycholorquine works,
given a reasonable side effect profile versus doing nothing, they
should be using it. Academics in Ivory Towers should NOT be
driving this conversation
. As a society, we can let the
academics run the clinical trials and if those don’t pan out,
then the frontline doctors can stop using it.

Why wouldn’t academics be on board here? One thought is that
this is not something they’re used to doing these days, putting
clinicians in the driver’s seat. The other is that you MUST
realize that universities are big businesses and many will make big
bucks by creating new drugs and therapies for COVID. Hence, in my
opinion, there is a big inherent conflict of interest here.

Shortages?

This drug supply is now being managed by the Department of
Health and Human Services (HHS) to make sure that enough is
available for both COVID-19 and the other diseases for which it’s
used (7).  For example, HHS recently received 30 million doses as a
donation from the pharma company Sandoz to the national stockpile
(8). Novartis is donating up to 130 million doses of
hydroxychloroquine (9).

The upshot? While the data on using hydroxychloroquine is NOT
perfect, if I were a physician treating these patients in the
hospital, I wouldn’t hesitate to use it in a high-risk patient.
Hence, it makes no medical sense that there’s been such a media
uproar about this drug. Again, the novel coronavirus doesn’t care
how you vote, it’s just looking for a way to make more of itself,
which is how viruses work. Republicans or Democrats are equally
good viral hosts.

_________________________________

References:

(1) Mediterranee Infection. RÉSULTATS DE L’ÉTUDE COCONEL :
CORONAVIRUS ET CONFINEMENT – ENQUÊTE LONGITUDINALE.
https://www.mediterranee-infection.com/resultats-de-letude-coconel-coronavirus-et-confinement-enquete-longitudinale/

Accessed 4/12/20.

(2) Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine
and azithromycin as a treatment of COVID-19: results of an
open-label non-randomized clinical trial [published online ahead of
print, 2020 Mar 20]. Int J Antimicrob Agents. 2020;105949.
doi:10.1016/j.ijantimicag.2020.105949

(3) The National Institutes of Health. NIH clinical trial of
hydroxychloroquine, a potential therapy for COVID-19, begins.

https://www.nih.gov/news-events/news-releases/nih-clinical-trial-hydroxychloroquine-potential-therapy-covid-19-begins
.
Accessed 4/12/20.

(4) Chen Z, Hu J, Zhang Z, et al. Efficacy of hydroxychloroquine
in patients with COVID-19: results of a randomized clinical trial.
Version 2. medRxiv 2020.03.22.20040758. [Preprint.] doi:
10.1101/2020.03.22.20040758

(5) Lenzer J. Covid-19: US gives emergency approval to
hydroxychloroquine despite lack of evidence. BMJ2020;369:m1335.
doi:
10.1136/bmj.m1335 pmid:32238355

(6) Ferner RE, Aronson JK. Chloroquine and hydroxychloroquine in
covid-19. BMJ. 2020 Apr 8;369:m1432. doi: 10.1136/bmj.m1432.

(7) Arthritis Foundation. Hydroxychloroquine (Plaquenil)
Shortage Causing Concern.
https://www.arthritis.org/drug-guide/medication-topics/plaquenil-shortage
.
Accessed 4/12/20.

(8) Department of Health and Human Services. HHS accepts
donations of medicine to Strategic National Stockpile as possible
treatments for COVID-19 patients.
https://www.hhs.gov/about/news/2020/03/29/hhs-accepts-donations-of-medicine-to-strategic-national-stockpile-as-possible-treatments-for-covid-19-patients.html
Accessed
4/12/20.

(9) Novartis. Novartis commits to donate up to 130 million doses
of hydroxychloroquine to support the global COVID-19 pandemic
response.
https://www.novartis.com/news/media-releases/novartis-commits-donate-130-million-doses-hydroxychloroquine-support-global-covid-19-pandemic-response

Accessed 4/12/20.

(10) Detroit Metro Times. Gov. Whitmer reverses course on
coronavirus drugs, is now asking feds for hydroxychloroquine and
chloroquine.
https://www.metrotimes.com/news-hits/archives/2020/03/31/gov-whitmer-reverses-course-on-coronavirus-drugs-is-now-asking-feds-for-hydroxychloroquine-and-chloroquine.
Accessed 4/13/20.

The post
Corona Episode: Hydroxychloroquine. Politics, and the Media

appeared first on Regenexx.

hydroxychloroquine covid19

hydroxychloroquine covid19

It’s bizarre when politics enter medicine, especially when
they enter into the debate over which treatments are best for
COVID-19. No medical treatment on earth has become more
politicalized in the last few weeks than the drug
hydroxychloroquine. So let’s try to push aside all of the red vs.
blue stuff and see if doctors on the front-line should be using
this drug or not.

Red, Blue, or Purple?

First, the novel coronavirus doesn’t know if you’re a
Democrat, Republican, or Independent. It doesn’t care that you
watch Fox News or MSNBC or read The Blaze or The Atlantic. If
you’ve got the wrong genes or are the wrong age or have a
preexisting condition, it will take you just the same long before
you can vote in November. In addition, everyone is for more
clinical trials until it’s a loved one who is dying from COVID
and then it’s “pull out all the stops†doc. I’ve had that
conversation with families more times than I can count.

What is Hydroxychloroquine?

This is a drug called Plaquenil. It’s been around for decades
and is a cheap generic drug first used for malaria in 1955 and also
more recently used to treat rheumatoid arthritis and lupus
patients. The generic version of the drug should run about $15
here. In Africa, to treat Malaria, it’s 8 cents a dose. Compare
that to the expensive antiviral drugs being used now to treat
COVID-19 that are thousands of dollars for a course of
treatment.

The Trump Pump?

President Trump discussed hydroxychloroquine a few weeks back as
a possible treatment for COVID-19 that was showing good results.
Since then the FDA has provided an Emergency Use Authorization
(EUA) for the drug to treat the novel coronavirus (5). However,
because this advice was uttered by the President, whether you love
or hate the guy, it’s clear that the use of this drug for COVID
patients has become political. That furor has lead to academics
writing in the British Medical Journal to claim that there just
isn’t enough evidence and attack the idea that this old and cheap
drug should be used (6). In addition, Michigan like other states
had threatened regulatory action against doctors using this drug
for COVID-19 patients until that order was later rescinded
(10).

Does This Stuff Work?

The answer is that we have some evidence. Viewing this as a
physician and without politics, it sure looks interesting. In
addition, not caring whether a pharma company will make big bucks
off of COVID-19 or not, let’s review what we know.

A group of French doctors published a small uncontrolled trial
looking at whether hydroxychloroquine would work for coronavirus
patients with early and mild disease (2). The study showed good
clearance of the virus.

The same group has now conducted a similar trial on 1,061 mild
COVID-19 patients who were treated for at least three days with
hydroxychloroquine and azithromycin (HCQ-AZ) (1). This was a
retrospective case review and not the gold standard randomized
trial. The mean age of patients was 44 years old and 92{5912a45c745f63b4e1319b77c6fdb181e25bf63cf770b3223e3f1fdb974c7356} of the
patients recovered by 10 days. 4{5912a45c745f63b4e1319b77c6fdb181e25bf63cf770b3223e3f1fdb974c7356} of the patients needed to go to
the ICU and half a percent died. Fewer patients died when treated
with HCQ-AZ versus other regimens. There were no serious side
effects of the medications. Interestingly, poor outcomes were
observed in patients who were on two different types of blood
pressure medications. One of these I have reported on before, which
are
ACE inhibitors
. However, the other medication, beta-blockers,
was a surprise.

A small randomized controlled trial of 61 patients using
Hydroxycholorquine was placed on a prepublication site by Chinese
physicians just a few days ago (4). The results were impressive
after 5 days of hydroxychloroquine treatment (HCQ). There was a
better resolution of high temperatures and cough in the HCQ group
and more patients showed imaging findings of improved pneumonia. In
addition, only those patients who didn’t get HCQ progressed to
severe disease. There were two patients out of 31 who had mild
adverse reactions to the drug.

The NIH has just begun a trial here in the US using
hydroxychloroquine (3). Hence, hopefully, we’ll have some data in
the next 2 months or so. However, this trial won’t be completed
when physicians on the front-line are treating the most COVID-19
patients.

Why the Push Back by Academics?

While I get that more high-level research is always better than
less, in a scenario like this one, to try to save lives,
decisions about efficacy can ONLY be made by doctors on the
frontlines
. If they see that Hydroxycholorquine works,
given a reasonable side effect profile versus doing nothing, they
should be using it. Academics in Ivory Towers should NOT be
driving this conversation
. As a society, we can let the
academics run the clinical trials and if those don’t pan out,
then the frontline doctors can stop using it.

Why wouldn’t academics be on board here? One thought is that
this is not something they’re used to doing these days, putting
clinicians in the driver’s seat. The other is that you MUST
realize that universities are big businesses and many will make big
bucks by creating new drugs and therapies for COVID. Hence, in my
opinion, there is a big inherent conflict of interest here.

Shortages?

This drug supply is now being managed by the Department of
Health and Human Services (HHS) to make sure that enough is
available for both COVID-19 and the other diseases for which it’s
used (7).  For example, HHS recently received 30 million doses as a
donation from the pharma company Sandoz to the national stockpile
(8). Novartis is donating up to 130 million doses of
hydroxychloroquine (9).

The upshot? While the data on using hydroxychloroquine is NOT
perfect, if I were a physician treating these patients in the
hospital, I wouldn’t hesitate to use it in a high-risk patient.
Hence, it makes no medical sense that there’s been such a media
uproar about this drug. Again, the novel coronavirus doesn’t care
how you vote, it’s just looking for a way to make more of itself,
which is how viruses work. Republicans or Democrats are equally
good viral hosts.

_________________________________

References:

(1) Mediterranee Infection. RÉSULTATS DE L’ÉTUDE COCONEL :
CORONAVIRUS ET CONFINEMENT – ENQUÊTE LONGITUDINALE.
https://www.mediterranee-infection.com/resultats-de-letude-coconel-coronavirus-et-confinement-enquete-longitudinale/

Accessed 4/12/20.

(2) Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine
and azithromycin as a treatment of COVID-19: results of an
open-label non-randomized clinical trial [published online ahead of
print, 2020 Mar 20]. Int J Antimicrob Agents. 2020;105949.
doi:10.1016/j.ijantimicag.2020.105949

(3) The National Institutes of Health. NIH clinical trial of
hydroxychloroquine, a potential therapy for COVID-19, begins.

https://www.nih.gov/news-events/news-releases/nih-clinical-trial-hydroxychloroquine-potential-therapy-covid-19-begins
.
Accessed 4/12/20.

(4) Chen Z, Hu J, Zhang Z, et al. Efficacy of hydroxychloroquine
in patients with COVID-19: results of a randomized clinical trial.
Version 2. medRxiv 2020.03.22.20040758. [Preprint.] doi:
10.1101/2020.03.22.20040758

(5) Lenzer J. Covid-19: US gives emergency approval to
hydroxychloroquine despite lack of evidence. BMJ2020;369:m1335.
doi:
10.1136/bmj.m1335 pmid:32238355

(6) Ferner RE, Aronson JK. Chloroquine and hydroxychloroquine in
covid-19. BMJ. 2020 Apr 8;369:m1432. doi: 10.1136/bmj.m1432.

(7) Arthritis Foundation. Hydroxychloroquine (Plaquenil)
Shortage Causing Concern.
https://www.arthritis.org/drug-guide/medication-topics/plaquenil-shortage
.
Accessed 4/12/20.

(8) Department of Health and Human Services. HHS accepts
donations of medicine to Strategic National Stockpile as possible
treatments for COVID-19 patients.
https://www.hhs.gov/about/news/2020/03/29/hhs-accepts-donations-of-medicine-to-strategic-national-stockpile-as-possible-treatments-for-covid-19-patients.html
Accessed
4/12/20.

(9) Novartis. Novartis commits to donate up to 130 million doses
of hydroxychloroquine to support the global COVID-19 pandemic
response.
https://www.novartis.com/news/media-releases/novartis-commits-donate-130-million-doses-hydroxychloroquine-support-global-covid-19-pandemic-response

Accessed 4/12/20.

(10) Detroit Metro Times. Gov. Whitmer reverses course on
coronavirus drugs, is now asking feds for hydroxychloroquine and
chloroquine.
https://www.metrotimes.com/news-hits/archives/2020/03/31/gov-whitmer-reverses-course-on-coronavirus-drugs-is-now-asking-feds-for-hydroxychloroquine-and-chloroquine.
Accessed 4/13/20.

The post
Corona Episode: Hydroxychloroquine. Politics, and the Media

appeared first on Regenexx.

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