Posted on Apr 02, 2020, 5 p.m.
Patients in China with COVID-19 treated with HCQ/hydroxychloroquine were observed to have a shorter time to clinical recovery as well as improved pneumonia in a randomized trial. HCQ is an antimalarial that is also used to treat autoimmune diseases such as lupus.
Those that received hydroxychloroquine with standard treatment were observed to have had a significantly shorter time to body temperature recovery of about one day as well as a significantly reduced time to cough remission of about a day compared to patients receiving only the standard treatment according to reports from Zhan Zhang, MD of Wuhan University.
A larger proportion of patients in the group receiving the hydroxychloroquine with standard treatment had improved pneumonia compared to those in the control group, according to a manuscript posted on the medRxiv preprint server.
Hydroxychloroquine and chloroquine have been getting much attention lately, and the FDA is looking into conducting randomized trials against COVID-19, it is worth noting that some hospital have begun using a cocktail of azithromycin and hydroxychloroquine to desperately ill patients on a compassionate care basis, and there are unconfirmed reports of some even using off label use of these agents.
Due to the attention the CDC has issued a warning to people against taking medications/remedies that they don’t understand as one unfortunate person died from ingesting chloroquine phosphate which is used to clean fish tanks, but thought it was the product getting all the attention in the media.
Previous trials exploring the in vivo activity of HCQ had found no benefit in clinical measures or viral clearance compared to standard care. The drug continues to be tested in trials including this randomized trial involving 62 hospitalized patients who were tested and confirmed to be infected with COVID-19. All patients received standard care including oxygen therapy, antiviral agents, antibacterial agents, and immunoglobulin with/without corticosteroids: those in the intervention groups also received 400 mg tablets of oral hydroxychloroquine sulfate per day on days 1-5.
Primary endpoint was time to clinical recovery which was defined as being the "return to body temperature and cough relief, maintained for more than 72 [hours]." The mean patient age was 45 and almost half were men, with no significant differences in the age and sex distribution between the groups according to the authors.
4 of the 62 patients in the control group were noted to progress to severe illness, and 2 patients reported having mild adverse reactions ( rash and headache) in the HCQ group. Those in the HCQ group had a one day shorter time to body temperature recovery and similar results were seen for time to cough remission.
Retinopathy is a known side effect from long term therapy with hydroxychloroquine which can often be seen in lupus patients who may remain on the drug for years. Those on long term use may also experience arrhythmias, gastrointestinal reactions, cramps, and liver dysfunction. Patients on hydroxychloroquine therapy should be monitored for adverse reactions, but according to Zhang and colleagues the "short-term application of HCQ is relatively safe."
The authors concluded that "considering that there is no better option at present, it is a promising practice to apply HCQ to COVID-19 under reasonable management,” while also acknowledging there is still a need for large scale clinical trials and other research to clarify the treatment mechanisms and to optimize the treatment plan.
This study was supported by the Epidemiological Study of COVID-19 Pneumonia to Science and Technology, Department of Hubei Province.
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