Hydroxychloroquine: Trump's Covid-19 'cure' increases deaths, global study finds

Hydroxychloroquine, the anti-malarial drug Donald
Trump is taking to prevent Covid-19, has increased deaths in patients treated
with it in hospitals around the world, a study has shown.
A major study of the way hydroxychloroquine and its
older version, chloroquine, have been used on six continents – without clinical
trials – reveals a sobering picture. Scientists said the results meant the drug
should no longer be given to Covid-19 patients except in proper research
settings.
While the paper, published online in the Lancet
medical journal, is not a trial designed to assess the drug, it shows that the
rush to use it around the world may be ill-advised. Significant numbers of
doctors have been prescribing it without evidence. It is known that the drug
can cause heart irregularities, but many have claimed it is safe because of its
long use treating malaria.
There was a rush to use the drug in Covid-19 cases
after the French doctor Didier Raoult said he was curing his patients at La
Timone hospital, in Marseille. The US president then claimed hydroxychloroquine
– less toxic than the original chloroquine – was a cure, and later said he was
taking it himself against coronavirus.
The drugs are fairly safe for patients being treated
for malaria, but Covid-19 is a very different disease. The authors of the paper
pulled together results for more than 96,000 patients in 671 hospitals, taking
one of the drugs, with or without an antibiotic such as azithromycin, between
20 December and 14 April.
The death rate among all groups taking the drugs was
higher than among people who were not given them. One in six of those taking
one of the drugs died, while one in five died if they were taking chloroquine
with an antibiotic, and one in four if they were on hydroxychloroquine and an
antibiotic. The death rate among patients not taking the drugs was one in 11.
The statistics are not exactly comparable because,
as this was not a trial, there were differences in the age, gender, general
health and stage of illness of the patients. But the US authors of the study
say, allowing for these differences, there was still higher mortality among
those taking the drugs.
The team also found that serious cardiac
arrhythmias, which cause the lower chamber of the heart to beat rapidly and
irregularly, were more common in all the groups receiving one of the four
treatment regimens. The biggest increase was in the group treated with
hydroxychloroquine in combination with an antibiotic, where 8% of patients
developed a heart arrhythmia compared with 0.3% of patients not given the
drugs.
“This is the first large-scale study to find
statistically robust evidence that treatment with chloroquine or
hydroxychloroquine does not benefit patients with Covid-19,” said Prof Mandeep
R Mehra, lead author of the study and executive director of the Brigham and
Women’s hospital advanced heart disease center in Boston, US.
“Instead, our findings suggest it may be associated
with an increased risk of serious heart problems and increased risk of death.
Randomised clinical trials are essential to confirm any harms or benefits
associated with these agents. In the meantime, we suggest these drugs should
not be used as treatments for Covid-19 outside of clinical trials.”
Others scientists suggested the drugs should no
longer be used in Covid-19 treatments, except for carefully controlled clinical
trials.
Dr Stephen Griffin, associate professor in the
school of medicine, University of Leeds, said the paper was “potentially a
landmark study for Covid-19 therapy. While not a placebo-controlled trial, an
observational study on this scale undertaken with stringent and meticulous
analysis is powerful indeed,” he said.
“Whilst controlled trials will be required for
confident affirmation, the indications are that these drugs certainly ought not
to be used outside of a trial setting where patients can be monitored for
complications. One might also question whether the resources necessary for
large studies might be better diverted to other causes, at the same time
allowing the drugs themselves to be used for their original purpose.
“Furthermore, it is clear that high-profile
endorsements of taking these drugs without clinical oversight are both
misguided and irresponsible.”
Stephen Evans, professor of pharmacoepidemiology at
the London School of Hygiene and Tropical Medicine, said it was unlikely that
trials would now find any substantial benefit from the drugs. “A definitive
answer still awaits the results of the randomised trials, but it is clear that
the drugs should not be given for treatment of Covid-19 other than in the
context of a randomised trial.
“It might even be said that to go on giving them,
other than in a trial, is unethical, given this evidence that is not yet
contradicted by other available evidence.”