What a big new study on malaria drugs as Covid-19 treatments tells us -- and what it doesn't [In-Depth]
Hydroxychloroquine pills. (GEORGE FREY/AFP VIA GETTY IMAGES}
A new study underlines safety concerns about using the malaria drugs hydroxychloroquine and chloroquine to treat Covid-19, and heightens questions about whether or not the drugs are effective at all.
The study, which was published in the Lancet, cannot answer the question of whether or not hydroxychloroquine and chloroquine can help patients fight off Covid-19 or whether the drugs increase or decrease the death rates in those patients. Those answers can only come from large studies in which patients are randomly assigned to either receive the drugs or a placebo. Dozens of such studies are ongoing.
The results, however, are a reminder of the risks of deciding to use medicines without clear evidence of their benefits and risks.
One of the findings of the current study seems hard to ignore: that the drugs increase the risk of dangerous disturbances in heart rhythms. These are known side effects of both medicines, but the increases in the study are striking. After adjustment for other risk factors, it appears that patients on hydroxychloroquine had double the risk of ventricular arrhythmias, and those on chloroquine had triple. When an antibiotic such as azithromycin was added, as some proponents have advocated, the risk jumped to fivefold.
"It's a very striking finding and it's convincing to me," said Steven Nissen, a cardiologist at the Cleveland Clinic. "Based upon these findings and others, no one should take hydroxychloroquine with or without an antibiotic unless they are in a randomized controlled trial. It should not be used in the general population to prevent or to treat Covid-19 infection."
Eric Topol, director and founder of the Scripps Research Translational Institute and a cardiologist, noted the risk in a series of tweets. "It's no longer that hydroxychloroquine has no sign of efficacy," he wrote, "it is associated with an increase in mortality."
The study is the largest observational study so far on the use of chloroquine and hydroxychloroquine to treat Covid-19; it combined data from 15,000 Covid-19 patients at 671 hospitals on six continents who were treated with the drugs. Those patients were compared to 81,000 patients who had Covid-19 but did not receive the drugs.
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Even if the results from the new study, led by researchers at the Brigham and Women's Hospital Center for Advanced Heart Disease/Cardiomyopathy in Boston, hold up, it's still possible the drug could have some benefit. Researchers are testing it for preventing people who are exposed to the virus from being infected. Again, that can only come from randomized controlled studies.
Hydroxychloroquine use spiked dramatically after the drug was embraced by President Trump, who on Monday said that he himself was taking the drug, and commentators on Fox News. Sean Hannity read a letter from a doctor recounting his own experience using the drugs as a treatment on air.
Results from some of the first large, randomized studies of hydroxychloroquine are expected soon, including a study being conducted by the French government and one at the University of Minnesota. If they show that the drugs were actually harmful, it will be another giant misstep in the response to the virus. If they show it works, we'll have another tool -- probably a small one -- in combating the pandemic.
cuz thats pointless exercise. But cuz deficient handling. But I suspect more awaits .. hopefully we as humans will learn something useful along the way.
India etc for what happens when you do little to nothing to mitigate the spread.
] denies the potential severity of this disease in terms of the risk it poses to a limited number of individuals [you can argue about how many, but this is another thing], but the ongoing restrictions in which large swathes of our economic and social activities is also not without consequence and while say, the wearing of face-masks, the cleaning of hands, the temperature scanning of individuals prior to the attendance of these activities are not in the main 'death-blows' to the activities proceeding, the maintenance of the social distancing rules most definitely are.