HCQ may harm Covid patients: Lancet study

The study’s authors say that these drug regimens should not be used to treat Covid-19 outside of clinical trials, and that urgent confirmation from randomised clinical trials is needed.

A study published on Friday in The Lancet has found links between the use of chloroquine or hydroxychloroquine and increased rates of mortality and heart arrhythmias among hospital patients with Covid-19.

The study’s authors say that these drug regimens should not be used to treat Covid-19 outside of clinical trials, and that urgent confirmation from randomised clinical trials is needed. United States President Donald Trump has been a persistent and vocal promoter of hydroxychloroquine.

Prof (Dr) Frank Ruschitzka, Director of the Heart Center at University Hospital Zurich and one of the co-authors of the study told The Indian Express over the phone that treatment with the antimalarial drug chloroquine or its analogue hydroxychloroquine (taken with or without the antibiotics azithromycin or clarithromycin) offers no benefit for patients of Covid-19.

“This is the largest observational study done so far. Clearly the use of the drug for treating Covid-19 patients shows harm, and I am very concerned. It is reasonably safe to treat malaria. But there is no benefit of this drug for Covid patients. We have studied patients from across the world and there is no reason to assume Indian patients would do any better,” Dr Ruschitzka said.

On Friday, India reiterated its recommendation for prophylactic use of HCQ, and the treatment recommendation for HCQ and azithromycin in certain cases.

“Joint Monitoring Group and NTF have now recommended the prophylactic use of HCQ in all asymptomatic healthcare workers involved in containment and treatment of COVID-19 and asymptomatic healthcare workers working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks, asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities and asymptomatic household contacts of laboratory confirmed cases,” a revised advisory issued late on Friday night said.

The drug, though, is not to be used in people with retinopathy, hypersensitivity to the disease, cardiac problems, or glucose 6 phosphate deficiency. It is also not to be used in pregnant or lactating mothers of children aged less than 15 years. Use has to be preceded by an ECG.

The Lancet study analysed data from nearly 15,000 patients with Covid-19 receiving a combination of any of the four drug regimens and 81,000 controls.

“Several countries have advocated use of chloroquine and hydroxychloroquine, either alone or in combination, as potential treatments for Covid-19. Justification for repurposing these medicines in this way is based on a small number of anecdotal experiences that suggest they may have beneficial effects for people infected with the SARS-CoV-2 virus. However, previous small-scale studies have failed to identify robust evidence of a benefit and larger, randomised controlled trials are not yet completed. However, we now know from our study that the chance that these medications improve outcomes in Covid-19 is quite low.” Dr Ruschitzka said.

Prof (Dr) Mandeep R Mehra, lead author of the study and Executive Director of the Brigham and Women’s Hospital Center for Advanced Heart Disease in Boston, said: “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. Our findings suggest it may be associated with an increased risk of heart problems and increased risk of death…”

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