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Hydroxychloroquine for Coronavirus

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Hydroxychloroquine (brand name Plaquenil), a treatment for rosacea, [and the related drug, chloroquine (brand name Arelene)] has been in the news for its alleged ability to treat coronavirus, mostly due to President Trump’s advocacy on its use during the pandemic. President Trump suffers from rosacea. This subject has ‘divided the medical community’ according to The New York Times. The American Society for Biochemisty and Molecular Biology reports that there are few published papers on this subject, acknowledging that one small study in France was 'encouraging,' however, other reports indicate that hydroxychloroguine are 'not effective for treating coronavirus.' [1] According to Forbes, "The Food and Drug Administration on Sunday issued an emergency authorization for experimental coronavirus treatments using chloroquine and hydroxychloroquine, anti-malaria drugs touted by President Donald Trump despite inconclusive clinical proof of their efficacy." 

Hydroxychloroquine for Rosacea
Hydroxychloroquine is also classified as an antiprotozoal treatment along with the larger category of anti-parasitic agents and is just one treatment for rosacea that is being investigated along with other rosacea treatments, with clinical papers indicating its use in improving rosacea. [3]

Hydroxychloroquine has been shown to be effective in treating rosacea. [2] Duffman reported in April 2017, "The only thing that finally worked for me with long lasting, real remission, is plaquenil." [3] Virus and rosacea has never, ever been ruled out

Hydroxychloroquine for Coronavirus
Dan Charles, on April 3, 2020, NPR reports, "Dr. Anthony Fauci of the National Institutes of Health was asked March 24 whether the drug was considered a treatment for the novel coronavirus."The answer is no," he said, "and the evidence that you're talking about ... is anecdotal evidence." "

James Hamblin, MD, staff writer for The Atlantic, wrote an article on the history of this subject on April 6, 2020 explaining in detail how the president has been advocating the use of this drug for the coronavirus epidemic, and concludes, "It is unclear how hydroxychloroquine would work to treat COVID-19, but the drug is one of many now being urgently studied for the treatment of the disease." [4] Two other anti-parasitic drugs being studied are ivermectin and metronidazole, both treatments are used for rosacea. [5]

The American Academy of Ophthalmology states on its website concerning hydroxychloroquine and chloroquine that, "These drugs may stop the immune system from going overboard in its attack on the virus." [6]

If you are interested in a clinical trial with hydroxychloroquine you may want to contact Elizabeth Oelsner, Columbia University. Of course, you won't be able to know whether you actually receive hydrochloroquine or the placebo. The CDC lists on it's Information for Clinicians on Therapeutic Options for COVID-19 Patients that "Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19."

A Chinese clinical study published in Cell Discovery concluded, "In conclusion, our results show that HCQ can efficiently inhibit SARS-CoV-2 infection in vitro. In combination with its anti-inflammatory function, we predict that the drug has a good potential to combat the disease. This possibility awaits confirmation by clinical trials." [7] 

Another Chinese study states, "In this study, hydroxychloroquine exhibited better in vitro anti-SARS-CoV-2 activity than chloroquine." [8]

The French study that may have started all this states, "In conclusion, we confirm the efficacy of hydroxychloroquine associated with azithromycin in the treatment of COVID-19 and its potential effectiveness in the early impairment of contagiousness. Given the urgent therapeutic need to manage this disease with effective and safe drugs and given the negligible cost of both hydroxychloroquine and azithromycin, we believe that other teams should urgently evaluate this therapeutic strategy both to avoid the spread of the disease and to treat patients before severe irreversible respiratory complications take hold." [9]

The controversy about hydroxychloroquine continues. "Not all researchers have given up on the drug, however, and recent developments show it is not yet dead as a potential weapon against COVID-19, especially as a preventative in people not yet exposed to the virus." [10]

The controversy about hydroxychloroquine continues. "Not all researchers have given up on the drug, however, and recent developments show it is not yet dead as a potential weapon against COVID-19, especially as a preventative in people not yet exposed to the virus." [10]

More on Coronavirus and Rosacea 

End notes

[1] A small trial finds that hydroxychloroquine is not effective for treating coronavirus, Katherine Seley-Radtke, April 05, 2020, ASBMBTODAY

[2] Int Immunopharmacol. 2020 Jan 06;79:106178
Hydroxychloroquine is a novel therapeutic approach for rosacea.
Li J, Yuan X, Tang Y, Wang B, Deng Z, Huang Y, Liu F, Zhao Z, Zhang Y

[3] Plaquenil (Hydroxychloroquine)

[4] Why Does the President Keep Pushing a Malaria Drug?, The Atlantic

The Guardian also has its version of the history of this subject. 

[5] Ivermectin Treats Coronavirus

[6] Treating Coronavirus With Plaquenil and Aralen, Reena Mukamal, AAO

[7] Cell Discov 6, 16 (2020). 
Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro
Jia Liu, Ruiyuan Cao, Mingyue Xu, Xi Wang, Huanyu Zhang, Hengrui Hu, Yufeng Li, Zhihong Hu, Wu Zhong & Manli Wang

[8] ciaa237.pdf

[9] COVID-IHU-2-1.pdf

]10] Hydroxychloroquine is not dead yet, Lisa Cavazuti, NBC News

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"South Dakota Gov. Kristi Noem on Monday announced a statewide clinical trial of hydroxychloroquine for the possible treatment of COVID-19, making her state the first in the country to institute a program exploring the potential effectiveness of the drug in treating and preventing coronavirus."

South Dakota implements statewide hydroxychloroquine clinical trial for potential coronavirus treatment, Fox News

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Updates

"But trials of other treatments, including those involving hydroxychloroquine, a malaria drug touted by President Trump, have been stopped because of a lack of efficacy and concerns about toxicity."
Blood thinners show promise for boosting the survival chances of the sickest covid patients
May 7, 2020 at 10:30 am Updated May 7, 2020 at 2:22 pm, By Ariana Eunjung Cha, The Washington Post

"There is currently not enough data available to support the routine use of HCQ and CQ as therapies for COVID-19. Pending further results from more extensive studies with more stringent study parameters, clinicians should defer from routine use of HCQ and CQ. There are several clinical trials currently underway with results expected soon."
Acad Emerg Med. 2020 May 2. doi: 10.1111/acem.14005. [Epub ahead of print]
A Rapid Systematic Review of Clinical Trials Utilizing Chloroquine and Hydroxychloroquine as a Treatment for COVID-19.
Chowdhury MS, Rathod J, Gernsheimer J.

"In this observational study involving patients with Covid-19 who had been admitted to the hospital, hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death."
NEJM, May 7, 2020, DOI: 10.1056/NEJMoa2012410
Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19
Joshua Geleris, M.D., Yifei Sun, Ph.D., Jonathan Platt, Ph.D., Jason Zucker, M.D., Matthew Baldwin, M.D., George Hripcsak, M.D., Angelena Labella, M.D., Daniel Manson, M.D., Christine Kubin, Pharm.D., R. Graham Barr, M.D., Dr.P.H., Magdalena E. Sobieszczyk, M.D., M.P.H., and Neil W. Schluger, M.D.

"It’s been some days since I posted on the hydroxychloroquine situation versus the coronavirus epidemic, but I have been getting plenty of inquiries....So overall we have one positive report (very positive indeed, and an outlier in that respect) and two safety warnings. Make of this what you will."
Hydroxychloroquine Update, Derek Lowe, May 4, Clinical Trials, In the Pipeline, AAAS

"Two studies published recently medical journals found that the anti-malaria medication hydroxychloroquine failed to help hospitalized coronavirus patients."
The malaria pill hydroxycholoroquine failed to help coronavirus patients in 2 big studies, Business Insider, Yahoo News

 

 

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In summary, this multinational, observational, real-world study of patients with COVID-19 requiring hospitalisation found that the use of a regimen containing hydroxychloroquine or chloroquine (with or without a macrolide) was associated with no evidence of benefit, but instead was associated with an increase in the risk of ventricular arrhythmias and a greater hazard for in-hospital death with COVID-19. These findings suggest that these drug regimens should not be used outside of clinical trials and urgent confirmation from randomised clinical trials is needed.

The Lancet
Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

Prof Mandeep R Mehra, MD 
Sapan S Desai, MD
Prof Frank Ruschitzka, MD
Amit N Patel, MD

Update: June 4, 2020

Retraction: "Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis"

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Update

"A massive study that raised health concerns over hydroxychloroquine, the anti-malaria drug touted by President Trump as a coronavirus treatment, is coming under scrutiny from scientists who are demanding to see the data behind it."

Massive hydroxychloroquine study raising health concerns about the drug under scrutiny from scientists, Tal Axelrod, The Hill, MSN

"After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure."

N Engl J Med DOI: 10.1056/NEJMoa2016638
A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19
David R. Boulware, M.D., M.P.H., Matthew F. Pullen, M.D., Ananta S. Bangdiwala, M.S., Katelyn A. Pastick, B.Sc., Sarah M. Lofgren, M.D., Elizabeth C. Okafor, B.Sc., Caleb P. Skipper, M.D., Alanna A. Nascene, B.A., Melanie R. Nicol, Pharm.D., Ph.D., Mahsa Abassi, D.O., M.P.H., Nicole W. Engen, M.S., Matthew P. Cheng, M.D., et al.

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"The U.S. Food and Drug Administration revoked its emergency authorization for hydroxychloroquine, a controversial malaria drug promoted by President Donald Trump for treating the coronavirus. The agency said in a letter the decision is based on new evidence that made it unreasonable to believe hydroxychloroquine and chloroquine "may be effective in diagnosing, treating or preventing" COVID-19, the illness caused by the virus."

Hydroxychloroquine: FDA pulls emergency use of malaria drug touted by Trump to treat the coronavirus
Adrianna Rodriguez
USA TODAY
 

 

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UPDATE

"The study concluded that treatment with hydroxychloroquine significantly reduces the death rate of COVID-19 patients, Zervos said. Of those treated with hydroxychloroquine alone, 13% of them died, compared to the 26.4% who died and were were not treated with the drug. There was an overall 18.1% in-hospital mortality rate and patients were over the age of 18, with a median age of 64."

Hydroxychloroquine is effective in treating COVID-19, says Henry Ford Health System study, Andrew Mullin, MLive

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UPDATE

"Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19." 

Annals of Internal Medicine, 16 Jul 2020
Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19
A Randomized Trial
Caleb P. Skipper, MD et al

"Hydroxychloroquine did not lead to faster symptom improvement among patients who had Covid-19 symptoms and were not hospitalized, according to a new study published Thursday in the Annals of Internal Medicine." 
New Covid-19 study, despite flaws, adds to case against hydroxychloroquine
By MATTHEW HERPER, STAT

"Hydroxychloroquine does not appear to keep people from getting the disease after they’ve been exposed to someone who has it. It does not change how many people hospitalized with Covid-19 die of the disease. It does not reduce symptoms for people with milder cases who aren’t in the hospital."
Hydroxychloroquine Still Doesn’t Do Anything, New Data Shows, Wired

"The first randomized clinical trial testing hydroxychloroquine as an early treatment for mild covid-19 found the drug was no better than a placebo in patients who were not hospitalized."
Hydroxychloroquine studies show drug is not effective for early treatment of mild covid-19
Laurie McGinley, The Washington Post, MSN 

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