There isn’t enough evidence that decades-old anti-malarial drugs work for the treatment or prevention of coronavirus, but here’s what we do know so far.
President Donald Trump’s excitement about decades-old anti-malarial drugs to treat the coronavirus has touched off widespread interest in the medications, hoarding by some doctors, new clinical trials on the fly and desperation among patients who take them for other conditions.
Many experts say there isn’t enough evidence that the drugs work for the coronavirus, but at least a few say there’s little to lose in giving hydroxychloroquine to patients who are severely ill with coronavirus.
“It’s unlikely to worsen COVID-19, and given that it might help ... we have literally nothing else to offer these patients other than supportive care,” said Dr. David Juurlink, an internist and head of the division of clinical pharmacology and toxicology at the University of Toronto in Canada.
Here’s what we know and don’t know about the drugs, chloroquine and hydroxychloroquine, also known by the brand name Plaquenil.
What We Know
The drugs are approved by the U.S. Food and Drug Administration, but not for the treatment of the coronavirus.
The drugs have been around for decades and are approved by the FDA. Hydroxychloroquine has been
approved for the prevention and treatment of acute attacks of malaria, as well as lupus and rheumatoid arthritis. Chloroquine is approved to prevent and treat malaria.
At a
briefing on March 19, Trump suggested that the FDA had approved hydroxychloroquine for treatment of the coronavirus, which is not accurate. At the same briefing, Dr. Stephen Hahn, the FDA’s commissioner said: “That’s a drug that the president has directed us to take a closer look at, as to whether an expanded-use approach to that could be done to actually see if that benefits patients. And again, we want to do that in the setting of a clinical trial — a large, pragmatic clinical trial — to actually gather that information and answer the question that needs to be answered and — asked and answered.”
That said, doctors are generally allowed to prescribe drugs for unapproved uses.
A number of hospitals are using the drug to treat patients with the coronavirus.
The
University of Washington, the
University of Michigan and other academic medical centers have added hydroxychloroquine to their treatment protocols. “Hydroxychloroquine is an inexpensive and generally safe drug for short term use, with few drug-drug interactions,” the University of Washington protocol says. “While it is unknown if it is effective to treat COVID-19, there is a favorable risk:benefit and cost ratio. Multiple trials are ongoing, and this recommendation will be updated when further data is available.”
While Trump has talked about the combination of hydroxychloroquine and the antibiotic azithromycin, also known as Zithromax, the University of Michigan recommends against the use of azithromycin for use in treatment of COVID-19, calling the evidence “weak.”
Patients who rely on hydroxychloroquine for other conditions can’t get it.
As we reported last week,
patients with lupus have not been able to refill their prescriptions. Anna Valdez, a nurse in California, told us that without the drug, she will likely have a disease flare or have to switch to stronger immune suppressing medicines that could, paradoxically, put her at more risk of serious consequences should she contract the coronavirus.
“When I think about the other people out there with lupus and other autoimmune disorders, we’re all really scared right now,” Valdez said a week ago. “If I get coronavirus, unlike someone else my age, almost 50 years old, who is likely to recover and will be fine, I will likely end up in the ICU.”
According to a report by
BuzzFeed News, health insurer Kaiser Permanente seems to be prioritizing getting the drug to COVID-19 patients above patients with lupus. The insurer told a California patient that it would not refill her prescription for hydroxychloroquine. “Thank you for the sacrifice you will be making for the sake of those that are critically ill; your sacrifice may actually save lives,” her doctor’s office said in a message.
A Kaiser regional medical director told BuzzFeed that Kaiser, like other health care organizations, “has had to take steps to control the outflow of the medication to ensure access to severely sick patients, including both COVID-19 and those with acute lupus.”..
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