By Erika Edwards – NBC News
Federal government guidance on the emergency use of the antimalarial drug hydroxychloroquine for coronavirus-infected patients may have made the drug a failure.
The reason is that the guideline limits its use to those sick enough to be hospitalized. However, many doctors suspect that if the drug is beneficial, can work better from the beginning of the disease.
“That is the case with any therapy,” said Dr. George Diaz, an infectious disease specialist at Providence Regional Medical Center in Everett, Washington. “Generally, the sooner you use it, the more effective it will be,” he said.
Antiviral treatments work by reducing the amount of virus in the body. They are best administered from the start, as symptoms begin and viral load remains low. For example, Tamiflu, an antiviral used to treat the flu, works best the sooner the patient takes it.
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“When you give it to someone who is already super sick, it probably won’t have an impact because the damage has already been done,” said Dr. Ken Lyn-Kew, a pulmonologist at the critical care department at National Jewish Health, a Denver hospital. .
A handful of critical care doctors across the country have confirmed to NBC News that they have seen no evidence that the drug is helping their sickest patients in intensive care.
“We have been using it, but have not observed any efficacy”, explained Dr. Hugh Cassiere, pulmonologist and medical director of Respiratory Care Services at North Shore University Hospital in Long Island (New York), focus of the pandemic in the United States.
“I’m not convinced it works,” said Lyn-Kew, adding: “I have not seen anyone have anything close to what they would call a miraculous recovery due to hydroxychloroquine.”
In Louisiana, Dr. Josh Denson, a pulmonary medicine and critical care physician at Tulane University Medical Center in New Orleans, noted that “many patients are fine and tolerated,” but “he doesn’t think that makes a difference.” .
“We are using it. It is all we have,” Denson said. Louisiana has also been hit hard by the coronavirus, with at least 16,284 cases and 582 deaths.
“I can’t say I think he’s an effective agent right now,” added Diaz, from the Providence Regional Medical Center in Washington state. Díaz participated in the treatment of the first patient in the country diagnosed with the coronavirus.
New use for an old medicine?
Hydroxychloroquine, and a related compound called chloroquine, is a drug that has been around for decades. It is used to treat malaria, as well as certain autoimmune diseases, including rheumatoid arthritis with lupus.
President Donald Trump and other political and corporate leaders have touted the use of the medication after some small studies suggested that it might be effective against the coronavirus.
Last month, the Food and Drug Administration (FDA) issued an emergency use authorization, allowing healthcare providers to use the drug, even though it has not been approved as a treatment. specific against the pandemic. It is unclear how many hospitals across the country have tested hydroxychloroquine.
“UC San Diego Health does not endorse the use of drugs that do not have scientific evidence of safety and efficacy,” the hospital system wrote in an email to NBC News, adding that researchers who are preparing to participate in clinical trials do their own studies of the drug.
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Critical care physicians at Northwestern Medicine in Chicago are also not using it. “According to our team at the Intensive Citizens Unit (ICU), the data supporting its use is insufficient for routine use, particularly when a patient becomes seriously ill,” argued Dr. Ben Singer, assistant professor of medicine in pulmonary and critical care Northwestern University Feinberg School of Medicine.
This week, the Centers for Disease Control and Prevention (CDC) withdrew its guidance for using hydroxychloroquine to fight coronavirus on the agency’s website, no longer offering recommendations for dosing. The CDC has also removed information about those early studies of the drug.
What science says
One of the first studies looking at hydroxychloroquine as a possible treatment for the pandemic came out of China in early February. That study looked at how the drug behaved at the cellular level, but did not examine how it would work in patients.
Small studies from later China and France hinted that the drug may be effective in treating patients with COVID-19. However, the journal that published the French study later reported that the article did not meet the expected standard.
But “those reports spoke of patients who received a particular medication and then got better. We know that most people with COVID-19 get better on their own,” said Dr. Wesley Self, an emergency physician at the University Medical Center. Vanderbilt in Nashville. , Tennessee, who studies the drug.
“If you take those same people and don’t give them medication, many of them would offer similar recovery rates,” Self said. In other words, these patients may have improved clinically, whether or not they got hydroxychloroquine.
Furthermore, those studies were published online before undergoing what is called a peer review, meaning that other scientists did not have a chance to analyze the data and point out possible flaws. Peer review is considered essential for quality research.
“People take these little studies and quote them as if they were the Gospel,” Lyn-Kew lamented. “We need real science behind this disease,” adding that doctors are “desperate to find something that will help the population.”
Science to come
Doctors across the country are investigating, in real time, to see if the drug could be beneficial in treating severe cases or even preventing coronavirus infections.
Researchers from NYU Langone New York Medical Center and the University of Washington Medical Center in Seattle are recruiting 2,000 people who have been in contact with infected patients but have not developed symptoms. Participants will receive hydroxychloroquine or vitamin C every day for two weeks, and will undergo periodic tests to detect the disease.
The study “Could provide answers for the summer on whether a preventive dose of the drug is safe and effective”, according to a press release released by NYU Langone. “If so, the strategy could give health officials a much-needed boost to slow down person-to-person transmission.”
New York Governor Andrew Cuomo said last Monday that state doctors are moving ahead with hydroxychloroquine testing for COVID-19 patients because “there has been superficial evidence that it is promising.”
But until there is definitive and solid research on the subject, doctors have very vague evidence of the effectiveness of hydroxychloroquine. Some details suggest a benefit, others do not.
Vanderbilt’s Self is leading a randomized clinical trial investigating the drug. Patients will be randomly selected to receive hydroxychloroquine or a placebo. Neither the patients, nor the doctors, nor the people who will evaluate the results at the end of the project will know which patients received the actual medication and which patients received a fake pill.
Ten patients have been enrolled in the past four days. But “it is too early to know whether the drug is working or not,” Self recalled.
Potential for harm and hope
All medications have possible side effects. Hydroxychloroquine is no different. The medicine can cause irregular heartbeats, which can be fatal in some patients. Very sick people in intensive care units may be at particular risk because they tend to be more susceptible to the side effects of medications in general, according to Self. “We have to understand if the side effects of this drug are worse than any improvement it can bring,” Self said.
Because the drug is believed to work best from the start, the Vanderbilt study is only enrolling patients within the first 10 days of developing symptoms of the disease, such as cough, fever, extreme fatigue, or shortness of breath. .
Hydroxychloroquine “clearly promises”. Self said. “But we need the data from clinical trials to understand what it’s doing in our patients. We have a duty to know that before we start prescribing it to thousands and potentially millions of people,” he concluded.
Also read:
How much does it cost to recover from the coronavirus in the United States?
Health authority alerts against the use of chloroquine to prevent and treat coronavirus. A man died for it
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