New data shows Hydroxychloroquine linked to greater risk of death in COVID-19 patients

Of all the experimental therapeutics targeted at critical COVID-19 cases, hydroxychloroquine (HCQ) has procured the most scrutiny from the media but now some of that scrutiny may be justified. In a new comprehensive study published in The Lancet that reviewed 96,000 coronavirus patients, it was found that subjects who were treated with HCQ dramatically increased their risk for death compared to those who didn’t take the anti-malaria drug,  

The drug was approved for medical use in the US back in 1955 for the treatment and prevention of malaria. However, since then HCQ, commonly administered under the brand name Plaquenil, has proven to be effective in mitigating symptoms associated with rheumatoid arthritis, lupus, and porphyria cutanea tarda.

“Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for the treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety, and benefit of these treatment regimens are poorly evaluated in COVID-19,” the authors wrote in the new paper. “We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for the treatment of COVID-19.”

Even when operating productively, hydroxychloroquine has been known to have serious side effects, including muscle weakness, vomiting, and heart arrhythmia.

Fourteen-thousand eight hundred and eighty-eight patients were treated with hydroxychloroquine or chloroquine in the new analysis, either alone or in combination with a macrolide, while the remaining 81,144 patients in the control group were treated with traditional supportive care. 

Roughly 10,700 participants died while in the hospital. After the researchers controlled for relevant factors, including age, race, sex, and underlying health conditions, there was a 34% increase in the risk of mortality for patients who took hydroxychloroquine and a 137% increased risk of serious heart arrhythmia.  

Further inspection revealed that abnormally high BMI’s emerged as a risk marker for worse in-hospital survival. Obesity is an independently documented risk factor for cardiac arrhythmias and sudden cardiac death.

These alarming findings arrive in the wake of a study published just last week in the JAMA Network that found that HCQ did not alleviate  Covid-19 symptoms but instead placed infected patients at an increased risk of cardiac arrest.

Early this year, limited research intimating HCQ’s utility with respect to the coronavirus pandemic was tailed by a series of unfortunate outcomes. In reaction, various health systems published documents directing those who are prescribed HCQ for any of the chronic conditions listed above to continue taking it, while more research is conducted in service of its role in SARS-CoV-2 prevention.  

The absence of an effective treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has led clinicians to redirect drugs that are known to be effective for other medical conditions to the treatment of COVID-19. Key among these repurposed therapeutic agents are the antimalarial drug chloroquine and its analogue hydroxychloroquine,” the authors conclude. ”This multinational, observational, real-world study of patients with COVID-19 requiring hospitalization 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 randomized clinical trials is needed.”

CW Headley is a reporter for the Ladders and can be reached at cheadley@theladders.com.

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