Dr. M Blatstein's Blog

BOP | COVID-19 | Hydroxychloroquine | The Science

BOP/ COVID-19 / Hydroxychloroquine / The Science Was Not There

BOP buys $60,000 worth of hydroxychloroquine

White House economic adviser Peter Navarro reportedly clashed with the National Institute of Infectious Diseases director Dr. Anthony Fauci over the efficacy of hydroxychloroquine as a coronavirus treatment.

Unproven COVID-19 treatment drug;

Many Trump-friendly pundits, however, are convinced of the drug’s effectiveness, most notably those on Fox News shows from which the president is known to take policy cues.

INDICATIONS:

Malaria (not recommended for the treatment of complicated malaria.)

Lupus Erythematosus

Rheumatoid Arthritis: the treatment of acute and chronic RA in adults.

Common side effects of Hydroxychloroquine include:

  • nausea,
  • vomiting,
  • stomach pain or cramps,
  • loss of appetite,
  • weight loss,
  • diarrhea,
  • dizziness,
  • spinning sensation,
  • headache,
  • ringing in your ears,
  • mood changes,
  • nervousness,
  • irritability,
  • skin rash,
  • itching, or
  • hair loss.

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Clinical Effectiveness COVID-19 Resources Available to All

UpToDate (Medical Experts for Physicians)

Clinical Effectiveness COVID-19 Resources

Drugs – COVID-19

Coronavirus disease 2019 (COVID-19): Management in adults

 

I) Hydroxychloroquine/chloroquine— 

There are insufficient data thus far to know whether hydroxychloroquine or chloroquine has a role in the treatment of COVID-19. For this reason, we strongly recommend that patients should be referred to a clinical trial whenever possible.

If hydroxychloroquine or chloroquine is used outside of a clinical trial, the potential for adverse effects should be carefully assessed. (See “Coronavirus disease 2019 (COVID-19): Arrhythmias and conduction system disease”, the section on ‘Monitoring for QT prolongation.)

 

Ia) Azithromycin and hydroxychloroquine –

We do not routinely use azithromycin in combination with hydroxychloroquine for treating COVID-19. Although one study suggested the use of azithromycin in combination with hydroxychloroquine was associated with more rapid resolution of virus detection than hydroxychloroquine alone [62], this result should be interpreted with caution…

 

II) Remdesivir (Testing canceled, not because the drug wasn’t working, but because it proved too difficult to enroll the required number of patients. (Endpoints News))

…is a novel nucleotide analog that has activity against SARS-CoV-2 in vitro [43] and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies [44]. Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 [45].

IIa) The WHO is launching a trial to further evaluate:

…remdesivir, hydroxychloroquine/chloroquine, and lopinavir-ritonavir with and without interferon beta [76]. Various other antiviral and immunomodulating agents are in various stages of evaluation for COVID-19. A registry of international clinical trials can be found on the WHO website and at clinicaltrials.gov.

 

III) Convalescent plasma —

In the United States, the Food and Drug Administration (FDA) is accepting investigational new drug applications for use of convalescent plasma for patients with severe or life-threatening COVID-19 [50]; pathways for use through these applications include clinical trials, expanded access programs, and emergency individual use.

 

IV) Tocilizumab

…is an interleukin (IL)-6 receptor inhibitor used for rheumatic diseases and cytokine release syndrome. Elevated IL-6 levels have been described in patients with severe COVID-19, and case reports have described good outcomes with tocilizumab [66-69].