Plain Language Summary of COVID-19 and Hydroxychloroquine
Swinging the pendulum: lessons learned from the public discourse concerning hydroxychloroquine and COVID-19. Sattui et al. Expert Review of Clinical Immunology 2020 in press
Lay Summary Contributed to by: Kristen J. Young, Akpabio Akpabio, Ariella Coler-Reilly, Herman Tam, Alice Lin, Carly Harrison, Emily Sirotich on behalf of the C19-GRA Lay Research Summaries Team
Introduction:
The COVID-19 pandemic has disrupted many parts of our lives, including scientific research. There has been a race to try to identify safe and effective treatments such as antimalarials. This article examines the “pendulum swing” from early enthusiasm related to Hydroxychloroquine (HCQ) to widespread skepticism of its effectiveness.
Interest in HCQ
Antimalarials like Hydroxychloroquine (HCQ) and it’s more toxic relative Chloroquine (CQ) have been effective against the virus in laboratory studies. It was hoped that this would translate to humans, and indeed initial research in China as of early February 2020 suggested that HCQ was beneficial. As the pandemic became more widespread, scientists from France also corroborated this finding. By mid-March, endorsement as a miracle cure for both treatment and prevention by popular figures ignited a media frenzy that resulted in widespread HCQ shortages globally. Late March saw the Food and Drug Administration (FDA) authorize emergency use of HCQ for hospitalized patients followed by its addition to the drug shortage list as companies reported limited supplies.
Scepticism of HCQ
In early April, there were suggestions that lupus patients could not develop COVID-19 if they were on HCQ. This myth was quickly dispelled by initial data from the COVID-19 Global Rheumatology Alliance (GRA) that indicated otherwise. Later that month, reports of serious heart problems began to emerge especially when HCQ was combined with the antibiotic Azithromycin. Further studies even suggested that more patients treated with HCQ died, though such data had its limitations. This was followed by advisories from national agencies such as the National Institutes of Health (NIH) and Food and Drug Administration (FDA) by late April 2020.
Current Evidence
By May 2020, the scientific community was beginning to realize that maybe HCQ was not the ‘game changer’ they had initially hoped for as further studies showed it was ineffective. The largest, published in the popular journal – The Lancet, resulted in the temporary suspension of drug trials involving HCQ following safety concerns. In another twist, however, it was discovered that the data source for the large study was questionable, leading to the withdrawal of the popular article and others that used the same data. Nonetheless, as of early June 2020, several reliable global drug trials had shown that HCQ was ineffective. This led the World Health Organization (WHO) and other similar bodies to finally halt studies involving antimalarials like HCQ.
Patient perspective and conclusion
Following initial hope of a “miracle drug” for COVID-19, misinformation and drug shortages have created doubts among rheumatic patients and the general public. Going forward, there is a need to provide reliable information and ensure better coordination between providers, advocacy groups and patient care partners. Well-designed clinical trials are necessary and possible during a public health emergency. Premature use of unstudied therapies can delay clinical trial enrollment and potentially harm recipients. The pendulum appears to have swung to a stop, and it is hoped that multiple lessons have been learned.