Do not use hydroxychloroquine for COVID: National Taskforce

Matt Woodley

7/08/2020 1:48:21 PM

The strengthened recommendation stems from studies that show a lack of efficacy and potential harmful side effects.

Hydroxychloroquine tablets
Hydroxychloroquine should only be used for COVID-19 in very specific circumstances, such as approved randomised controlled trials.

The recommendation applies to adults, children and adolescents, pregnant and breastfeeding women, older people living with frailty, and those receiving palliative care.
Associate Professor Julian Elliott, Executive Director of the National COVID-19 Clinical Evidence Taskforce, said the evidence indicates hydroxychloroquine is potentially harmful and no more effective than standard care in treating patients with COVID-19.
‘We have reviewed all the scientific data around hydroxychloroquine and we can now say, definitively, that hydroxychloroquine should not be used as a treatment for anyone with COVID-19,’ he said.
‘There is now sufficient data for us to make a very clear and strong recommendation. In this instance, that is based on data from randomised controlled trials that enrolled nearly 6000 patients.
‘This is a substantial amount of very high-quality scientific data upon which we’ve based the recommendation.
‘The pooled results show the drug does not reduce mortality, or shorten the amount of time a sick person spends in hospital. It also exposes them to side effects including cardiac toxicity.’
The taskforce, of which the RACGP is a member, also warned against the use of hydroxychloroquine for post-exposure prophylaxis but said it may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include hydroxychloroquine.
Hydroxychloroquine was one of the first drugs touted as a potential treatment for COVID-19, after a small French clinical trial, run by a highly respected microbiologist, produced seemingly promising results shortly after the virus appeared in Europe.
These results were seized on by many, including world leaders Donald Trump and Jair Bolsonaro, following claims of a ‘100% cure rate’. The widespread promotion led to hoarding and shortages of the medication, which is critical for treating rheumatoid arthritis, mild systemic and discoid lupus erythematosus, or the suppression and treatment of malaria.
Australian billionaire Clive Palmer also purchased nearly 33 million doses of the drug and took out three-page advertisements in newspapers across the country labelling it the ‘best hope’ for people infected with coronavirus.
However, questions were soon raised regarding the design of the original trial and the drug’s claimed efficacy, after it was revealed four of the patients who received the medication still ended up either dead or in intensive care, but were excluded from the final paper.
Despite this revelation, debate regarding the continued use of the anti-malaria drug continued, especially after The Lancet published – then retracted – a major study that claimed coronavirus patients taking the drug were at higher risk of death and heart problems than those who were not.
Other further studies also indicated a lack of efficacy, but trials continued – including in Australia – and some were reported to show positive results.
This led to accusations of politicisation of hydroxychlroquine, and as recently as last week Australian Federal Liberal MP Craig Kelly stated Victorian Premier Daniel Andrews could be ‘jailed for 25 years’ for blocking the use of the drug.
Meanwhile, thousands of illegally imported doses have been intercepted by Australian Border Force and Mr Palmer is continuing to promote its use as a COVID-19 treatment, even challenging Western Australia’s hard border closure in the High Court in a reported effort to spruik the drug in person.
But regardless of the outcome of the proposed trial, the taskforce’s new recommendation would appear to indicate the use of hydroxychloroquine for COVID-19 will only continue in Australia in very specific circumstances.
‘For people exposed to individuals with COVID-19, only administer hydroxychloroquine for post-exposure prophylaxis in the context of randomised trials with appropriate ethical approval,’ a taskforce release stated.
‘There are ongoing prevention trials investigating the use of hydroxychloroquine to reduce the risk of contracting COVID-19, and the taskforce will continue to review these data as soon as they become available.’
In announcing the recommendation, Associate Professor Elliott said it is important to remember that there are already effective treatments available for people with COVID-19.
‘Just last week, the Taskforce strengthened its recommendation for the use of dexamethasone – an inexpensive, widely available steroid that has been shown to reduce the risk of death by 14% in patients requiring oxygen and 29% in ventilated patients,’ he said.
We also know that antiviral drug remdesivir has been shown to reduce the time to recovery for moderate or severe cases of COVID-19.
‘Australians should be reassured that our leading expert panels are reviewing new research every week to provide evidence-based guidance to clinicians on the frontline.’
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Dr Shikha Parmar   9/08/2020 1:13:51 AM

But, the door remains open for prophylaxis – but only post-exposure? There is a currently approved trial to study HCQ for prophylaxis for HCW’s Why contradict this? The basis for prophylaxis being how we understand the virus invades human cells and how HCQ can block this. In addition rheumatologists vehemently defend the safety of HCQ for their patients with autoimmune diseases who aren’t exactly robust individuals. This write-up leaves no scope for ongoing study or use as a mere week-long course in early Covid disease in the community to treat to avert disease progression, its touted benefit by clinicians the world-over who are championing this use. All in all a premature write-up by a taskforce of primary care doctors who are not treating the most sick in whom it’s not a great drug. But who I feel should be asking questions about its possible merit in early disease in the community or in prevention.

Dr Ada Comfort Nelson-Iye   15/08/2020 8:00:13 AM

I Thought there was evidence for it in early use as a triple therapy with AZT and zinc?

Dr Elias Youssef Samaha   15/08/2020 9:36:26 AM

Hydroxycholoroquine . I don’t understand why people are so for or against it. If a patient wants it , they are explained risks and benefits and make an informed decision there is no reason as to why they should be restricted from having it. We give drugs to patients all the time with potentially harmful side-effects

evidence: There is demonstrated efficacy in vitro (read lancet) rather than articles in the news, it works in vivo for renal COVID. RCTs showed it just doesn’t work for respiratory illness (which is the majority of Covid related disease) , this is probably related to different PH micro environment in the lungs reducing efficacy . Conclusion: more research needed .

Niti   29/08/2020 12:18:15 PM

The best trial done was conducted by Gilead that makes Remdesvir- talk about conflict of interest