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TL;DR: President Trump keeps hyping a potential coronavirus treatment – a “cocktail” of hydroxychloroquine and azithromycin. Does it work? Well, it doesn’t appear to be a miracle cure, but some early evidence suggests it might help. South Korea and China recommend it. Lots of doctors are prescribing it. There are risks, of course, and it might not actually help. More tests are needed.
The coronavirus drug cocktail Trump is obsessed with
In late March, President Trump tweeted excitedly about a potential drug treatment for the coronavirus.
“HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine,” the president tweeted.
Since then, Trump has extolled the virtues of this cocktail, even as his medical advisers and other experts have urged caution. There’s no proof that the drugs are effective, the experts have said. There are risks and potential side effects. And the rush on the drug in the wake of the presidential endorsement has tightened supplies for people who depend on it to treat other conditions.
As with most things Trump, the discussion about HCQ has gotten passionate and politicized. Fans rally around a creative new use of an old drug, and cast anyone urging caution as an obstructionist bureaucrat. Meanwhile, others blast the president as a reckless charlatan.
So what’s the truth?
Is the hydroxychloroquine-azithromycin cocktail a coronavirus wonder drug?
Or does it do nothing?
With the help of Andy Dunn, Insider’s pharma and biotech reporter, I spent the past two days trying to figure that out. I also tried to answer a specific question: If I get sick, and my doctor recommends trying it, would I try it?
Here’s what I learned …
What is it?
As Andy explains, hydroxychloroquine is an old antimalarial drug that’s been around since the 1950s. It’s a “generic” medication also used to treat lupus and arthritis. It’s cheap. It’s widely available (at least when people aren’t hoarding it). And it comes in a simple pill.
Hydroxychloroquine works by slowing the rate at which a virus reproduces itself. This, the theory goes, buys time for a person’s immune system to build up its own defences to take on the coronavirus.
Does it work?
In some small, early, and subsequently criticised trials, hydroxychloroquine and a hydroxychloroquine-azithromycin cocktail appear to have helped people recover faster and avoid the most severe symptoms of COVID-19.
Medical experts, including Trump adviser Dr. Anthony Fauci, caution that this evidence is anecdotal and that further studies are needed.
The head of the American Medical Association, Dr. Patrice Harris, regards use of the drug for this purpose as dangerous, warns that it could kill you, and says she would not prescribe it.
Well, what’s the evidence?
On the positive side, lab experiments have concluded that hydroxychloroquine (HCQ) has some antiviral effect on the coronavirus.
A study of 62 patients in China who were treated for COVID-19 in February concluded that patients treated with HCQ recovered faster than a control group. Thirty-one patients who took the drug stopped coughing and reduced fevers earlier than 31 patients in a control group. The four patients of the 62 who got seriously sick were in the control group. But two patients in the HCQ group had “adverse reactions.”
A study released in late March by a research team in France also found anecdotal evidence that the hydroxychloroquine-azithromycin cocktail was effective.
The French team studied 42 patients with moderate to mild symptoms. Twenty-six received hydroxychloroquine, and 16 were in a control group. The study described a startling “100%” recovery rate among the patients who took hydroxychloroquine.
But while personalities such as the celebrity physician Dr. Oz soon celebrated this apparently amazing success, there were a number of significant issues with the study.
First, the recovery rate of patients who took HCQ actually wasn’t 100%. That was just the percentage of patients who took HCQand completed the study.
As Michael Hiltzik of the Los Angeles Times has meticulously reported – and as the study itself says – six of the patients who took HCQ didn’t finish the study. One dropped out because he or she died. (!) Three dropped out because their symptoms worsened and they were moved to intensive care. A fifth stopped taking the medication because it made him or her sick. The last left the hospital on day three of the study and went home, after testing negative for the virus on the previous two days.
The doctor who led the French study is himself no stranger to controversy. He was once temporarily barred from publishing research in a medical journal after a paper with his name on it contained misleading data. He has ridiculed climate change. In January, he scoffed at the idea that the coronavirus was a global health hazard, calling the idea “crazy.”
As for the study itself, the publishing society that sponsors the journal where the data appeared said the study did not meet their “expected standard,” and other researchers have raised concerns about the quality of the data generated by the study.
Other studies, meanwhile, have found HCQ to be less effective or ineffective.
A small study of 30 patients published by the Journal of Zhejiang University, in China, found the hydroxychloroquine to be no more effective than treatment without the drug.
A second study in France found “no evidence” of benefit in patients with severe COVID-19 symptoms. So if the HCQ-azithromycin cocktail does help patients early on, by the time the infection has progressed it may be too late.
Overall, there seems to be a consensus that hydroxychloroquine shows enough promise to at least move forward with more trials. A “study of studies” concluded this. More studies are now underway.
What about the risks?
Chloroquine is considered a relatively “safe” drug, at least when used as directed. But that doesn’t mean it doesn’t have some nasty potential side effects.
These side effects aren’t just irrelevant “fine print.” Hospitals in Sweden, in fact, have stopped using hydroxychloroquine to treat COVID-19 because the side effects have been so strong.
In addition to nausea, some of the complications experienced by patients cited in the FDA’s write-up of Plaquenil, a branded version of the drug, include:
- “Irreversible retinal damage.”
- “Life-threatening and fatal cardiomyopathy.”
- “Skeletal muscle myopathy or neuropathy leading to progressive weakness and atrophy of proximal muscle groups, depressed tendon reflexes, and abnormal nerve conduction.”
- “Suicidal behaviour.”
- If you take too much of it – unsurprisingly – it can kill you.
Also, as with other substances, you have to be certain you’re taking the right drug. After Trump recommended hydroxychloroquine, a couple in Phoenix took some chloroquine phosphate – aka fish-tank cleaner. The husband died and his wife was hospitalized.
So, what to conclude?
Everyone agrees that more studies are needed. Happily, they’re coming soon.
But South Korea and China have already recommended that doctors use the drug to treat COVID-19. Doctors in France have been prescribing it. And many US doctors seem persuaded that hydroxychloroquine is at least worth trying.
Insider’s Andy Dunn shared a recent survey of 6,227 physicians conducted by the research firm Sermo. It found that they already consider hydroxychloroquine the most effective treatment of COVID-19.
Andy also passed on a chart from the investment advisory firm Raymond James showing that prescriptions for the drug began surging even before Trump’s breathless tweet.
Even the US Food and Drug Administration has gotten on board, issuing an emergency-use authorization to allow prescriptions of HCQ for COVID-19 – prescriptions that doctors have apparently already been writing for weeks.
So it seems a lot of medical experts agree with the conclusion of the authors of the Chinese study from February: “Considering that there is no better option at present, it is a promising practice to apply HCQ to COVID-19 under reasonable management.”
Would I take it?
Yes. Based on what I know at this moment, if I got COVID-19 and my doctor suggested I try HCQ, I’d take it. I wouldn’t have high hopes that it would help. And I’d expect it might make me feel nauseated, or worse. But I’d probably give it a try. (That’s not advice to you or anyone else, obviously.)
Huge thanks to my colleagues (pharma and biotech reporter)Andy Dunn and (healthcare editor) Zach Tracer, without whom I – and now you – would be much less informed. Thanks again to all of you for reading this second edition of Insider Today. Please feel free to share your thoughts by writing to me at [email protected]