Hydroxychloroquine (HCQ) is not a game changer in COVID-19. I'm going to give you an update on hydroxychloroquine and why there's some new evidence coming to light that is suggesting that hydroxychloroquine may not have been the game changer many were hoping for so we all know just a few weeks ago the FDA approved an emergency authorization for the use of hydroxychloroquine to treat COVID-19 patients now hydroxychloroquine was recommended by President Trump and health experts having not only strong reservations about the effectiveness of hydroxychloroquine against COVID-19 but also the potential cardiac side effects associated with it unlike the FDA the European regulators refused to clear a hydroxychloroquine against COVID-19 infections.

HCQ is not useful in Covid 19, HCQ cause QT Prolongation

Without more data chloroquine and hydroxychloroquine effectiveness against COVID-19 infections is unsubstantiated and was derived heavily from the research of controversial French researcher Didier Raoult now in his study he concluded that hydroxychloroquine along with azithromycin was effective in treating COVID-19 infections however there were significant problems with his study first the study was not randomized which means researcher bias would affect the results. second the study started with 26 patients but only the data from 20 patients were given of the six patients who had not included in the final data three were admitted to the ICU. one died and two patients left the hospital so by not including these six patients for the results also skewed Dr. Raoult also published a second observational study looking at 80 patients but again any study with few patients and no controls cannot determine if a drug works or not so people have been asking why do we need a clinical trial in research in the middle of a pandemic.

No Thalidomide Tragedy again?

We need treatment options now. I mean why not just get the drug and see what happens we've been using hydroxychloroquine for decades to treat lupus and malaria so what's the worst that can happen here. well history is taught us whenever we make clinical decisions and treatment options without evidence and research disastrous effects occur in the 1950s a German pharmaceutical company introduced a drug called thalidomide to treat pregnancy-related nausea and vomiting the company had no reliable evidence to back up its claims that the drug was safe many babies born to women who took thalidomide developed severe malformations and many died because of these conditions the term flipper baby was a term given to babies whose mothers had taken thalidomide during pregnancy despite being introduced in Europe the drug was never introduced into the United States market because of the diligence of an FDA Revere named Dr. Frances Kelsey Congress went on to pass a drug act in 1962 that revamped and toughened the U.S. drug approval process the strict FDA guidelines we have today are guided by the thalidomide tragedy and also in the back of the mind of physicians scientists and researchers.

So in this article I'm gonna go over some new research and evidence that suggests that hydroxychloroquine may not be the game changer many were hoping and touting it to be in fact the cardiac toxicity associated with hydroxychloroquine that was downplayed by many might be more real than we initially thought now. there are a lot of social media theories and anecdotal reports from other physicians and so-called experts and they might be right in their assessments and their treatments but remember until randomized controlled double blinded studies are done anecdotes are not facts no matter how badly we want to believe in them.

China Study on HCQ

So make sure that you subscribe to this domain so you get those updated COVID-19 articles that I post and that you join in our discussion and the community we have created so in a small study recently reported from China hydroxychloroquine was found COVID-19 patients get rid of the virus in fact hydroxychloroquine was not only found to be ineffective it was also more likely to cause side effects in the study 75 patients were assigned hydroxychloroquine with standard of care treatment and another 75 patients only received standard of care treatment the hydroxychloroquine group received a loading dose of 1200 milligrams daily for three days followed by a maintenance dose of 800 milligrams daily for the next two to three weeks even with a high dose of hydroxychloroquine the researchers concluded their study by saying they found no difference in the rate of viral load reduction or symptom alleviation between the group treated with hydroxychloroquine and the one that had not been and if it is true that hydroxychloroquine is ineffective then is it worth risking the cardiac toxicity more specifically ventricular arrhythmias with a QT prolongation from hydroxychloroquine.

See many people have been saying that we've been using hydroxychloroquine for decades to treat malaria lupus and inflammatory arthritis and the cardiac risks are low and the same should apply for COVID-19 infections but the doses we use to treat those diseases are much lower than the protocols clinicians and hospitals are using to treat COVID-19 infections the recommended dose to treat acute malaria with hydroxychloroquine is 800 milligrams then 400 milligrams at 6, 24 and 48 hours and with chloroquine the dose is 600 milligrams then 300 milligrams at 6, 24 and 48 hours the prophylaxis dose of hydroxychloroquine is 400 milligrams and 4 chloroquine is 300 milligrams once per week for two weeks before exposure and continued for four weeks after departure from an endemic area for lupus the maximum recommended dose of hydroxychloroquine is 400 milligrams once a day and for rheumatoid arthritis it is 600 milligrams once per day but we don't have a recommended daily dose for chloroquine and hydroxychloroquine and protocols and when to start treatment for COVID-19 infections in Korea a task force is recommending 400 milligrams of hydroxychloroquine every day but in China they're giving up to 1600 milligrams of hydroxychloroquine every day.

QT Prolongation due to HCQ in various studies

At Mount Sinai Hospital in New York their COVID-19 protocol is 400 milligrams PO twice a day for two doses then 12 hours later starting 400 milligrams PO once a day times four doses for a total of five days of therapy other hospitals in the US are treating COVID-19 patients with hydroxychloroquine 400 milligrams twice a day for the first day and then 200 milligrams twice a day for four days so the lack of reliable studies and lack of standard protocols has created confusion in even more questions so our higher dose is more effective but cause more side effects than lower doses and now the side effects more theoretical and rare than what we see in real life so some answers could be found in a recent study from NYU School of Medicine where researchers suggested the QT prolongation with hydroxychloroquine and azithromycin may not be as low as some have suggested so the study looked at 84 adult patients with COVID-19 who were treated with hydroxychloroquine and azithromycin combination and they found that in patients treated with hydroxychloroquine and azithryomycin QT prolonged significantly in 11 percent of patients.

QT prolonged greater than 500 milliseconds a known marker for risk of malignant arrhythmia and sudden cardiac death what was interesting was they said our data suggests that baseline QT prolongation is not a reliable predictor of severe QT prolongation in these patients and suggested that QT should be followed repeatedly in patients with COVID-19 infection treated with hydroxychloroquine and azithromycin particularly in patients with renal failure a common complication in patients with COVID-19 and in another study from Brazil researchers observed QTc prolongation greater than 500 milliseconds was seen in seventeen point nine percent of patients which is not too dissimilar from what has been reported in patients with COVID-19 using hydroxychloroquine at 11 percent myopathy has also been associated with chloroquine use in our study one patient developed rhabdomyolysis which is attributed to chloroquine and the drug was withdrawn in to patients myocarditis was suspected based on the CK-MB elevation since the first day of hospitalization suggesting myocarditis related to COVID-19 itself in such cases drugs prolonging QTc could lead to severe arrhythmias and in terms of dosages the Chinese study.

I talked about earlier showed no impact of hydroxychloroquine with a dose of 400 milligrams of hydroxychloroquine daily for five days on increasing virus negative conversion rate and alleviation of clinical symptoms in 30 patients with COVID-19 so the preliminary findings from the Brazilian study suggested that higher doses of chloroquine which researchers defined as greater than 1200 milligrams per day was associated with a higher risk for QT prolongation now eleven patients died in both dosage groups and researchers actually had to stop the study after six days citing cardiac rhythm problems in a high dosage group so some of these studies might be suggest that at low doses chloroquine and hydroxychloroquine is ineffective but that at higher doses you have a higher risk for QT prolongation and cardiac toxicity and could these side-effects be potentially potentiated by combining azithromycin a drug known to also cause QT prolongation and do we risk people dying of cardiac toxicity before realizing that hydroxychloroquine is ineffective so hospitals in Sweden have decided this was not a risk worth taking the Swedish guidance stated that considering the very low evidence of any significant effect on COVID-19 and since serious side-effects cannot be ruled out the use of chloroquine outside of clinical trials is not recommended.

In fact, the infectious disease Society of America is also no advising hydroxychloroquine and hydroxychloroquine with azithromycin combination only for COVID-19 clinical trials for now so we can speculate and discuss all day long about different treatment options and medications but this is why more research and studies need to be done so that we can make more conclusive decisions.

I'm not saying hydroxychloroquine is ineffective. I'm merely stating that there's nothing conclusive yet from the evidence to say that it is now there many physicians and hospitals who are using hydroxychloroquine and azithryomycin as part of their COVID-19 protocols despite having mixed evidence about its effectiveness and in my opinion this was driven mainly to quell the fear and uncertainty of the general public but the encouraging thing is there are now over 100 clinical trials being conducted to study hydroxychloroquine in COVID-19 and many of the medications have also shown promise including tocilizumab and remdesivir so my point is hydroxychloroquine and any other medication should still be investigated in the context of a clinical trial.

I know we're in the middle of a pandemic and people at spirit for a treatment option so that they can get on with their lives but treatment should be based on sound medical and scientific evidence and data this what do we have to lose attitude risks us having another thalidomide tragedy so if you have any questions or comments about what I went over in this article send me a message down below in the comment section.

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