June 2, 2020
Antimalarial drug touted by Trump is linked to increased risk of death in coronavirus patients
BOSTON, MA - A study of 96,000 hospitalized coronavirus patients on six continents found that those who received an antimalarial drug promoted by President Trump as a “game changer” in the fight against the virus had a significantly higher risk of death compared with those who did not.

People treated with hydroxychloroquine, or the closely related drug chloroquine, were also more likely to develop a type of irregular heart rhythm, or arrhythmia, that can lead to sudden cardiac death, it concluded.

The study published Friday in the medical journal Lancet is the largest analysis to date of the risks and benefits of treating covid-19 patients with antimalarial drugs. Like earlier smaller studies, it delivered disappointing news to a world eager for promising treatments for the novel coronavirus as the global death toll grows to more than 300,000. While doctors have refined how they treat the disease, they have yet to discover a magic bullet against a pathogen for which humans have no known immunity.

“It’s one thing not to have benefit, but this shows distinct harm,” said Eric Topol, a cardiologist and director of the Scripps Research Translational Institute. “If there was ever hope for this drug, this is the death of it.”

David Maron, director of preventive cardiology at the Stanford University School of Medicine, said that “these findings provide absolutely no reason for optimism that these drugs might be useful in the prevention or treatment of covid-19.”

At a White House press briefing Friday, Deborah Birx, who is coordinating the government’s coronavirus response, deflected a question about the president’s use of the drug, and added the Food and Drug Administration “has been very clear on their website about their concerns about hydroxychloroquine."

The Lancet analysis, by Mandeep Mehra, a Harvard Medical School professor and physician at Brigham and Women’s Hospital, and colleagues at other institutions, included patients with a positive laboratory test for covid-19 who were hospitalized between Dec. 20, 2019, and April 14, 2020, at 671 medical centers worldwide. The mean age was 54 years, and 53 percent were men. Those who were on mechanical ventilators or who received remdesivir, an antiviral drug made by Gilead Sciences that has shown promise in decreasing recovery times, were excluded.

Mehra said in an interview that the widespread use of antimalarials for covid-19 patients was based on the idea of “a desperate disease demands desperate measures,” but that we have learned a hard lesson from the experience about the importance of first doing no harm.

In retrospect, Mehra said, using the drugs without systematic testing was “unwise.”

“I wish we had had this information at the outset, as there has potentially been harm to patients,” he said.

Nearly 15,000 of the 96,000 patients in the analysis were treated with hydroxychloroquine or chloroquine alone or in combination with a type of antibiotics known as a macrolide, such as azithromycin or clarithromycin, within 48 hours of their diagnosis. The study is a retrospective analysis of their medical records, rather than a controlled study in which patients are divided randomly into treatment groups, the method considered the gold standard of medicine. But the sheer size of the study was convincing to some scientists.

And the difference between those who received the antimalarials and those who did not was striking.

For those given hydroxychloroquine, there was a 34 percent increase in risk of mortality and a 137 percent increased risk of a serious heart arrhythmias. For those receiving hydroxychloroquine and an antibiotic, the cocktail endorsed by Trump — there was a 45 percent increased risk of death and a 411 percent increased risk of serious heart arrhythmias.

Those given chloroquine had a 37 percent increased risk of death and a 256 percent increased risk of serious heart arrhythmias. For those taking chloroquine and an antibiotic, there was a 37 percent increased risk of death and a 301 percent increased risk of serious heart arrhythmias.

Cardiologist Steven Nissen of the Cleveland Clinic said the new data, combined with data from smaller previous studies, suggests that the drug “is maybe harmful and that no one should be taking it outside of a clinical trial.” (Source: The Washington Post)
Story Date: May 23, 2020
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