No evidence of benefit for anti-malarials in COVID-19 patients, study says

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A large observational study suggests that treatment with the antimalarial drug chloroquine or its analogue hydroxychloroquine, taken with or without the antibiotics azithromycin or clarithromycin, offers no benefit for patients with the novel coronavirus (COVID-19), according to new research published in The Lancet.

Following the study publication, the World Health Organization (WHO) halted its hydroxychloroquine trial for COVID-19, citing safety concerns. President Donald Trump, who previously stated he was taking hydroxychloroquine as a preventative measure, has since announced he is no longer taking the drug.  

The study analyzed data from nearly 15,000 patients with COVID-19 receiving a combination of any of the four drug regimens and 81,000 controls. For the study, researchers analyzed data from 96,032 patients hospitalized between December 20, 2019 and April 14, 2020 with laboratory confirmed SARS-CoV-2 infection from 671 hospitals. All the patients included in the study had either been discharged or had died by April 21, 2020.

The team compared outcomes from patients treated with chloroquine alone (1,868), hydroxychloroquine alone (3,016), chloroquine in combination with a macrolide (3,783) or hydroxychloroquine with a macrolide (6,221). Patients from these four groups were compared with the remaining control group of 81,144 patients.

At the end of the study period, around one in 11 patients in the control group had died in hospital. All four of the treatments were associated with a higher risk of dying in hospital. Of those treated with chloroquine or hydroxychloroquine alone, around one in six patients had died. When the drugs were used in combination with a macrolide, the death rate rose to more than one in five for chloroquine and almost one in four for hydroxychloroquine.

Treatment with these medications among patients with COVID-19, either alone or in combination with macrolide antibiotics, was also linked to an increased risk of serious heart rhythm complications in these patients. The team found that serious cardiac arrhythmias, which cause the lower chamber of the heart to beat rapidly and irregularly, were more common in the groups receiving either of the four treatment regimens.

Researchers suggest these treatment regimens should not be used to treat COVID-19 outside of clinical trials until results from randomized clinical trials are available to confirm the safety and efficacy of these medications for COVID-19 patients.

Chloroquine is an antimalarial drug and its analogue, hydroxychloroquine, is used to treat autoimmune diseases including lupus and arthritis. Both drugs have a good safety profile as treatments for those specific conditions, and researchers said the findings do not imply patients should stop taking these drugs if they are prescribed for approved conditions.

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