Amid hydroxychloroquine hopes, lupus patients face shortages

March 23, 2020|Psychiatry

Blazer understands that people are scared and says it’s natural that they would want to protect themselves. But she said, the medicine is a limited resource and should be reserved for people with a rheumatological disease or active Covid-19 infection. In order to minimize fallout from the pandemic, she says, “we all have to function as a community.”

As it turns out, there is an extreme paucity of data when it comes to hydroxychloroquine and Covid-19. On March 10, the Journal of Critical Care published online a systematic review of the safety and the effectiveness of hydroxychloroquine and chloroquine in treating Covid-19. The authors’ goal was to identify and summarize all available scientific evidence as of March 1 by searching scientific databases. They found six articles. (In contrast, a search of the database PubMed for hydroxychloroquine and lupus yields 1,654 results.)

“The articles themselves were kind of a menagerie of things that you don’t want to get data from,” said Michael Putman, a rheumatologist at Northwestern University, McGaw Medical Center, in his rheumatology podcast. The study authors found one narrative letter, one test tube study, one editorial, two national guidelines, and one expert consensus paper from China. Conspicuously missing were randomized controlled trials, which randomly assign human participants to an experimental group or a control group, with the experimental group receiving the treatment in question.

“It is kind of scary that that is all the data we had until March 1, for a drug that we are currently talking about rolling out en masse to the world,” said Putman.

Shortly after the systematic review appeared online, Didier Raoult announced the results of his team’s clinical trial. (The paper is now available online.) At first blush, the results are striking. Six days into the study, 70 percent of patients who received hydroxychloroquine were “virologically cured,” as evidenced from samples taken from the back of each patient’s nose. In contrast, just 12.5 percent of the control group, which did not receive the drug cocktail, were free of the virus.

But experts who have looked more closely at the study have begun raising questions about whether the medication is responsible for the groups’ different outcomes. Alfred Kim, a rheumatologist, researcher, and director of the Washington University Lupus Clinic, noted that the French study was small, with just 42 total participants, and only 26 patients actually receiving the medication. Six patients also ended up dropping out of the study — all of them from the group receiving hydroxychloroquine. Among these, three were transferred to the intensive care unit, one died, one left the hospital, and one stopped the treatment because of nausea. Kim suggested some of these could be viewed as failures of the drug to work against the virus.