Everyone understands the urgency to control the COVID-19 pandemic. Recently, there have been arguments claiming hydroxychloroquine is the solution to control this pandemic, in the form of published opinion pieces and online videos. As a pharmacist, I study everything about drugs, write treatment guidelines, practice evidence-based medicine and serve as the last line of defense between drugs and patients. I strongly disagree with these claims. In fact, these claims are working against our efforts to defeat COVID-19.
When we evaluate data in clinical settings where patient care and health interventions are present, we need to examine the quality of the data. We look at whether studies were designed and done well, and we update ourselves with the most recent data. What we have been calling for is randomization and control. Randomization assures each individual has an equal probability to be in any group, and that groups are as balanced as possible. Control reduces the influence of factors outside of what we want to study.
On July 15, Oxford University reported in a randomized and controlled study that hydroxychloroquine did not reduce 28-day mortality after randomly allocating 1,561 patients to receive hydroxychloroquine and 3,155 patients to receive standard care. On July 23, The New England Journal of Medicine published a study of 667 patients, who were randomly given hydroxychloroquine, hydroxychloroquine and azithromycin or standard care, with a 1:1:1 ratio. This study found that the use of hydroxychloroquine, either alone or with azithromycin, did not improve outcomes. Cardiac side effects, however, were more frequent in individuals receiving hydroxychloroquine. Other well-designed studies published earlier have all shown that hydroxychloroquine has no benefit in managing COVID-19. Earlier observational studies have also pointed out the lack of benefits and safety profile when treating COVID-19 patients with hydroxychloroquine.