May 8, 2020
5/8/2020: There are many factors to be considered in evaluation of a drug. The first issue is safety. Hydroxychloroquine has met that standard for 50 years in treatment of malaria, lupus and rheumatoid arthritis. The main potential side effect is adverse effect on the heart and that is infrequent.
A prescription for any treatment selects the intended patient based upon certain criteria. Is the patient without the disease? In this case the treatment is called preventative or prophylactic.
The treatment should be disease specific and in this case the physicians considering the use of hydroxychlorquine for the coronavirus symptoms is called “off label (not FDA approved for this use). It is not being proposed as virilcidal for SARS CoV 2. There is no such certified drug at present. It is being prescribed to affect the symptoms of a specific patient.
The next consideration for a use of a drug is for those presently affected by the disease is the disease stage at time of onset. Did it just start or is the disease progressive?
The magnitude of the disease in the patient is the next factor.
So why all the controversy concerning reports of hydroxychloroquine? So far the answer appears simple and logical. There is a difference in severity of the condition and the amount of the drug given.
The success reports have a patient population that are at the early stage of the disease and treated with low dose.
The failure reports are the use of those advanced to hospitalization and/or very high doses known to be toxic.
The complication in the negative reports are related to the amount of the dose. Those taking 200 mg twice day are not as sick and have fewer complications than those taking greater amounts. There also is the caveat that those getting the higher dose are those most severely effected and with other conditions.
For emphasis, the patients not likely to get a benefit are those in the hospitalized group. They are those (recent New England Journal Medicine) who are the sickest and those with most comorbidity (other disease conditions) and on the highest doses. This is not unexpected adverse result.
The two opposing views, may be agenda driven, but both have credible logical medical rationale. However, but each is based upon different patient selection and treatment parameters.
Bottom Line: It is legal for a patient and their doctor to decide on the individual’s treatment and/or prescription. You may decide with the advice of your physician.