Incomplete facts: Washington Post says anti-malaria drug increasingly linked to deaths, omitting available screening protocols
“In the largest reported cohort of COVID-19 patients to date treated with chloroquine/hydroxychloroquine {plus minus} azithromycin, no instances of TdP or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.”
The CDC web site has liberally advised the use of hydroxychloroquine as a preventive medicine for Americans traveling to areas where malaria is transmitted.
By TATIANA PROPHET
Friday May 15, 2020.
The Washington Post, always on the lookout to protect your health, published a pre-emptive strike against anti-malaria drug hydroxychloroquine, citing as the news hook “a growing cache of data linking the anti-malaria drug to serious cardiac problems.” (Oddly, they must have expected Trump to “tout” the drug at least one more time, and he did not disappoint, announcing to a gobsmacked press corps on Monday May 18 that he himself had been taking the drug under the guidance of the White House doctor, for a week and a half as a preventive measure).
Read the article here: Drug promoted by Trump as coronavirus ‘game changer’ increasingly linked to deaths
Alarmed by this growing data cache, “some drug safety experts are now calling for even more forceful action by the government to discourage its use,” the authors wrote. Several have called for the FDA to revoke its emergency use authorization, given hydroxychloroquine’s documented risks.” The first forceful action was when the FDA on April 30 warned against use of the drug outside a hospital setting due to the potential for cardiac problems.
That warning came on the heels of a study from the Veterans Administration hospital that was widely publicized by multiple media outlets. The study was observational and not double-blinded, randomized or controlled as the medical community has been calling for. And it was retrospective, meaning it looked at records after resolution of a patient’s case.
Wrote the Washington Post on April 21, “More than 27 percent of patients treated with hydroxychloroquine died, and 22 percent of those treated with the combination therapy died, compared with an 11.4 percent death rate in those not treated with the drugs, the study said. The results were from an observational study of outcomes and were not part of a randomized, placebo-controlled clinical trial, which is the gold standard for testing drugs.”
What the article didn’t tell you was that many of the patients in the medicated group had a blood condition; and all of the patients received the drug after being sedated and placed on ventilators. The literature on hydroxychloroquine is that it inhibits the entry of the virus into cells, specifically the hemoglobin, and that it also appears to calm the so-called cytokine storm that appears to result as an overactive immune response to try to combat the novel coronavirus that causes Covid-19. All of that activity would occur before the need for a ventilator.
Further, the original study in the Lancet that prompted an interest in its use for this pandemic showed HCQ inhibits many viruses in vitro; and it clearly stated that it was more promising early on, and as a prevention due to the fact that it counteracts an acidic environment needed for the coronavirus to latch on to the cell.
Yet it was the Veterans Administration retrospective study alone that was the hyperlink over one word: “lives.” That is what the May 15 WaPo authors said people had to lose, in answer to President Trump’s question when “touting” the drug.
The May 15 article goes on to describe a longer QT interval (time between heartbeats) associated with hydroxychloroquine in some patients.
What the May 15 article failed to reveal was that the Mayo Clinic, concerned about a small percentage of cardiac patients who might suffer from “torsades de pointes,” even leading to sudden death from drug-induced cardiac arrest due to prolonged QT, issued an emergency screening guidance to help clinicians get the most out of the repurposed malaria drug while still protecting cardiac patients at risk.
You can read the Mayo guidance here: Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19).
The guidance stated: “In advance of more definitive evidence, clinicians on the front lines of the pandemic have begun to use these medications under the auspices of “off-label,” “compassionate-use,” or FDA-approved Emergency Use Authorization (for chloroquine and hydroxychloroquine) with anecdotal success. In light of (1) the need for this practice to continue in the absence of viable, evidence-based therapies and (2) the proclivity of many promising COVID-19 pharmacotherapies specifically antimalarial agents such as hydroxychloroquine to prolong the QTc, thereby increasing the risk of drug-induced torsades de pointes (DI-TdP) and drug induced-sudden cardiac death (DI-SCD), this document was assembled to help health care professionals safely use these medications and minimize concomitant risks.”
The guidance concludes that 90 percent of those screened with a positive Covid test would be able to receive hydroxychloroquine. See chart:
A study published by the American Heart Association on April 29, similarly found prolonged QT, but no deaths from the administration of hydroxychloroquine or chloroquine with azithromycin antibiotic as compared with the control. The study concluded: “In the largest reported cohort of COVID-19 patients to date treated with chloroquine/hydroxychloroquine {plus minus} azithromycin, no instances of TdP or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.”
Whatever the motive of the Washington Post, they did not use complete facts in publishing this article. Instead, they went with the initial fear anyone feels when hearing about risks in a certain part of the population, and instead of searching for a solution that would allow this long-time drug touted by the CDC for decades to be used to save lives, they used a snarky tone to look down on the President for bringing the therapy to light.
President Trump announced to a gobsmacked White House press corps Monday morning that he had been taking the anti-malaria drug hydroxychloroquine for a week and a half as a preventive measure against Covid-19. There are currently at least five studies under way around the world to look at the drug’s potential as a preventive therapy against SARS-CoV-2 in health care workers and first responders. Trump told the press that the White House doctor had prescribed it for him. The CDC has pushed the drug for years on its web site for short term use in travelers going to areas of the world where malaria is transmitted.
