What happened to hydroxychloroquine against Covid-19?

Among critical voices of those who still support its potential validity against Covid, in recent months the results of several studies have arrived that instead deny its usefulness

(photo: Marilia Kimie Shimabukuro / Getty images) Enthusiasm, caution and finally widespread skepticism, if not surrender. That of hydroxychloroquine was what we could now define as a downward parabola. At the beginning of the pandemic, the hypothesis of being able to use old drugs such as chloroquine and hydroxychlorine in fact appeared interesting for several reasons. The possible activity of drugs against the new coronavirus suggested by some doctors and preclinical analyzes, with the hypothesis of an antiviral activity already advanced at the time of Sars, combined with the fact that we were talking about old and cheap medicines (and also used in diseases autoimmune, such as lupus and rheumatoid arthritis) had sparked the enthusiasm. Too much, with President Trump declaring that he was taking hydroxychloroquine for preventive purposes.

All of this was happening in a period - at the turn of April and May - in which antimalarials in the fight against Covid were actually seen by the scientific community only as a potential treatment. At that time there was no certain evidence of their efficacy for both preventive and therapeutic purposes. There was basically no rationale and evidence of efficacy so strong as to justify the enthusiasm, even then. So much so that AIFA had also intervened in the matter: despite the entry of antimalarials into clinical practice, the evidence on their effectiveness was incomplete, he explained, "a randomized study that evaluates their clinical effectiveness is urgently needed". And our own doctors themselves after the first few moments began to declare themselves less enthusiastic about the use of hydroxychloroquine.

In the while, however, next to the experiences reported by the clinical practice, the problems on some research, came also the results of the studies prepared in recent months to make the most complete evidence on the possible effectiveness of hydroxychloroquine . And not only resize the enthusiasm, but them diminish substantially. It did, only a few days ago the immunologist Anthony Fauci , who was interviewed by Andrea Mitchell of Msnbc on the topic, said : “The scientific data, the cumulative data about the trial, that is to say of the clinical trials that were randomized and controlled properly, they have all consistently shown that hydroxychloroquine is not effective”.

The hopes on hydroxychloroquine have begun to be resized at the beginning of June, with the arrival of the results from the few experiments set up to investigate the potential of the drug in the fight against Covid-19 . Some of these came from the clinical trial launched by the world health Organization (Who), the Solidarity . In the absence of evidence on the ability of the hydroxychloroquine to reduce mortality in patients hospitalized with Covid, Who had decided to stop this arm of the treatment. A few days before the same results were arrived experts of the trial, the british Recovery : no clinical benefit for hospitalized patients. In a matter of a few days, however, to the same conclusions as would be arrivat the clinicians of the Orchid Study overseas: no benefit compared to placebo for hospitalized patients.

while the Food and Drug Administration has revoked the use emergency of antimalarial granted by hospitals for patients who could not be included in clinical trials and in the light of lack of evidence of effectiveness. Also l’ Aifa , before that, was suspended (and later confirmed ) the use of drugs outside of clinical trials, both in the hospital and home. To all this we added also data from other randomised clinical trials which had shown how the hydroxychloroquine is not to help or prophylactically administered post-exposure or to speed up the negativizzazione of the patients. He wrote a few days ago in an editorial on the Annals of Internal Medicine-Neil W. Schluger of the New York Medical College, doing the balance of what he calls the “saga of the hydroxychloroquine, and Covid-19” .

The opportunity, to Schluger, is the publication of a new study that hydroxychloroquine does not help to reduce the symptoms in patients with mild forms of the disease, who are not hospitalized (with all the limitations of the study, for example, to lack of ability of the test he was able to test only a part of the population involved). The latest chapter of a saga now to be considered practically over, writes Schluger, including the critical voices of those who take hydroxychloroquine is still a valid option, maybe used early in patients at the highest risk, at different doses, or in combination with zinc. “It's time to turn the pages on the hydroxychloroquine,” concludes Schluger in his editorial. Where have explains how the failure of a drug within the testing is far from exceptional, happens frequently, and only represents the way in which science works . Method challenged in times of pandemic, by not a few difficulties, argues the expert, from those to set up clinical trials , dissemination of preliminary results and incomplete on this or that treatment, to the desire – part of it is understandable – to want to believe that something will work. All: patients, doctors, and politicians, he writes.

The same opinion of Schulger is also the Scientific Medical Policy Committee of the American College of Physicians, which, passing in review the evidence in the field has stated – and reiterated – as now exists in favour to justify the use of the drossiclorochina and chloroquine alone or in combination with azithromycin to prevent the disease after infection nor to treat it. Because in the face of known risks – such as those of the cardiac – no evidence of effectiveness, it is law yet.