No, hydroxychloroquine is not recommended against Covid-19

No, hydroxychloroquine is not recommended against Covid-19


The controversy over the administration of hydroxychloroquine for the home treatment of non-severe forms of Covid-19 is rekindled. But if it works for some doctors, the scientific literature and health authorities say more

(Photo: George Frey / AFP via Getty Images) After Piedmont updated its home care protocol to include the possibility of administering hydroxychloroquine to Covid-19 patients in the early stage of the disease, the controversy reopens on the now known antimalarial. The more or less famous experts, once again, are divided. But for the main health authorities and the scientific literature, the response is unanimous: hydroxychloroquine has not given evidence of efficacy either as a treatment in the symptomatic phase of Covid-19 or as a preventive drug, and therefore its administration is not recommended.

Not useful in severe forms, in hospitalized patients

Although at the beginning of the pandemic it was also strongly supported by some governments, it was soon realized that administering hydroxychloroquine in hospitalized patients did not give any benefit. In other words, its use did not lower the mortality rate of people being treated compared to that of control patients who had not received it. The strength of this evidence is all in the large numbers of Solidarity and Recovery, the two largest clinical trials in the world on Covid-19 therapy, which together involved thousands of patients.

Based on these evidences both the World Health Organization (WHO) and Ema and Aifa advise against the use of hydroxychloroquine.

Does not appear to serve for the prevention of infection

A Cochrane meta-analysis was published in February 2021 which included 14 clinical trials of hydroxychloroquine carried out in different countries, for a total of over 8,500 adults, including Covid patients and people who have taken the drug for the purpose of preventing infection. The survey results were disappointing, the authors write, who believe hydroxychloroquine is unlikely to protect against coronavirus infection. Furthermore, the data confirm that hydroxychloroquine has little or no effect on the risk of death and on the likelihood of the disease developing into more severe forms.

The WHO recently published a note on this: a " strong recommendation against the preventive use of hydroxychloroquine for individuals who do not have Covid-19 ", based on the evidence of the first living Guideline (ie a continuously updated guideline) published in the British medical journal which examines 6 studies (more than 6 thousand participants).

Not recommended for home treatment

Based on the results obtained from large international trials and the conclusions of meta-analyzes, not only the WHO but also the European Medicines Agency (Ema) and our Aifa do not recommend the use of hydroxychloroquine for Covid-19. Not even as a treatment for asymptomatic or mild forms in home care. Even in this case, in fact, the large numbers do not confirm the usefulness of the drug.

So why last December did the Council of State come out in favor of the use of hydroxychloroquine? In reality, the decision of the Council of State did not subvert Aifa's indications. As we clearly read in the document of our drug agency, in fact, "in patients with Sars-Cov-2 infection managed at home, of low severity and in the initial stages of the disease, there is more limited evidence that demonstrates the lack of efficacy at in the face of an increase in adverse events, albeit not serious ". Aifa therefore does not recommend the use of hydroxychloroquine, but does not prohibit its off-label prescription, which as such is not reimbursable by the national health service and can take place (just as confirmed by the State Council) "under the responsibility of the doctor prescriber and prior informed consent of the individual patient ".

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