Recommendations, trials don't find benefit from hydroxychloroquine for COVID-19

New guidance from ACP and recent trials do not support the use of hydroxychloroquine for COVID-19, and a pharmacokinetic analysis showed potential problems with lopinavir/ritonavir therapy.

ACP issued a set of practice points addressing whether clinicians should use chloroquine or hydroxychloroquine alone or in combination with azithromycin for prophylaxis or treatment of COVID-19. The conclusion, based on a systematic evidence review, was that they should not, due to known harms and no available evidence of benefit. However, the guidance said that in the context of a clinical trial, clinicians may use the drugs to treat hospitalized COVID-19-positive patients, using shared and informed decision making with patients (and their families). The points were approved by the ACP Board of Regents on May 4 and published by Annals of Internal Medicine on May 13. They will be updated as new evidence becomes available. A new edition of Annals Consult Guys also focuses on hydroxychloroquine.

Several studies published in the past week failed to find benefit from hydroxychloroquine in COVID-19. A retrospective analysis of 1,438 patients hospitalized in New York, published by JAMA on May 11, found no significant differences in inpatient mortality among patients receiving hydroxychloroquine, azithromycin, both drugs together, or neither drug. Cardiac arrest was significantly more likely in patients receiving both drugs together than those receiving neither. A trial of hydroxychloroquine in hospitalized Chinese patients with persistent but mostly mild to moderate cases of COVID-19 did not find a significant difference in the rate of negative conversion between 75 patients randomized to the drug and 75 who didn't receive it, according to results published by The BMJ on May 14. Similarly, no differences in outcomes were found in a retrospective study of French patients with COVID-19 who required oxygen but not intensive care, also published by The BMJ on May 14. Rates of ICU transfer and survival were similar in the 84 patients who received hydroxychloroquine within 48 hours of admission and the 89 patients who did not receive it.

In other recent research on potential therapies for COVID-19, a letter published by Annals of Internal Medicine quantified trough plasma concentrations of lopinavir and ritonavir in eight patients hospitalized for COVID-19. The patients received 400 mg of lopinavir and 100 mg of ritonavir twice daily for three to 10 days before the analysis, but the observed trough levels make “effective treatment of COVID-19 with lopinavir and ritonavir at the currently used doses unlikely,” the authors concluded.