WHO ‘strongly’ against hydroxychloroquine use for COVID-19 prevention
A WHO panel has issued a ‘strong recommendation’ against the use of hydroxychloroquine for the prevention of COVID-19.
Laboratory-based studies and non-randomized preliminary studies in humans initially led researchers and public health officials to support the use of hydroxychloroquine as a potential preventive treatment for COVID-19. However, as researchers gathered more evidence, the Food and Drug Administration (FDA) eventually revoked their emergency use authorization for treating COVID-19. Now, based on the findings of a new analysis, an international panel of experts strongly advises against the use of hydroxychloroquine to prevent COVID-19. These recommendations could help reduce the risk of experiencing adverse side effects from taking hydroxychloroquine unnecessarily. The guidelines could also help encourage the exploration of other therapies with more promising results. Research is currently underway to determine whether it is possible to repurpose existing medications to prevent or treat COVID-19. To guide healthcare professionals through this ever-evolving wave of new evidence, the World Health Organization (WHO) is creating a ‘living’ guideline outlining the most complete, accurate, up-to-date information on COVID-19 management.
This guideline also offers patients the chance to consider their best treatment options. The WHO have called it a ‘living’ guideline because they will continuously update it to reflect new knowledge. To create this living guideline, experts, doctors, patients, and methodologists from around the world are assessing existing studies to produce a set of universal recommendations. On March 1, 2020, the panel released the first installment of the living WHO guideline on drugs to prevent COVID-19 in the British Medical Journal. In this first installment, the panel evaluates whether hydroxychloroquine can help prevent COVID-19. These findings could focus research efforts on more effective, safer treatment and prevention options for COVID-19. It could also discourage doctors and patients from using a medication that is likely to do more harm than good.
Why focus on hydroxychloroquine?
Scientists developed hydroxychloroquine in 1946 to reduce the risk of getting malaria and help treat it. Today, doctors use the drug to treat several autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus.
Some early in vitro studies suggested that hydroxychloroquine may help reduce the risk of developing COVID-19 in several ways.
Hydroxychloroquine raises the pH inside of endosomes, a group of organelles inside cells that regulate the exchange of proteins and lipids. This may make it difficult for SARS-CoV-2 to fuse with cell membranes.
Some studies have also shown that hydroxychloroquine appears to block the release of SARS-CoV-2 viral particles from infected cells.
Once viruses enter cells, they take over the cell’s machinery to reproduce its own genetic material, ribonucleic acid (RNA). The cell typically releases these new viral particles with help from late-stage or mature endosomes.
Hydroxychloroquine appears to prevent the transport of new viral particles into these special endosomes, preventing their release.
But scientists have not confirmed most of these findings in humans, only in cells from organisms.
In one study, hydroxychloroquine had some antiviral effect in African green monkey kidney cells, but not in cell models from the lining of human airways.
Another study using macaque monkeys also concluded that hydroxychloroquine was not effective in preventing infection with SARS-CoV-2.
A few early studies, including small human studies without a control group, suggested that hydroxychloroquine could treat patients with COVID-19.
The FDA issued an emergency use authorization in March 2020 that allowed healthcare professionals to use hydroxychloroquine in teens and adults hospitalized for COVID-19 who weigh more than 110 pounds.
And doctors in many hospitals starting using hydroxychloroquine routinely in COVID-19 patients.
But even at the time of its issuing, the FDA noted that a person should only use the drug when a healthcare professional feels the possible benefits outweigh the risks.
That is because hydroxychloroquine carries substantial health risks, including:
- serious heart rhythm problems
- anemia
- low blood sugar
- damage to the tissues in the inner eye that may cause a vision problem
- worsening of neurological problems or seizures
- drug interactions, such as with some beta-blockers, antidepressants, antipsychotics, and methadone