COVID-19 & Hydroxychloroquine
By Dr. Rosalind Ramsey Goldman
Solovy Arthritis Research Society
Research Professor at Northwestern Medical
This article was written in response to published articles like the the one on newsweek here.
There are no studies that have looked at whether or not using hydroxychloroquine will prevent the infection with the COVID-19 virus. However, we are recommending that patients continue their medications for their rheumatic diseases, and this includes hydroxychloroquine for patients with lupus. If patients become symptomatic and they are worried about this or other infections, they should seek guidance from their rheumatologists and/or other treating physicians.
Because there is a biologic basis for considering the use of an anti-malarial such as hydroxychloroquine, in the treatment of COVID-19, this drug was tried in France in hospitalized patients to see if the virus was cleared faster than those who did not receive this treatment. In addition, some patients also received an antibiotic. Patients treated with either hydroxychloroquine alone or with antibiotic did clear the infection faster than those who did not receive these medications. This was a very small study, both patients and physicians knew what they were getting because this was an open label study, and this study has yet to be peer reviewed by scientific journals. Therefore, one would ideally want more information before this is an accepted treatment. There is some confusion over whether or not the FDA has approved hydroxychloroquine for COVID-19 so this too needs to be confirmed.
Since hydroxychloroquine has been used for many years, its safety profile is well known, as opposed to experimental medications with limited use in humans or with those medication used for other conditions. This information from France is encouraging, but it needs to be studied further. This is one of the treatments being used in the US and there are disease registries being set up to get as much information as possible to understand the role of hydroxychloroquine in the treatment of COVID-19.
For patients with lupus, they should continue their medication, but there may be difficulties getting long term or even new prescriptions filled. There are plans to work together with multiple advocacy groups supporting patients with rheumatic diseases such as lupus to ensure that our patients get the medications they need for their underlying disease while also working with those who are treating patients with the current COVID-19 infection. This is an unprecedented time where stakeholders are collaborating world-wide to control and treat this new viral infection.
Addendum: added 3.23.20:
For those on hydroxychloroquine (plaquenil) as part of your treatment for lupus, please do not change your dose unless directed to do so by your rheumatologist. As reported in the media, higher doses of hydroxychloroquine (plaquenil) were used in the small and uncontrolled study in France where they measured the amount of virus still in the blood stream. This was not a treatment study and was not controlled (please see comments above). We do not know the safety of this medication when used in these high doses in the setting of COVID-19 infection. As mentioned above, we need to know a lot more before routinely prescribing hydroxychloroquine (plaquenil) as a treatment for COVID-19. If it is used to treatment COVID-19, it should only be used under the supervision of a physician and ideally within the context of a study.