Risks of hydroxychloroquine use for COVID-19 prophylaxis
Authors: Muskaan Sachdeva, Monica Shah, Michael Ziv, Eyal Leshem, Roni P. Dodiuk-Gad
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: We were very pleased to read the article by Alia et al,1Alia E. Grant-Kels J.M. Does Hydroxychloroquine combat COVID-19? A timeline of evidence.J Am Acad Dermatol. 2020; 83: e33-e34Abstract Full Text Full Text PDF Scopus (23) Google Scholar "Does hydroxychloroquine combat COVID-19? A timeline of evidence." After thoroughly summarizing the literature studies on the efficacy and safety of hydroxychloroquine (HCQ), they rightly concluded that there is currently no robust evidence to support prescribing HCQ as a treatment or prophylaxis for COVID-19. As they mentioned, the United States President Donald Trump tweeted on March 21, 2020, that HCQ and azithromycin "taken together, have a real chance to be one of the biggest game changers in the history of medicine" and further urged that these drugs "be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST."1Alia E. Grant-Kels J.M. Does Hydroxychloroquine combat COVID-19? A timeline of evidence.J Am Acad Dermatol. 2020; 83: e33-e34Abstract Full Text Full Text PDF Scopus (23) Google Scholar,2Narea N. Trump's reckless promotion of hydroxychloroquine to fight coronavirus, explained: it might not be the "game changer" Covid-19 treatment the president promised. Vox; 2020.https://www.vox.com/2020/3/26/21193912/trump-hydroxychloroquine-coronavirus-treatmentDate accessed: March 31, 2020Google Scholar Furthermore, on March 22, 2020, the National Task force of India for COVID-19 recommended that high-risk individuals—asymptomatic health care workers of laboratory- suspected or confirmed cases and household contacts of laboratory-confirmed cases—be placed on a 400 mg/wk dose of HCQ prophylaxis for 7 weeks.3Indian Council of Medical ResearchAdvisory on the use of hydroxychloroquine as prophylaxis for SARS-CoV-2 infection. 2020.https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloroquinasprophylaxisforSARSCoV2infection.pdfDate accessed: March 27, 2020Google Scholar We would like to bring attention to the dangerous medical consequences of these endorsements by guideline recommendations and institutional leaders, which have led to asymptomatic individuals using HCQ without prescriptions and without awareness of the serious adverse effects of this drug. This is a serious potential risk, especially because consuming higher than standard doses can lead to fatal outcomes. In the United States, an asymptomatic man recently died, and his wife was hospitalized in critical condition, after self-medicating for COVID-19 using HCQ prophylaxis.2Narea N. Trump's reckless promotion of hydroxychloroquine to fight coronavirus, explained: it might not be the "game changer" Covid-19 treatment the president promised. Vox; 2020.https://www.vox.com/2020/3/26/21193912/trump-hydroxychloroquine-coronavirus-treatmentDate accessed: March 31, 2020Google Scholar France's drug safety agency has also linked the deaths of 3 asymptomatic people to potential self-medication with HCQ.4France 24French watchdog warns of dangerous side effects of unproven COVID-19 treatments. 2020.https://www.france24.com/en/20200331-french-watchdog-warns-of-dangerous-side-effects-of-unproven-covid-19-coronavirus-treatmentsDate accessed: March 31, 2020Google Scholar In Italy, a similar case was anecdotally reported, with 1 individual dying from prophylactically consuming nonprescribed HCQ. Further, there has been a report of HCQ poisoning after 2 asymptomatic individuals from Nigeria self-medicated, leading to overdose.5Democracy Now! Two Nigerians Overdose Self-Medicating with Chloroquine After Trump Praised Anti-Malaria Drug as Possible COVID-19 Treatment. 2020.https://www.democracynow.org/2020/3/23/headlines/two_nigerian_overdose_self_medicating_with_chloroquine_after_trump_praised_anti_malaria_drug_as_possible_covid_19_treatmentDate accessed: March 31, 2020Google Scholar Recently, a Brazilian trial immediately halted the high dose use of HCQ (600 mg as opposed to 450 mg) after 11 patients died by the day 6 of the intervention.6National PostCOVID-19: Brazilian trial for drug touted by Trump halted after 11 patients die on high dose. 2020.https://nationalpost.com/news/world/covid-19-brazil-trial-for-drug-chloroquine-touted-by-trump-stopped-after-11-patients-dieDate accessed: April 15, 2020Google Scholar Health officials, including France's drug safety agency, Mayo Clinic Proceedings, and the British Columbia Centre for Disease Control, have now publicly addressed the importance of recognizing that HCQ is associated with severe and some fatal adverse effects. Thus, we suggest that politicians, governments, and health care providers avoid the recommendation of HCQ prophylactic treatment to the public without evidence-based information and critically appraise upcoming studies on COVID-19 treatment and prophylaxis before formulating guidelines. We encourage individuals to avoid purchasing HCQ without prescriptions and medical consultations, because self-medicating can lead to accidental overdoses. Further research is required with transparent reporting of adverse effects to evaluate the efficacy of HCQ as a prophylactic agent for COVID-19. Does hydroxychloroquine combat COVID-19? A timeline of evidenceJournal of the American Academy of DermatologyVol. 83Issue 1PreviewTo the Editor: Chloroquine (CQ) and hydroxychloroquine (HCQ) garnered scientific attention in early February after publication of reports showing in vitro activity of CQ against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19.1 On February 17, 2020, the State Council of China held a news conference indicating that chloroquine (CQ) had demonstrated efficacy in treating COVID-19–associated pneumonia in multicenter, nonrandomized, clinical trials.2,3 This prompted multiple clinical trials in China (9 as of April 3, 2020). Full-Text PDF Response to: "Risks of hydroxychloroquine use for COVID-19 prophylaxis"Journal of the American Academy of DermatologyVol. 83Issue 1PreviewTo the Editor: Thank you to Sachdeva et al1 for their interest in our letter, "Does hydroxychloroquine combat COVID-19? A timeline of evidence."2 As they noted, we reviewed the current literature supporting the preliminary evidence regarding the efficacy and safety of hydroxychloroquine (HCQ) as a treatment or prophylaxis for COVID-19. What we tried to emphasize is that many of these pilot studies, in our opinion, have been done under duress during a pandemic and are flawed. There is a vital need for additional high-quality prospective, randomized, placebo-controlled clinical studies to establish efficacy, safety, and guidelines for the use of HCQ to combat this virus before mainstreaming this therapy. Full-Text PDF