Hydroxychloroquine Explained

In March, an old anti-malarial drug known as Hydroxychloroquine (HCQ) made headlines as a possible treatment option for SARS-CoV-2, the virus responsible for COVID-19.

As with most things COVID-19, HCQ shook the news cycle and became highly politicized, with contradicting reports citing different studies, all while thousands desperately sought out news of effective treatments for loved ones stricken with the virus. Unfortunately, objective interpretations of news reports and scientific articles on COVID-19 are hard to come by, and hastened scientific studies, many of which were published prior to rigorous evaluation of peer-review, exacerbated the problem.

When the virus transitioned the New York Tech community into remote learning, students in the Department of Biological and Chemical Sciences, including Simran Kaur, Helly Amin, Georgio Desmornes, Angelo Matteis, Param Shukla, Josepha Kormylo, Jade Reid, and Rowaida Wardak, participated in an independent research class with Bryan Gibb, Ph.D., assistant professor of Biological and Chemical Sciences. The researchers focused their efforts and science background toward weekly scientific and objective reviews of COVID-19. Here is what the class has uncovered regarding what is known now about HCQ and the trials using it to treat COVID-19:

What is HCQ?
HCQ and its close relative chloroquine are drugs taken orally to prevent and treat malaria, a deadly disease transmitted via mosquito bites in many tropical regions and associated with high fevers and flu-like symptoms. Azithromycin is a common antibiotic often taken synergistically with HCQ to combat malaria. 

HCQ is also used to treat autoimmune diseases like lupus and rheumatoid arthritis. Lupus is a disorder that hijacks the immune system to induce inflammation in areas of the human body. Skin rash, fatigue, and fevers are some common symptoms of Lupus. Rheumatoid arthritis, a progressive disease, uses the immune system to cause inflammation and thickening in the joints throughout the body. HCQ is effective in stopping inflammation in rheumatoid arthritis and lessening skin defects associated with lupus.

Scientists and doctors are considering whether HCQ may be an effective treatment for COVID-19, as studies show that HCQ may be able to block the replication of several viruses, including SARS-CoV-1 and Ebola virus in an in-vitro setting. The drug also inhibits SARS-CoV-2 replication in these settings, but has not been shown to be an effective antiviral treatment in clinical settings.

More to Lose?
The use of HCQ was initially popularized by American news media as a result of President Trump, who cited a study by French microbiologist Didier Raoult in his support of the use of HCQ. Raoult’s study appears to show remarkable benefits of HCQ with azithromycin in treating COVID-19.

While this study appears promising, there are numerous flaws with Raoult’s research paper, which resulted in widespread criticism from the scientific community. Among the flaws cited, the study did not do an effective job of utilizing proper research protocols and, thus, could be presenting questionable results.

When President Trump first mentioned HCQ on March 19, cases across the country were on a steep climb and his rationale for using HCQ seemed to stem from a “what do we have to lose?” mentality, as pointed out by The New York Times. With the backing of the current administration, the FDA provided an Emergency Use Authorization on March 28. However, as the drug began to be used widely in hospitals, it proved to have several severe side effects and hospitals were forced to stop using the drug. On April 30, the FDA advised that the drug, along with any others taken with it, should not be used unless explicitly mandated by a physician in a hospital setting, due to increased risk of heart rhythm problems.

A recent study published in the Journal of the American Medical Association examined New York City hospitals, which have 88.2 percent of the region’s COVID-19 patients. The probability of death for patients receiving HCQ and azithromycin was 25.7 percent, 19.9 percent for HCQ alone, 10 percent for azithromycin alone, and 12.7 percent for neither drug. These results indicate HCQ offered no benefit in treating COVID-19. In addition, the cardiotoxic side effects of HCQ resulted in a significantly higher rate of cardiac arrest in individuals who took HCQ, whether with other drugs or alone. Upon a closer look at HCQ’s main function (weakening the immune system to fight autoimmune disease), the New York Tech research team was able to see how it could cause more harm than good.

Can HCQ Help COVID-19 Patients?
Based on their research of published studies and other information, the student researchers were able to determine HCQ and azithromycin are not considered effective treatments for COVID-19. Many small clinical studies, which were not peer-reviewed in the context of the current pandemic have been published, but they include flaws that dismiss the viability of HCQ or azithromycin as good treatment options. Both drugs have side effects, with HCQ having the potentially fatal side effect of irregular heart rhythm, which can lead to cardiac arrest.

On the other hand, azithromycin is well known to treat a wide variety of bacterial infections, which, in rare cases, can block ion channels and tinker with electrical heart patterns. Therefore, many experts are concerned about this drug cocktail of HCQ and azithromycin because it may double the risk of cardiovascular death. A recent clinical study in Brazil was halted because of growing concerns, and a study at NYU Langone Medical Center indicated that 11 percent of COVID-19 patients who received HCQ and azithromycin had prolonged QT intervals (a measure of heart function from an electrocardiogram), which could lead to a high risk of arrhythmia.

What’s the Bottom Line?
The Infectious Diseases Society of America, the American College of Cardiology, and the U.S. National Institutes of Health all recommend that patients only receive chloroquine or hydroxychloroquine in the context of a clinical trial until there is more evidence that the drugs are effective.