UAB expert: Study shows hydroxychloroquine has ‘no benefit or harm’ for coronavirus in-patients
A top infectious disease doctor with the University of Alabama at Birmingham (UAB) told Yellowhammer News that a major new study published this week reinforces UAB’s stance that hydroxychloroquine is not an effective treatment for patients hospitalized with the coronavirus.
The comment was made by Dr. Paul Goepfert, MD, a professor in UAB’s Division of Infectious Diseases who has an advisory role in all COVID-19 treatment decisions made at UAB Hospital.
The nationally respected infectious disease expert said that “UAB has a weekly meeting concerning COVID treatment and we have never recommended [hydroxychloroquine] outside of a study.”
Goepfert further advised that UAB does not recommend that doctors in Alabama should prescribe hydroxychloroquine for coronavirus cases, because to his knowledge there has never been a high-quality study showing the drug to have positive results for COVID-19 patients.
“We would not recommend it based on the fact that there has never been a randomized control study with enough patients enrolled to say anything,” he said.
In response to a question about the use of hydroxychloroquine within UAB hospital, Goepfert replied, “I cannot say that nobody received it, but it was rare – if at all.”
Goepfert’s takeaway from the recent hydroxychloroquine study published in The Lancet, a respected science journal, was that hydroxychloroquine has “no benefit or harm” when used to treat hospitalized coronavirus patients.
He further said that the study “certainly reinforces” UAB having never recommended hydroxychloroquine to treat COVID-19.
Public awareness of hydroxychloroquine has grown in past months due to repeated mentions by President Donald Trump. Though in most appearances touting the drug Trump has prefaced his comments with a version of “I’m not a doctor,” the president has also repeatedly championed the idea hydroxychloroquine could have a big impact.
The drug, primarily used to treat malaria before the coronavirus pandemic, was given an emergency use authorization by the FDA on March 29, enabling it to be legally used as a coronavirus treatment.
Trump took a regimen of hydroxychloroquine in recent days.
Though some small anecdotes of success appeared on television news, especially during early April, scientific data has not born out the president’s optimistic outlook for hydroxychloroquine when used for hospitalized patients.
The article published in Lancet Friday was a retrospective study tracking 96,032 patients hospitalized with COVID-19 across six continents with the largest group being from North America.
“We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19,” reads the study’s topline interpretation.
USA Today ran an article with the headline “Coronavirus patients who took hydroxychloroquine had higher risk of death, study shows.”
The Lancet study does say hospitalized coronavirus cases treated with hydroxychloroquine show “a greater hazard for in-hospital death.”
However, other writing in the Lancet study urged caution not demonstrated by the excitable pieces that circulated widely on Friday.
Part of the Lancet study’s discussion section reads, “The association of decreased survival with hydroxychloroquine or chloroquine treatment regimens should be interpreted cautiously. Due to the observational study design, we cannot exclude the possibility of unmeasured confounding factors.”
Put simply, the kind of study performed by Lancet leaves open the possibility that other unknowable factors caused some or all of the link between hydroxychloroquine and higher COVID-19 death rates.
Dr. Goepfert chose not to endorse the idea that hydroxychloroquine lowered survival odds for coronavirus patients when commenting on the Lancet study.
He told Yellowhammer, “[L]arge retrospective studies like the one in the Lancet and another from the VA showed no benefit or harm” for patients treated with the much-discussed drug.
Yellowhammer News asked the Alabama Department of Public Health (ADPH) whether the new study results had changed their guidance on hydroxychloroquine.
Dr. Karen Landers, MD, Assistant Alabama State Health Officer, referred Yellowhammer to hydroxychloroquine guidelines the department initially issued in the first week of May. She said that guidance is still in place.
The guidance, directly imported from the U.S. Food and Drug Administration (FDA), says only hospitalized patients are recommended recipients of hydroxychloroquine outside of clinical trials.
The ADPH by way of FDA guidance also notes that “hydroxychloroquine has significant and serious side effects, such as QT prolongation and hypoglycemia. Cases of life-threatening cardiomyopathy have been reported with its use, as have ventricular arrhythmias, torsades de pointes, irreversible retinal damage and critical issues with blood glucose.”
Alabama’s hydroxychloroquine news is not all negative.
Dr. Turner Overton, MD, also of UAB’s Division of Infectious Diseases is helping conduct a new hydroxychloroquine trial.
In remarks to Yellowhammer, Overton noted that nearly every piece of published data on hydroxychloroquine’s effectiveness has exclusively involved patients whose COVID-19 cases had developed to the point that hospitalization was required.
He told Yellowhammer that the new study on which he is working will test Hydroxychloroquine “early in the course of COVID-19 disease to determine whether hospitalization and severe disease can be prevented.”