Scientists have linked the death of almost 17 thousand patients with coronavirus to treatment with the antimalarial hydroxychloroquine
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Scientists have linked the death of almost 17 thousand patients with coronavirus in France, Belgium, Italy, Spain, Turkey and the United States to the fact that the antimalarial drug hydroxychloroquine was used during treatment. It was tested during the first wave of coronavirus infection and was interrupted when the WHO announced heart problems caused by the drug. The Ministry of Health of the Russian Federation then recognized the cardiotoxicity of the drug and stated that in Russia no deaths associated with rhythm disturbances were identified in patients taking it. The Ministry of Health called the current study “one of many contradictory publications that cannot take into account all the factors that influence the course and outcome of the disease,” and called for “the conclusions to be treated with a certain degree of criticism.”
A group of medical scientists from France working at the University of Quebec in Canada published a study in the journal Biomedicine & Pharmacotherapy, according to which about 16.9 thousand people with coronavirus infection could die due to taking the antimalarial drug hydroxychloroquine. Such conclusions were made based on a study of case histories during the first wave of the pandemic in France, Belgium, Italy, Spain, Turkey and the USA. The publication Vademecum was the first to draw attention to the work of scientists.
Hydroxychloroquine – a medicine against malaria and the treatment of rheumatoid arthritis, systemic lupus erythematosus. The drug was used in a number of countries, including Russia, in the treatment of coronavirus infection and for its prevention, and in the United States it had the status of an emergency use drug.
The study took place from March to June 2020. The article states that during this time, physicians have used many treatments “with varying degrees of success” based on their effectiveness against other pathogens with a structure or mechanism of action similar to SARS-CoV-2. Among the experimental treatments was hydroxychloroquine. Studies have documented an “unfavorable risk-benefit balance” for its use. Scientists note that the toxicity of hydroxychloroquine in patients with COVID-19 is partly due to cardiac side effects, including conduction disturbances (ventricular tachycardia or fibrillation).
The authors cite, in particular, the British Recovery study (4.7 thousand patients), which demonstrated that instead of reducing mortality rates, the drug increased the length of patients’ hospital stay and increased the risk of disease progression. There is also a Brazilian study on the effectiveness of using hydroxychloroquine with or without azithromycin, which showed an increase in side effects from the liver and heart. In this work, the incidence of fatal adverse events was estimated at 0.4%. Reports of side effects in other randomized trials “were alarming,” the scientists said in the report. In rheumatoid arthritis, long-term use of hydroxychloroquine was associated with a higher risk of major adverse cardiovascular events, including myocardial infarction, hospitalization for heart failure, all-cause mortality, and cardiovascular mortality in patients with a history of heart failure. An analysis of the European EudraVigilance database also showed the presence of “non-cardiac side effects” in patients with COVID-19, including hepatitis, acute kidney failure, hemolytic anemia and rhabdomyolysis (a syndrome characterized by the breakdown of muscle tissue).
Scientists concluded that 16.9 thousand deaths likely “represent just the tip of the iceberg,” and the number of deaths due to the use of hydroxychloroquine in the treatment of coronavirus is underestimated worldwide. In their opinion, the results of the analysis illustrate “the dangers of using drugs with a low level of proven effectiveness to combat future pandemics.”
It should be noted that hydroxychloroquine was first included in the recommendations of the Ministry of Health on coronavirus at the end of March 2020 (the fourth version of the protocols). In June 2020, WHO announced the termination of trials of hydroxychloroquine as a treatment for COVID-19 due to heart problems identified in patients. The Russian Ministry of Health then admitted that hydroxychloroquine has cardiotoxicity, but did not abandon its use. In Russia, the department assured, there were no deaths associated with rhythm disturbances in patients taking hydroxychloroquine. However, in May 2021, the ministry nevertheless excluded hydroxychloroquine from recommendations for the treatment of coronavirus infection.
Yesterday, commenting on the study, the Ministry of Health explained to Kommersant: since the effectiveness of hydroxychloroquine against COVID-19 was limited, with the advent of more effective drugs and treatment approaches, it went out of practice. At the same time, the exclusion of hydroxychloroquine from the recommendations was not associated with an increased frequency of adverse events, the department assured: “By 2020, much experience had already been accumulated in the use of hydroxychloroquine in medical practice, and its side effects were well known. The drug was prescribed by doctors taking into account the characteristics of the patients and with the necessary monitoring, which was emphasized in the guidelines. The meta-analysis published by French colleagues is one of many contradictory publications that cannot take into account all the factors that influence the course and outcome of the disease.” The department called on “to treat the authors’ conclusions with a certain degree of criticism.”
Olga Shuppo, scientific director of the Grand Clinic network of immunorehabilitation and preventive medicine clinics, says that hydroxychloroquine “fortunately, has not been widely used in Russia.” “It was supposed to provide immunosuppression during cytokine storm (a particularly severe form of systemic inflammatory response.— “Kommersant”) in patients with coronavirus infection. But in addition to immunosuppression, the drug provoked the development of arrhythmia, which is associated with an increase in the number of deaths during that period,” noted Ms. Shuppo.
Infectious disease specialist at the Doctis telemedicine service Tatyana Kogut points out that in general, in the professional environment during the pandemic, there was no common understanding of how to properly treat coronavirus. Doctors tried to use different methods, based on the structure of the virus, the ability to influence its reproduction, and the course of the disease in a particular patient. “We used not only hydroxychloroquine, but also antiretroviral drugs, which are used to treat HIV, and antibacterial drugs, although they do not have indications for use in the absence of bacterial complications,” continues Ms. Kogut. “Most likely, the deaths could not be associated with the drug, but with its interaction with other medications that the patients were taking.” According to the infectious disease specialist, such interaction must be taken into account especially carefully when treating elderly people and patients with chronic diseases who use other medications to treat pathologies, since this has a significant impact on the course of the disease and the outcome of treatment not only with COVID-19, but also with influenza and other infections.
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