The side of the anti-HCQ

By Modesto P. Sa-onoy

Since the start that this column commented on the need for a treatment for the Covid-19 disease, I had presented the side of the advocates of hydroxychloroquine and its “cocktail” of other drugs. No less than US President Donald Trump had considered this drug as a treatment in the United States while the supposed Covid-19 czar, Dr. Anthony Fauci did not favor it. The disagreement reached a point that Fauci was removed from the White House briefings on the pandemic and charged as having made “a lot of mistakes.”

The Philippines followed Fauci and the World Health Organization and banned the use of this drug HCQ here. Several doctors were using HCQ and they said it works but there are others who obeyed the Department of Health and refrained from prescribing HCQ.

Although there are still many researches and anecdotal reports claiming HCQ is effective, we will give space to the defenders of the claim that HCQ does not work and is even hazardous to health.

In an article published in Manila Bulletin (September 29, 2020), “I repeat, hydroxychloroquine does not work (for now)”, Dr. Edsel Muarice T. Salvana presented a contrary view.

He claimed that initial evidence for the use of HCQ and chloroquine “came from in-vitro experiments” and “that these experiments showed that hydroxychloroquine was able to affect the reproduction of SARS-CoV-2 in cultured cells in a variety of ways. When Covid-19 first hit, this data became the basis for further studying the effect of the drug” and because of the pandemic, “several countries including the US allowed compassionate use of hydroxychloroquine based on two reasons. First, hydroxychloroquine is a reasonably safe drug that is used for conditions such as lupus and malaria. Second, there is some scientific plausibility it might work based on the in-vitro studies.”

While waiting “for results of studies, doctors continued to use HCQ and  chloroquine for treatment of Covid-19” and “since hydroxychloroquine was already being used in humans for other diseases, the studies for the treatment of Covid-19 jumped directly to phase three.”

However, the “evidence from these early studies was mixed, but there was enough motivation for physicians to use them in the absence of anything better.” The doctors therefore used HCQ as an interim treatment.

According to Dr. Salvana, “as more RCT (randomized controlled trial) accumulated, it became apparent that hydroxychloroquine was not only ineffective, but came with significant side effects, especially when combined with the antibiotic azithromycin. WHO stopped its phase three trials, and the US FDA withdrew its emergency use authorization.”

However, because of “polarization brought about by pundits touting its benefits” Dr. Salvana said, “the push to keep using it for Covid 19 refused to die” and to “make things more confusing, doctors with large followings, including a renowned cancer epidemiologist from Yale University, opined that the studies that disproved its use were insufficient and flawed.”

Dr. Salvana insisted that “there were also RCTs on severe disease, moderate disease, as well as post-exposure prophylaxis (taking the drug after a possible exposure) using lower than usual doses. All these studies showed no effect. There are also many RCTs with all sorts of dosing regimens and in combination” but he “hopes the data from these trials will help clarify and, with hope, put the matter to rest.”

Dr. Salvana criticized the “group of doctors” who also “touted the hydroxychloroquine prophylaxis in the Philippines, calling an end to all lockdowns. To prove their point, they held an unauthorized mass gathering and shockingly refused to wear masks. They stated that they were all taking hydroxychloroquine and were therefore protected. When confronted by RCT evidence on the ineffectiveness of the drug, they produced a voluminous list of previous studies, none of which reached the standard of rigor required to refute the RCT data.”

Nevertheless, Dr. Salvana said, “To be fair, it would be prudent to wait for the ongoing RCT studies before completely dismissing their claims. The act of not wearing their masks, however, shows that these doctors have clearly gone beyond the realm of science” and he claimed that former DoH Secretary Jaime Galvez-Tan “clarified that he does not believe hydroxychloroquine is effective as prophylaxis against Covid-19.”

Salvana concluded: The preponderance of evidence for hydroxychloroquine shows it does not work.

We continue on Monday.