• 15 May 2020
  • 4 min 30
  • 15 May 2020
  • 4 min 30

In this episode, we look at emerging evidence for the use of hydroxychloroquine during COVID-19, and whether it is actually a ‘miracle drug’ that will save lives during this pandemic.

Transcript

Voiceover:

Welcome to the NPS MedicineWise Podcast. Helping health professionals stay up to date with the latest news and evidence about medicines and medical tests.

Steve Morris:

Hi, I'm Steve Morris, CEO of NPS MedicineWise, which is an independent not-for-profit organisation, focused on improving the quality use of medicines and medical tests. This is the first of a series of podcasts with a specific focus on COVID-19 issues and questions as they relate to medicines and medical tests. Our aim is to wade through the morass of information, and often misinformation, to provide answers based on evidence from trusted sources. And I'm joined in today's podcast by Anna Samecki. Anna, tell the listeners a little bit about yourself.

Anna Samecki:

Yeah. Hello Steve, and thanks for having me. So my name's Anna, I'm a GP based in Sydney and I have a special interest in medical education. I joined the NPS MedicineWise team earlier this year and have been working hard with our dedicated COVID-19 team to bring health professionals and consumers the latest updates.

Steve Morris:

Welcome Anna. Looking in this first podcast, we're going to be discussing one of the most widely talked about medicines, which is at full page pronouncements they're putting in newspapers recently. And that medicine is hydroxychloroquine. So Anna, hydroxychloroquine has been touted in some quarters as a miracle drug. So why aren't we treating everyone with it?

Anna Samecki:

Yeah. Look Steve, that's a great question. As you know, all medications need to undergo a process of research and scrutiny to determine whether or not they're effective and safe to use in the treatment of certain conditions. And hydroxychloroquine is no exception. Even though it's technically not a new drug and has been around for some time, it's never actually been used to treat, or prevent, COVID-19 before. So it has been the subject of several studies due to some initial promising results.

Now there is data available from three randomised controlled trials. And the reason I mention that is that randomized controlled trials are the gold standard study design for comparing interventions. These particular trials compared hydroxychloroquine plus standard care to standard care alone in the management of COVID-19. But unfortunately the data from these is not yet strong enough to support its widespread use in the community, and that's for several reasons.

Steve Morris:

So you're saying these trials have real limitations then?

Anna Samecki:

Well, yeah, exactly. The trouble is that as with any study, there will be some limitations. And without going into all the nitty gritty fine detail, the three studies did have a few limitations which I can point out today. And that includes introduction of bias from the patient selection allocation and randomization process. It wasn't actually clear in some of these studies how that was done, on top of a lack of blinding as well. So not all the patients and researchers were blinded to the interventions.

In addition to that, the sample sizes were relatively small. So one of the studies, for example, only had about 30 patients. And last but not least, outcome relevance is another very important consideration. When we talk about outcome relevance, we're talking about things that are relevant to the real clinical practice world. So one of the end points in one of the studies was actually looking at negative swab rate. And I can tell you that this doesn't really tell us much about the incidence of respiratory failure or mortality, which is probably what clinicians and patients are most interested in.

So in summary, the evidence as it stands at the moment is unfortunately lacking for hydroxychloroquine, and more research is needed.

Steve Morris:

Thank you, Anna. So in a sentence how would you sum up our positioning in relation to hydroxychloroquine?

Anna Samecki:

Yeah. So unfortunately as it stands the evidence is just not robust or strong enough to recommend hydroxychloroquine be used as a medication to treat or prevent COVID in the community.

Steve Morris:

Okay. Thanks Anna, that's really clear. Thanks for joining us today.

Anna Samecki:

Thank you so much for having me.

Steve Morris:

And just further to the podcast, there's a complete evidence-based summary on hydroxychloroquine on the NPS MedicineWise website. That's nps.org.au. And there's also a forthcoming series of podcasts. Our next topic will be on antivirals. So hopefully you'll join us then. Thank you for listening.

Voiceover:

For more information about the safe and wise use of medicines, visit the NPS MedicineWise website at nps.org.au.