A WHO expert panel has strongly advised against use of hydroxychloroquine to prevent COVID-19, based on high-certainty evidence
A World Health Organization (WHO) panel of experts, comprising intensive care physicians, infectious disease and respiratory medicine specialists among others, has strongly advised against the use of hydroxychloroquine to prevent COVID-19.
Their recommendation is based on a linked systematic review and network meta-analysis, including six randomised controlled trials with a total of 6059 participants, which found that hydroxychloroquine had a small or no effect on mortality and admission to hospital.
This finding was based on high certainty evidence, with no serious concerns regarding risk of bias, imprecision, indirectness, inconsistency or publication bias.
The review and meta-analysis also found a small or no effect of hydroxychloroquine on laboratory confirmed SARS-CoV-2 diagnosis, with moderate certainty evidence of this finding.
However they also found hydroxychloroquine probably increased adverse events leading to discontinuation, also based on moderate certainty evidence.
The panel judged that almost all people “would not consider this drug worthwhile”, according to the living guideline published in the BMJ.
In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation.
They felt that further research was unlikely to uncover a subgroup of patients who benefit from hydroxychloroquine prophylaxis on the most important outcomes – mortality and admission to hospital – given the consistent results of trials completed to date.
The experts considered that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent COVID-19.
This guideline applies to all individuals who do not have COVID-19, regardless of their exposure to a person with COVID-19 infection.
For patients who have been infected with COVID-19, the WHO has also strongly recommended against using hydroxychloroquine or chloroquine in addition to usual care for their treatment, regardless of disease severity or duration of symptoms.
Despite stronger, higher quality research coming out in recent months regarding the efficacy of hydroxychloroquine, interest in the drug for the treatment of COVID-19 remains.
Just last month, Health Minister Greg Hunt responded to a petition from a group of nearly 400 Australians calling for hydroxychloroquine be made available over the counter.
The petition argued that hydroxychloroquine is safe and can be used to effectively prevent and reduce the mortality rate of COVID-19.
Minister Hunt knocked back the request, pointing to the serious side effects of the drug.
“Based on the current available evidence, my Department strongly discourages the use of hydroxychloroquine to treat or prevent COVID-19, unless the patient is enrolled in a clinical trial,” he added.