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Costa Rica using hydroxychloroquine for COVID-19 treatment

April 22, 2020

Costa Rica is using hydroxychloroquine to treat patients with COVID-19, the country’s medical experts confirmed.

The drug’s use in Costa Rica follows the guidance of medical experts from China, where the novel coronavirus is believed to have originated.

“In Costa Rica, we have been using hydroxychloroquine since we had a teleconference meeting with personnel from China, personnel from Shanghai and Wuhan,” said Mario Ruíz, Medical Manager of the Costa Rican Social Security System (CCSS, or Caja).

“They were the ones who attended the emergency that arose in China, and hydroxychloroquine has its specifications and specific doses. Thanks to this help provided by the Chinese scientific community and a therapeutic care manual, we are using these treatments at the established doses.”

Costa Rica received “a substantial amount” of hydroxychloroquine from Novartis, a Swiss pharmaceutical company, earlier this month. At the time, CCSS said it would use the drug to treat patients and collect clinical data on its efficacy.

In the United States and elsewhere, clinical trials are testing the drug — more commonly prescribed to prevent malaria — in patients infected with SARS-CoV-2 infection, according to the CDC.

The Costa Rican health system has not released data comparing the outcomes of patients treated with hydroxychloroquine to other methods, but it suggested positive results.

“The drug has proven to be successful in patients who have been treated currently,” Ruíz said last week.

U.S. study suggests no benefit to hydroxychloroquine

Hydroxychloroquine showed no benefit against COVID-19 over standard care — and was in fact associated with more deaths, the biggest U.S. study of its kind showed Tuesday.

The United States government funded analysis of how its military veterans fared on hydroxychloroquine was posted on a medical preprint site and has not yet been peer reviewed.

The experiment had several important limitations, but adds to a growing body of doubt over the efficacy of the medicine that counts President Donald Trump among its biggest backers.

Researchers looked at the medical records of 368 veterans hospitalized nationwide who either died or were discharged by April 11.

Death rates for patients on hydroxychloroquine were 28%, compared to 22% when it was taken with the antibiotic azithromycin — a combination favored by French scientist Didier Raoult, whose study on the subject in March triggered a surge of global interest in the drug.

The death rate for those receiving only standard care was 11%.

Hydroxychloroquine, with or without azithromycin, was more likely to be prescribed to patients with more severe illness, but the authors found that increased mortality persisted even after they statistically adjusted for higher rates of use.

Other drawbacks include the fact that the study did not assign people randomly to groups, because it was a retrospective analysis, meaning it looked back on what had already happened.

In addition, the results are hard to generalize because the population was highly specific: most of the patients were male, with a median age over 65, and black, a group that is disproportionately affected by underlying illnesses like diabetes and heart disease.

There was no added risk of being on ventilator among the hydroxychloroquine-only group, leading the authors to suggest that increased mortality among this group might be attributable to side-effects outside the respiratory system.

Previous research has found that the medicine is risky for patients with certain heart rhythm issues and can cause blackouts, seizures or at times cardiac arrest in this group.

Hydroxychloroquine and a related compound, chloroquine, have been used for decades to treat malaria, as well as the autoimmune disorders lupus and rheumatoid arthritis.

They have received significant attention during the novel coronavirus pandemic and have been shown in lab settings to block the virus from entering cells and prevent it replicating — but in the pharmaceutical world, “in vitro” promise often fails to translate into “in vivo” success.

The true answer can only be determined through very large, randomized clinical trials that assign patients to receive either the drug under investigation or a placebo.

Several of these are underway, including notably in the United States, Europe, Canada and the United Kingdom.

 

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