Lupus Experts Divided Over Hydroxychloroquine Use Against COVID-19

Hydroxychloroquine and chloroquine tablets are shown in at the IHU Mediterranee Infection Institute in Marseille, France, on Feb. 26, 2020. Gerard Julien/AFP via Getty Images

Some doctors say their patients with lupus aren’t getting COVID-19 while others are cautioning against linking those findings with hydroxychloroquine, a drug approved as an anti-malarial and lupus treatment that’s been prescribed across the nation for the COVID-19.

President Donald Trump on Saturday pointed to a study that showed people with lupus “aren’t catching this horrible virus.” COVID-19 is caused by the CCP (Chinese Communist Party) virus, commonly known as novel coronavirus.

“They’re not affected so much by it. Now, maybe that’s correct; maybe it’s false. You’re going to have to check it out,” Trump told reporters in Washington.

Trump did not name the study. But Chinese researchers published a preprint clinical study (pdf) that, they said, found patients treated with hydroxychloroquine recovered quicker than those who weren’t given the drug.

Researchers in China previously found that 80 lupus patients in Wuhan, where the virus emerged last year, did not contract the illness.

Rescue workers transport a patient from the Zaandam of the Holland America Line cruise ship, afflicted with COVID-19 at Port Everglades in Fort Lauderdale, Florida, on April 2, 2020. Joe Skipper/Reuters

‘No Evidence’

Several groups and a number of experts have said there isn’t evidence supporting hydroxychloroquine’s efficacy against COVID-19, asserting that more rigorous, peer reviewed studies are needed, along with clinical trials.

The Lupus Foundation of America said in a statement that “there is no evidence” that taking hydroxychloroquine, also known as Plaquenil, “is effective in preventing a person from contracting the coronavirus.” The COVID-19 Global Rheumatology Alliance said that over 25 percent of the 110 COVID-19 patients on its registries were taking Plaquenil at the time of diagnosis. One of those patients later died.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters after Trump spoke that the effectiveness of hydroxychloroquine is still being looked at, adding: “We don’t have any definitive information to be able to make any comment ... . That’s something that is now being looked at, but we don’t have any data to be able to say anything definitively.”

Taking hydroxychloroquine is subject to approval by a doctor, Trump added before saying: “But I hope they use it because I’ll tell you what: What do you have to lose? In some cases, they’re in bad shape. What do you have to lose?”

No drug is approved by the Food and Drug Administration for treating COVID-19 but doctors can prescribe drugs approved for one use for a different use. The agency last month issued an emergency use authorization for hydroxychloroquine and the closely-related chloroquine. The Centers for Disease Control and Prevention also said last month that hydroxychloroquine has been administered to hospitalized patients.

Cedars-Sinai Hospital in Los Angeles, California in a file photograph. Frederick M. Brown/Getty Images

Few Lupus Patients Get COVID-19

Several doctors who treat lupus patients have said they’ve found suggestions the drug may be effective.

“None of my lupus patients have developed covid, which is quite remarkable,” Dr. Daniel Wallace, a rheumatologist at Cedars-Sinai Hospital in Los Angeles, said in a teleconference. The seven hospitals that are affiliated with Cedars-Sinai have treated some 1,000 patients, of whom one had lupus.

“It may be that the drugs that these patients are taking provides them with type of protection. I find this rather interesting and I can’t quite explain it,” Wallace said.

Dr. Peggy Crow, chief of rheumatology at the Hospital for Special Surgery in New York, said there’s anecdotal evidence from New York hospitals “that many more presumably healthy people are developing infections with COVID-19 than we’ve seen in our lupus patients or rheumatoid arthritis patients.”

Lupus patients are being very careful, she added, and doing well considering the pandemic. Lupus is a chronic long-term disease that can cause inflammation and pain in any part of your body, according to the Lupus Research Foundation.

Preliminary indications suggest hydroxychloroquine may be effective in the treatment of COVID-19 patients, Dr. Ken Farber, president and CEO of the Lupus Research Alliance, said during the teleconference.

“Why it’s effective is not entirely clear. It may help prevent the virus from replicating, from reproducing; it may be because Plaquenil has certain properties that allow it to, let’s just say, mellow out the immune system,” Dr. Ken Farber, president and CEO of the Lupus Research Alliance, said during the teleconference.

If lupus patients are less susceptible for COVID-19, there’s “finally silver lining” for patients with the disease, Farber said.

Demand for the drug has caused shortages in some areas.

Transmission electron micrograph of the CCP virus, commonly known as novel coronavirus or SARS-CoV-2, isolated from a patient. Photo published March 10, 2020. NIAID

Previous Studies

Other doctors have also said they’ve found hydroxychloroquine effective. Of over 6,000 physicians across 30 countries asked about the “most effective therapy” in treating CCP virus patients, more than one out of three chose the lupus and malaria drug.

Dr. Ramin Oskoui, CEO of Foxhall Cardiology, said during an appearance on Fox News last week that he doesn’t know of anyone with lupus getting the CCP virus and referenced the study from China. “We’re not seeing patients with lupus who take Plaquenal, we’re not seeing these individuals develop COVID. I’m not aware of any reported case; the Chinese have actually looked at this,” Oskoui said.

Before the Chinese study, two studies in France suggested hydroxychloroquine can be effective against the CCP virus. Neither study was peer reviewed or published as of yet. Hungary, the United Kingdom, and India are among the countries that have banned export of the drug as further study is done; Trump has asked India’s Prime Minister Narendra Modi to carve out an exception to the ban for the United States.

America recently received 30 million hydroxychloroquine doses and federal officials were distributing them to various states, officials said this week. In addition to prescribing the drug to patients with COVID-19, some doctors have been giving the drug to healthy patients as a prophylactic.

A number of studies are underway in the United States, including a 1,500-person trial at the University of Minnesota. Researchers there expect initial results around the end of April.