NIH Panel Recommends Against Using Hydroxychloroquine With Z-Pak to Treat COVID-19

A pharmacist shows a bottle of the drug hydroxychloroquine in Oakland, California, on April 6, 2020. Ben Margot/AP Photo

Doctors and experts on a panel created by the National Institutes of Health are recommending against using hydroxychloroquine, an anti-malaria drug, with azithromycin, an antibiotic known as Z-Pak, in the treatment of COVID-19.

The panel released its recommendations on Tuesday, including recommending against the combination, which is being used by a number of doctors in the United States and elsewhere.

The panel said it was recommending against the combination “because of the potential for toxicities.”

The panel cited a single study, which has not been peer reviewed, for their recommendation.

Researchers from the New York University School of Medicine retrospectively studied the combination of hydroxychloroquine and azithromycin in 84 adult patients and reported an increased QTc, or an interval measured on an electrocardiogram that can signal a higher risk of having heart incidents.

An arrangement of hydroxychloroquine pills in Las Vegas on April 6, 2020. John Locher/AP Photo

The panel also recommended against the use of lopinavir and ritonavir, as well as other drugs that block protease, an HIV enzyme, “because of unfavorable pharmacodynamics and negative clinical trial data.”

There are no approved treatments for COVID-19 but researchers around the world are racing to figure out which ones work against the new disease, which is caused by the CCP (Chinese Communist Party) virus.

Hydroxychloroquine is one of the most promising existing or experimental drugs, along with remdesivir.

The National Institutes of Health (NIH) panel said that insufficient clinical data is currently available to recommend either for or against the use of hydroxychloroquine, the closely related chloroquine, or remdesivir. If the drugs are used, clinicians are advised to monitor the patient for adverse effects.

A vial of the investigational drug remdesivir is visually inspected at a Gilead manufacturing site in the United States, in March 2020. Gilead Sciences via AP

Insufficient data led the panel to say it couldn’t recommend for or against the use of convalescent plasma, which involves taking blood from people who were infected with COVID-19 and later recovered and transfusing it to patients with the new illness. The panel also couldn’t recommend for or against using hyperimmune globulin, which are concentrated preparations high in antibodies that protect against specific diseases, or interleukin inhibitors, targeted antibody therapies used to treat a range of conditions such as sarilumab, tocilizumab, and anakinra.

Similar to the recommendations against the combination including hydroxychloroquine, the experts recommended against the use of proteins released by cells known as interferons or drugs that temper overactive immune systems known as janus kinase inhibitors—the former because of a lack of effectiveness in other coronaviruses and the latter “because of their broad immunosuppressive effect.”

The panel was co-chaired by Dr. Roy Gulick, chief of the Infectious Disease Division at Weill Medical Hospital of Cornell University in New York City, Dr. H. Clifford Lane, clinical director of the National Institute of Allergy and Infectious Diseases at NIH, and Dr. Henry Masur, chief of the Critical Care Medicine Department at the NIH Clinical Center.

Members of the panel were appointed by the co-chairs.