Dear Patients,

With the continued (but slowing!...) COVID-19 pandemic, and questions and concerns over proposed treatments, the following may prove useful. Some of the more notable and popularly discussed drugs proposed as potential treatments for COVID-19 follow:

Hydroxychloroquinine
(with or without azithromycin)

This is an anti-malarial drug also used to treat Lupus and Rheumatoid Arthritis. While there is not sufficient evidence yet to conclude that hydroxychloroquine (sometimes in combination with a macrolide antibiotic, azithromycin) is an effective cure or even treatment for COVID-19, there are anecdotal reports from doctors (and patients) who believe that hydroxychloroquine may be at least helpful if not curative for COVID-19. Some evidence suggests that it may be prophylactic (preventive) against COVID-19 as well. Given the nature of COVID-19 as we currently understand it, and its potential to do harm or cause death, we are, of course, looking for any and all options to treat it. But, we must also address one of the most important tenets of good medicine: “first do no harm”. As with most medical decisions, there is often a risk versus benefit analysis that must be made. In the case of whether to use hydroxychloroquine, we know that the risk associated with use of this drug is a relatively small one associated with a frequency of an electrical disturbance of the heart called a “QT-prolongation”. QT-prolongation is relatively uncommon, but it could be very serious, and its risk of occurrence is assessed by age (over 68 years old), gender (female), serum potassium levels, medical history including heart attack and heart failure, sepsis, and use of certain drugs (“loop diuretics” and other drugs known to cause QT-prolongation). One of these drugs also known to cause QT-prolongation is the aforementioned drug, azithromycin, often used in combination with hydroxychloroquine to treat COVID-19.

For those interested in or considering using hydroxychloroquine, despite its current status as an unproven treatment for COVID-19, we have obtained a source of hydroxychloroquine for our patients that will not affect the supply needed for those being treated for Lupus and Rheumatoid Arthritis.
 

Remdesivir

This is an antiviral drug that was, until today, unavailable except under special circumstances designated as “compassionate use” reserved for patients in severe condition. However, based upon results of a government-sponsored trial with Gilead (the maker of Remdesivir), the FDA has issued Emergency Use Authorization of Remdesivir. Initial results of the randomized, placebo-controlled trial (considered the “gold standard” in trials) show that patients infected with SARS-CoV-2 recovered 31% faster (11 versus 15 days), and fewer patients died (8% versus 11.6%) when given Remdesivir instead of a placebo (an inert substance). While this is not a “cure”, it certainly provides some help in treatment and hope that other treatment can be developed.

Ivermectin

This is an antiparasitic drug that seems to work against SARS-CoV-2 in vitro (in a test tube) but there is no evidence that it will affect the virus in vivo (in an infected patient).

Lopinavir, Ritonavir, Tocilizumab and Others

There are a significant number of other drugs that are being considered for use against COVID-19, but known with any “proof” as we would consider it scientifically other than anecdotal. For those interested in following some of what is being researched, a good resource is: https://www.idstewardship.com/coronavirus-covid-19-resources-pharmacists/.

Meanwhile, there are supplements we can take that might directly affect the virus or indirectly so by helping to support the immune system and reduce inflammation: