Quebec health institute advises caution in use of hydroxychloroquine to treat COVID-19

Quebec's provincial health institute is advising health-care workers to be cautious in using prescription drugs that haven't been adequately studied to treat COVID-19 patients.

The institute, known by its French acronym INESSS, recommends only using chloroquine and hydroxychloroquine on a case-by-case basis for COVID-19 patients whose symptoms are more severe such as those in intensive care.

Some studies have shown that the drugs have antiviral capabilities.

"The uncertainty surrounding the efficacy and safety of these treatments does not support the widespread use of chloroquine or hydroxychloroquine, regardless of the stage of the disease," the INESSS said in a statement Sunday.

During the 2002-2004 SARS outbreak, studies suggested that hydroxychloroquine had some antiviral properties. The drug has been around for about 40 years and is used to treat malaria and some autoimmune conditions including lupus.

On March 21, U.S. President Donald Trump tweeted that hydroxychloroquine, combined with AZT, could be considered a breakthrough in the fight against COVID-19.

But INESSS director general Dr. Luc Boileau says it's too early to make that claim.

"It has not been even close to proven that this medication should be used on a global scale," Boileau said.

Whether or not hydroxychloroquine and chloroquine can be used safely to treat COVID-19 on a widespread level will depend on the results and quality of data coming from studies currently being conducted.

"There is a need for hundreds or thousands of patients that would be involved in those studies, but so far it's moving very, very fast," Boileau said.

Some side effects of hydroxychloroquine include cardiac arrhythmia. As much as it would be ideal to go ahead and treat people with these drugs, it can't happen until it's been studied more effectively, Boileau says.

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"This is a promising situation, but it's not the case right now so we have to be careful, and this is our job," he said.

He said it will probably take about a month for one or many studies to determine whether hydroxychloroquine and chloroquine can be used on a widespread level to treat COVID-19.

"All the scientists in the world are working very hard and closely together to make sure that if it appears that there might be a solution, it will be on the table very rapidly," Boileau said.

He advised people to continue social distancing efforts to quell the spread of the virus.

The INESSS also recommends integrating all COVID-19 patients who receive chloroquine or hydroxychloroquine into research protocols, in order to document the use and clinical effects of these treatments in Quebec.

MUHC hydroxychloroquine study underway

One study, organized by McGill University Health Centre specialists along with researchers in Manitoba, Alberta and Minnesota, is currently looking for 3,000 participants to study the effectiveness of hydroxychloroquine in not only treating COVID-19, but preventing the spread of the virus, too.

About 400 people have enrolled so far, eight of whom are from Canada, according to co-lead investigator Dr. Emily McDonald.

The study is currently enrolling health-care workers who have tested positive for COVID-19 and are in the early days of their diagnosis with minimal symptoms, and health-care workers who have had a high-risk contact with someone who has tested positive.

"Next week, we hope to be enrolling the general public," McDonald said. "We're working with the Research Ethics Board to do a staged approach. So, starting with health care workers, and then moving on to the general public."

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Half the participants will receive a placebo, with the other half receiving hydroxychloroquine. McDonald said it will take about four to six weeks to finish enrolling patients, and another two for analysis.

She echoed Boileau's call for caution when it comes to hydroxychloroquine's potential for treating COVID-19 cases.

"We're all really eager to get answers but we need to make sure that we study all of these drugs safely," McDonald said.

The speed at which this study was mounted is unprecedented, she added, thanking Health Canada for working so closely with researchers.

It's currently being funded by the McGill University faculty of medicine's clinical practice assessment unit, though McDonald says researchers are applying for other sources of funding as well.

If you fit the criteria to participate, sign up to register for the study here.