Hydroxychloroquine and COVID-19: critiquing the impact of disease public profile on policy and clinical decision-making

Aquino, Yves Saint James; Cabrera, Nicolo L.

doi:10.1136/medethics-2020-106306

Cited by 14 publications

(27 citation statements)

References 36 publications

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“…Indications that the use of chloroquine, or hydroxychloroquine, can have potential benefits in COVID-19 patients were found in n = 24 (46.2%) of the publications analyzed. Hydroxychloroquine is listed in the class of antimalarials with antiviral immunomodulatory effects [ 23 , 24 ]. An effect could be demonstrated with SARS-CoV in vitro and in vivo, as well as with SARS-CoV-2 in vitro [ 23 , 24 , 25 ].…”

Section: Results Of the Ethical Analysismentioning

confidence: 99%

Medication of Hydroxychloroquine, Remdesivir and Convalescent Plasma during the COVID-19 Pandemic in Germany—An Ethical Analysis

Voit

Timmermann

Steger

2021

IJERPH

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This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions.

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Section: Results Of the Ethical Analysismentioning

confidence: 99%

Medication of Hydroxychloroquine, Remdesivir and Convalescent Plasma during the COVID-19 Pandemic in Germany—An Ethical Analysis

Voit

Timmermann

Steger

2021

IJERPH

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“…Therefore, the recent experience of antimalarial drug repositioning in the era of COVID-19 showed us that even in pandemic times the use of repurposed drugs should be cautiously investigated only in randomized controlled trials, mainly to avoid drug-related toxicity and potentially lifethreatening adverse events. Moreover, it is worth outlining that healthcare decision-making should be based on key ethical concepts, such as evidence-based practice, sustainable allocation and meaningful consent [76]. However, various randomized studies are currently ongoing to investigate the safety and efficacy of HCQ as early treatment of non-hospitalized patients with mild to moderate COVID-19, as well as PrEP and PEP for COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Hydroxychloroquine in the COVID-19 pandemic era: in pursuit of a rational use for prophylaxis of SARS-CoV-2 infection

Infante

Ricordi

Alejandro

et al. 2020

Expert Review of Anti-infective Therapy

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Introduction Over the last few months, coronavirus disease 2019 (COVID-19) pandemic caused by the novel coronavirus SARS-CoV-2 has posed a serious threat to public health on a global scale. Given the current lack of an effective vaccine, several drugs have been repurposed for treatment and prophylaxis of COVID-19 in an attempt to find an effective cure. Areas covered The antimalarial drug hydroxychloroquine (HCQ) initially garnered widespread attention following the publication of preliminary results showing that this drug exerts an anti-SARS-CoV-2 activity in vitro. Expert opinion To date, clinical evidence suggests lack of benefit from HCQ use for the treatment of hospitalized patients with COVID-19. In such patients, HCQ also appears to be associated with an increased risk of QT interval prolongation and potentially lethal ventricular arrhythmias. Therefore, FDA has recently revoked the Emergency Use Authorization (EUA) for emergency use of HCQ and chloroquine to treat COVID-19. Conversely, whether HCQ use may represent an effective prophylactic strategy against COVID-19 is a separate question that still remains to be answered. In addition, relevant aspects regarding the potential risks and benefits of HCQ need to be clarified, in pursuit of a rational use of this drug in the COVID-19 pandemic era.

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“…The information shared by various leaders on news and social media, highlighting only the expected advantages of CP may cause a positive bias in the minds of the population, obstructing their ability to make a well-informed, voluntary decision (10).…”

Section: Impact On Informed Consent and Autonomymentioning

confidence: 99%

Convalescent plasma, political narrative, and public health ethics in the Covid-19 pandemic

Agrawal¹,

Agarwal²,

Jain³

2021

IJME

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Convalescent plasma therapy emerged as an early experimental therapy for the treatment of Covid-19. However, despite limited data regarding its safety and efficacy, the therapy was extensively publicised by multiple politicians as a cure. We analyse the impact of this political narrative around medical therapeutics on the pandemic using the coherentist model of public health ethics. The clinical benefits of the therapy are evaluated in terms of reduction in mortality and disease progression as compared to the potential transfusion-related adverse events. Political advocacy of therapeutics might hamper the autonomy and decision-making of individuals and institutions. Marketing and monetisation of convalescent plasma might cause inequitable distribution and unregulated use. It also creates an economic burden on the government and healthcare which should be justified by the additional cost/effectiveness ratio of the therapy. This article exemplifies the inadvertent effects and ethical challenges following political narratives about medical therapeutics and the importance of involving ethics in designing policies concerning public healthcare.

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Hydroxychloroquine and COVID-19: critiquing the impact of disease public profile on policy and clinical decision-making

Cited by 14 publications

References 36 publications

Medication of Hydroxychloroquine, Remdesivir and Convalescent Plasma during the COVID-19 Pandemic in Germany—An Ethical Analysis

Medication of Hydroxychloroquine, Remdesivir and Convalescent Plasma during the COVID-19 Pandemic in Germany—An Ethical Analysis

Hydroxychloroquine in the COVID-19 pandemic era: in pursuit of a rational use for prophylaxis of SARS-CoV-2 infection

Convalescent plasma, political narrative, and public health ethics in the Covid-19 pandemic

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