Question explored with the scientific record
what did harvey risch say about hydroxychloroquine use in Covid in 2020
Harvey Risch argued early in the pandemic that hydroxychloroquine, used early and with zinc, could reduce hospitalizations and deaths in COVID-19. He based this on clinical reasoning, observational data, and small trials, not on large randomized controlled trials.
The evidence retrieved here does not settle the question. One review from 2020 notes that Gautret et al. reported viral load reduction with hydroxychloroquine, but other researchers could not replicate the effect, and high-dose chloroquine combinations were linked to deaths and cardiac adverse events [2]. A 2020 study of healthcare workers using hydroxychloroquine as pre-exposure prophylaxis found a higher infection rate in the hydroxychloroquine group (23.2%) than in the comparison group (15.6%), though this was not a randomized trial and the groups were not matched [9]. A separate trial from Iran tested favipiravir plus hydroxychloroquine against lopinavir/ritonavir plus hydroxychloroquine and found no difference in mortality or ICU admission between the two arms, but this trial had no placebo group and every patient got hydroxychloroquine, so it cannot measure whether hydroxychloroquine itself helped or harmed [1].
The evidence that exists is low quality: small studies, no placebo-controlled trials testing early outpatient use, and conflicting signals. The most informative study design—a large, randomized, placebo-controlled trial of early hydroxychloroquine with hard endpoints like hospitalization and death—was never completed in a way that settled the question. The evidence base is too thin and too conflicted to say whether Risch was right or wrong.
My call: the evidence does not support a confident verdict on hydroxychloroquine for early COVID-19.
Sources examined 12
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Safety and efficacy of Favipiravir in moderate to severe SARS-CoV-2 pneumonia
A multicenter randomized open-label trial in Iran comparing Favipiravir plus hydroxychloroquine versus Lopinavir/Ritonavir plus hydroxychloroquine in adults with moderate-to-severe SARS-CoV-2 pneumonia found no benefit of Favipiravir on ICU admission, mortality, or time to clini…
DOI: 10.1016/j.intimp.2021.107522 -
Novel therapeutic approaches for treatment of COVID-19
This review summarizes potential therapeutic approaches for COVID-19, including antivirals, immunotherapies, cell therapies, and nanomedicine, highlighting both promising results and unresolved controversies.
DOI: 10.1007/s00109-020-01927-6 -
Cyclin E Overexpression Relates to Ovarian Cancer Histology but not to Risk Factors
The study critiques the conclusions drawn by Schildkraut et al. regarding the relationship between cyclin E overexpression and ovarian cancer risk factors, arguing that their analysis fails to adequately control for histological differences among cancer types.
DOI: 10.1158/1055-9965.epi-08-0271 -
ABO Blood Group, Helicobacter pylori Seropositivity, and Risk of Pancreatic Cancer: A Case-Control Study
This population-based case-control study in Connecticut (373 pancreatic cancer cases and 690 controls) found that non-O ABO blood groups and Helicobacter pylori seropositivity—particularly with CagA-negative strains—are associated with increased pancreatic cancer risk, while Cag…
DOI: 10.1093/jnci/djq007 -
An application of capture-recapture methods to the estimation of completeness of cancer registration
Capture-recapture modeling of Ontario Cancer Registry data estimates cancer-registration completeness at about 95%, with site-specific variation, and shows that modeling with three data sources yields similar overall completeness to two-source methods while accounting for depend…
DOI: 10.1016/0895-4356(88)90052-2 -
Family history of cancer and risk of esophageal and gastric cancers in the United States
A large US multicenter population-based case-control analysis finds no association between a family history of digestive cancers and esophageal cancer risk, but shows elevated risks for gastric cardia and non-cardia gastric cancers, especially with a stomach or breast cancer fam…
DOI: 10.1002/ijc.1294 -
Chronic hydroxychloroquine exposure and the risk of Alzheimer’s disease
An observational evaluation of whether long-term hydroxychloroquine exposure affects the risk of Alzheimer's disease in an elderly Taiwanese population, finding no proven association and calling for randomized controlled trials.
DOI: 10.1136/annrheumdis-2019-216173 -
Unusual Fundus Autofluorescence Appearance in a Patient with Hydroxychloroquine Retinal Toxicity
Unusual fundus autofluorescence appearance in hydroxychloroquine retinal toxicity observed in a 53-year-old woman after nine years of therapy and three years post-cessation.
DOI: 10.1159/000433417 -
Hydroxychloroquine pre-exposure prophylaxis for COVID-19 in healthcare workers
This study evaluates the efficacy of hydroxychloroquine as pre-exposure prophylaxis for COVID-19 among healthcare workers, finding no significant benefit in preventing infection.
DOI: 10.1093/jac/dkaa477 -
False-negative RT-PCR in SARS-CoV-2 disease: experience from an Italian COVID-19 unit
In a retrospective observational study from an Italian hospital's COVID-19 unit, researchers document cases of false-negative initial RT-PCR results and highlight chest CT (HRCT) as a crucial diagnostic tool to manage suspected COVID-19 when RT-PCR is negative.
DOI: 10.1183/23120541.00324-2020 -
Autophagy mechanisms in sputum and peripheral blood cells of patients with severe asthma: a new therapeutic target
The study demonstrates that autophagy is upregulated in sputum granulocytes, peripheral blood cells, and eosinophils of patients with severe asthma, shows IL-5 and inflammatory cytokines induce autophagy in relevant cell types, and suggests autophagy modulation as a potential th…
DOI: 10.1111/cea.12585 -
Hydroxychloroquine in the primary thrombosis prophylaxis of antiphospholipid antibody positive patients without systemic autoimmune disease
This study aimed to evaluate the efficacy of hydroxychloroquine in preventing thrombosis in persistently antiphospholipid antibody-positive patients without systemic autoimmune diseases, but was terminated early due to low recruitment and no observed thrombotic events.
DOI: 10.1177/0961203317724219