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Hydroxychloroquine: Ineffective as a therapy, can it help protect health care workers?

Posted by on Monday, October 5, 2020 in Fall 2020, Related Content .

In addition to remdesivir, several other drugs are being tested for the treatment of COVID-19.

One of them is hydroxychloroquine (HCQ), a drug originally developed to treat malaria but which currently is prescribed as an anti-inflammatory medication to reduce the pain and swelling of rheumatoid arthritis and systemic lupus erythematosus (lupus).

In laboratory studies HCQ can inhibit replication of SARS-CoV-2. Some observational studies in patients have suggested that the drug may have a beneficial effect, while other studies have reported mixed results.

In June, for example, recruitment to a nationwide study of HCQ called the ORCHID trial, which was led by VUMC, was completed, showing no evidence of clinical benefit for HCQ.

“These results provide a high level of certainty that HCQ is not a useful treatment for adults admitted to the hospital with COVID-19,” said Wesley Self, MD, MPH, associate professor of Emergency Medicine who led the trial.

But while HCQ does not appear to be an effective treatment for COVID-19, the question remains: can it protect people who are exposed to the virus from being infected?

Two studies at VUMC are trying to answer that question.

This spring about 1,500 health care workers at high risk of being exposed to SARS-CoV-2 were enrolled at several sites throughout the country, including VUMC, in a randomized, controlled clinical trial of HCQ’s effectiveness in preventing infection.

Justin Balko, PharmD, PhD, Ingrid Mayer, MD, MSCI, and Brian Rini, MD, are the principal investigators of the VUMC study, which is part of a national trial led by researchers at the University of Minnesota.

VUMC also is participating in the Healthcare Worker Exposure Response and Outcomes (HERO) research program, which is establishing a national registry of health care workers to study how they are impacted by COVID-19.

Funded by the nonprofit Patient-Centered Outcomes Research Institute (PCORI) in Washington, D.C., the HERO initiative is led by the Duke Clinical Research Institute.

The registry is recruiting thousands of health care workers from across the country including doctors, nurses, respiratory therapists and paramedics, many of whom work on the frontlines of the coronavirus pandemic and are at high risk for infection.

They are being recruited at about 40 PCORnet sites across the country including VUMC and Williamson Medical Center. A subset will participate in an HCQ protection study.

Russell Rothman, MD, MPP, VUMC’s Senior Vice President for Population and Public Health, professor of Internal Medicine, Pediatrics and Health Policy and Ingram Professor of Integrative and Population Health, co-chairs the HERO Steering Committee.

Fellow HERO Steering Committee member Sean Collins, MD, MSCI, professor and executive vice chair of the Department of Emergency Medicine at VUMC, leads VUMC’s engagement in the HERO study and serves as the site’s principal investigator.

Besides the HCQ trial, “we are learning valuable information about how COVID-19 is impacting health care workers, including their risk of getting COVID-19, their access to PPE (personal protective equipment), and the stress and other challenges (they) and their families face related to dealing with the epidemic,” Rothman said.