how about that Plaquenil?

That much maligned cinchona bark extract derivative got a little boost recently. On January 14, a group out of Hackensack (New Jersey) Meridian Health Network published their findings on the effect of Plaquenil on keeping COVID-infected patients out of the hospital*. They looked at all the patients diagnosed with COVID in their ERs or clinics from March 1st to April 22nd, then saw what happened to them through May 22nd. Since they were looking back, and treatment decisions were up to individual doctors, this was a retrospective uncontrolled study, pretty weak in the eyes of science types. Still, what they found was pretty interesting.

Among 1274 outpatients with documented COVID infection 7.6% were prescribed hydroxychloroquine (Plaquenil). In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to Plaquenil were hospitalized, and 31.4% without exposure were hospitalized. Propensity score matching is a quasi-experimental method in which the researcher uses statistical techniques to construct an artificial control group by matching each treated patient with a non-treated patient having similar characteristics. Using these matches, the researcher can estimate the impact of an intervention. So using these stats, they showed that the reduced rate of hospitalization for the patients who received Plaquenil was statistically significant. It looks even better graphically

Looks like something you might wanna take if your COVID test comes back positive, eh? The stuff is very safe, especially in short term, and quite cheap. I used to prescribe it by the buckets full to patients with mild rheumatoid arthritis or lupus, and those treatment courses were long term. Except for having to see an eye doctor annually (Plaquenil can build up in the retina long term), patients didn’t run into trouble as long as we minded the dose, adjusting for body weight. Controlled studies have shown Plaquenil doesn’t have much of an effect on COVID patients who are already quite sick and in the hospital, or in protecting health care workers at high risk of exposure from getting it themselves. President Trump was taking Plaquenil when he came down with COVID, but he had a pretty mild course, and maybe that was the Plaquenil in part (although most who catch COVID have a pretty mild course).

None of our betters seemed to like Plaquenil very much, although that opposition is being quietly rolled back, like the AMA’s cave last month Who knows how many could have been saved from the hospital or maybe even from death had more liberal use of Plaquenil been the thing from the get go? Well, COVID is still with us and the vaccines aren’t going to do everything. If you’re unfortunate enough to test positive, do what they tell you to do on the TV adds: “ask your doctor”.

Here’s the reference. If you click on the link, you can see the paper itself, maybe print it out to have in your back pocket when you go to your doctor’s office.

*Ip, A., Ahn, J., Zhou, Y. et al. Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: a multi-center observational study. BMC Infect Dis 21, 72 (2021).

Published by rike52

I retired from the Rheumatology division of Michigan Medicine end of June '19 after 36 years there. Upon hitting Ann Arbor for the second time (I went to school here) it took me almost 8 months to meet Kathy, 17 months to buy her a house (on Harbal, where we still live), and 37 months to marry her. Kids never came, but we've been blessed with a crowd of colleagues, friends, neighbors and family that continues to grow. Lots of them are going to show up in this log eventually. Stay tuned.

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