Swinging the pendulum: lessons learned from public discourse concerning hydroxychloroquine and COVID-19

ABSTRACT

Introduction

Several months into the COVID-19 pandemic, safe and effective treatments against this global health disaster have yet to be identified. Clinical research trials around the world are underway testing a wide array of possible medications. In particular, the off-label use of hydroxychloroquine for COVID-19 prophylaxis and treatment has created many unprecedented challenges for the scientific community and the public.

Areas covered

We critically assessed major events from February – May 2020 that contributed to widespread use of hydroxychloroquine for the treatment and prophylaxis of COVID-19. We aimed to explore how opinions toward hydroxychloroquine may shift from early enthusiasm (based on in vitro and preliminary clinical data) to the hope for a miracle cure (through communication and promotion of questionable results) and, finally, to a rise of skepticism as more in-depth analyses are emerging.

Expert opinion

Mindful and rigorous acquisition of data, as well as its interpretation, are essential to an effective pandemic response. The rapid and premature promotion of results has had major implications for global crisis management, even creating distrust among the public. It is crucial for the medical and scientific community to incorporate the lessons learned from this situation.

KEYWORDS:

• Hydroxychloroquine
• chloroquine
• antimalarials
• coronavirus disease 2019
• SARS-CoV-2

Article highlights

• The COVID-19 pandemic has resulted in the rapid dissemination of research, both through scientific and non-scientific channels.

• We highlight the narrative of antimalarial therapy for the treatment of COVID-19 over the course of the pandemic from February through June 2020.

• Researchers and clinicians should be mindful of the public’s uptake of both pre-print and published data and provide meaningful interpretations.

• Premature use of unstudied therapies can delay clinical trial enrollment and potentially harm recipients.

• Well-designed rigorous clinical trials are possible and necessary during a public health emergency.

Acknowledgments

Drs. Sattui, Liew, and Graef and contributed equally.

Drs. Kim and Sparks contributed equally.

Figure was created with BioRender.com.

Data availability

Data was extracted from the U.S. Top Sources 2018 collection, a collection of the top U.S. newspapers and digital native sources of 2018, based on research from the Pew Research Center published in Aug 2019.

Declaration of interest

S Sattui is supported by the Vasculitis Clinical Research Consortium (VCRC)/Vasculitis Foundation Fellowship. The VCRC is part of the Rare Diseases Clinical Research Network, an initiative of the Office of Rare Diseases Research, National Center for Advancing Translational Science (NCATS). The VCRC is funded through collaboration between NCATS and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (U54 AR057319). No conflicts of interest or competing interests, and no funding relevant to this manuscript. J Liew is supported by a grant from the NIH/NIAMS outside of the submitted work. No conflicts of interest or competing interests relevant to this manuscript. F Berenbaum reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Sereno, MSD, Nordic, Novartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica, and 4P Pharma outside of the submitted work. No funding relevant to this manuscript. M Ugarte-Gil is supported by grants from Pfizer and Janssen outside of the submitted work. No conflicts of interest or competing interests, and no funding relevant to this manuscript. M Konig is supported by NIH/NIAMS T32AR048522, and received personal fees from Bristol-Myers Squibb and Celltrion, unrelated to the submitted work. No conflicts of interest or competing interests. P Korsten reports personal fees from GlaxoSmithKline, Sanofi-Aventis, Pfizer, AbbVie, Novartis Pharma, Lilly, and Bristol-Myers Squibb outside of the submitted work. No funding relevant to this manuscript. M Putman is supported by the Rheumatology Research Foundation outside of the submitted work. No conflicts of interest or competing interests. P Robinson reports personal fees from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche and UCB and research grant funding from Janssen, Novartis and UCB all outside of this work. A Kim is supported by grants from NIH/NIAMS, Rheumatology Research Foundation, and GlaxoSmithKline as well as personal fees from Exagen Diagnostics, Inc. and GlaxoSmithKline outside of the submitted work. J Sparks is supported by grants from NIH/NIAID/Autoimmune Centers of Excellence, Rheumatology Research Foundation, the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund as well as personal fees from Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum outside of the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.