There has been much talk about the drug hydroxychloroquine since the President introduced it to the general public a few weeks ago as a potential effective treatment for those infected with the Novel Coronavirus (SARS-CoV-2).
As rheumatologists, we have the largest experience using the drug and therefore are able to describe our experiences using it. We do not claim to have expertise on the management of COVID-19 (the disease caused by SARS-CoV-2) but we are very experienced experts on the use of hydroxychloroquine.
Hydroxychloroquine has been prescribed by rheumatologists for treatment of rheumatoid arthritis and lupus for the past few decades. As research has evolved, the drug has been proven safe and effective. It has withstood the test of time. The most common side effect in short term use is nausea, which usually resolves with continued treatment. Occasional rashes have been observed.
More than one well designed clinical trial has demonstrated the safety of hydroxychloroquine use in systemic lupus patients. In fact, these studies show that lupus patients on hydroxychloroquine have less risk of death than those who are not on the drug. The results have been so compelling that it is now standard of care that all patients with serious Lupus be treated with hydroxychloroquine.
These recommendations would not be made if the drug was as toxic as some commentators would have us believe. All drugs have potential risks and the risks must be considered in the context of benefit.
As long time prescribers of hydroxychloroquine, we can attest to the safety of this drug. Virtually no rheumatologist has had a patient suffer an acute fatal cardiac arrhythmia that has been reported in the prescribing information about this drug. Virtually none of us monitor an ECG prior to use. None of us have seen retinal toxicity with short term (less than one year) use of the drug. Most of us start our patients on 400 mg, similar to the dose used for treatment of COVID-19 infection. COVID-19 patients are only treated 6-10 days. We have patients successfully maintained on this drug for years.
In every situation the benefit vs risk of drug for the specific disease must be carefully considered. COVID-19 is a new disease and we are all just learning about disease manifestations and potential treatments. There may be unique aspects of treating such patients that are currently unknown. Nevertheless, based on extensive prior experience, we as experts in the use of hydroxychloroquine, would like the public to know that we have used this drug for long term therapy of our patients safely for decades.