Hydroxychloroquine: A Potential Ethical Dilemma for Rheumatologists during the COVID-19 Pandemic

Abstract

Two antimalarial agents, chloroquine (CQ) and hydroxychloroquine (HCQ), have been trusted treatments for a range of rheumatic diseases over the past 70 years1. These agents have attracted intense media attention in the past few weeks with suggestions that this category of drugs may have potential in the management of the coronavirus (SARS-CoV2)–associated disease called COVID-192,3. In this unprecedented time of a world viral pandemic that is associated with considerable mortality, rheumatologists can anticipate challenges in clinical care. We must counsel patients about the appropriate use of HCQ (CQ is not currently available in Canada) in the management of rheumatic diseases, provide valid scientific information regarding the current evidence for effect in COVID-19 disease, and be poised to provide alternative drug treatment in the event that HCQ may be allocated away from routine rheumatology clinical care to treat seriously ill viral-infected patients. These issues are pertinent and imminent for the rheumatologist and require an understanding of the current available knowledge, and consideration of a possible ethical dilemma in the event that drug supply is limited. Antimalarial therapy began in the mid-17th century with observations by Jesuit missionaries in Peru that the bark of a specific tree, later named Cinchona, could be used to treat the severe febrile illness now know to be malaria4. In the late 17th century, the Peruvian bark, mixed with rose leaves, lemon juice, and wine was a widely used secret treatment for fever in the malarial regions of England4. Quinine is a complex structured alkaloid and the active therapeutic component of the Cinchona tree. It was isolated and named in 1820 by 2 French chemists, Pelletier and Caventou4. Until the 1850s all the Cinchona bark came from the wild forests of the Andean republics of … Address correspondence to Dr. M.A. Fitzcharles, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: mfitzcharles{at}sympatico.ca

Topics & Concepts