Fleet Surgeon Article June_July 2022

retracted the article a month later due to fraudulent data. Three of these same authors published another COVID article in the prestigious New England Journal of Medicine the same month which was similarly retracted. Interestingly, NEJM has blocked the link to that article. 21 The FDA had approved an emergency use authorization (EUA) for hydroxychloroquine and chloroquine on March 28, 2020 but revoked it in June after publication of the Lancet article. 22 With regard to dosage safety, one study in Brazil treated COVID–19 compared high dose versus low dose HCQ with either 1200 mg of chloroquine daily for 10 days (12 grams total) versus a mix of chloroquine and placebo for a total of 2.7 grams. Excess lethality in the high – dose group caused cessation of that part of the study and prompted recommendation to use lower doses. 23 On e large review reported increased mortality for patients receiving hydroxychloroquine (7.7%) versus those not receiving it (7.1%) in 26 studies. This increase, although statistically significant, was obviously pretty minimal. 24 No statistically significant difference was noted with chloroquine (which, curiously, has the 40% higher toxicity). They noted that most (67%) of these patients were enrolled in the large RECOVERY and WHO SOLIDARITY trials. 25,26 Oddly, the raw data on the 10,012 patients calculate to 14% mortality for HCQ and 17% not receiving the medication. 23 The Cochrane Collaboration publishes very well – respected, authoritative reports on many medical topics. Their 2021 review of studies involving a total of 8,569 patients reported that that HCQ, “clearly did not affect how many people died . ” 27 The RECOVERY trial enrolled 4,716 patients. 25 1,561 patients received 2 grams of hydroxychloroquine within the first 24 hours and then 800 mg daily for the next 9 days. A non–statistically difference in death within 28 days of 27% HCQ and 25% for controls (no HCQ). 62.9% of controls and 59.6% of HCQ patients were discharged alive within 28 days. Mechanical ventilation or death was noted in 30.7% HCQ and 26.9% control. The

Anchorlines, June/July 2022

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