Editorial: COVID-19 and the quality use of medicines: evidence, risks and fads

Abstract

COVID-19 and the quality use of medicines: evidence, risks and fads Some studies that have been popularised by the media have been uploaded to online preprint servers without the rigour of peer review. This may not be apparent from an abstract or media report so a high level of scepticism is required.A global survey of physicians in early April 2020 found that hydroxychloroquine and azithromycin were prescribed or seen to be prescribed by nearly 50% of respondents. However, only 38% perceived efficacy in COVID-19. 10 Some healthcare workers have prescribed hydroxychloroquine for themselves and their families. This represents extrapolation of the very low-quality evidence for treatment 11 to experimental use for prophylaxis. 12 The decision may have been their own, but it has been rumoured that some doctors were advised by their employer to self-prescribe hydroxychloroquine due to their increased risk of being infected by patients with COVID-19. This highlights the ethical questions about prescribing experimental treatments. 13 It is important to distinguish off-label from experimental prescribing.Given the rate that the pandemic is evolving, the processes required to start a clinical trial may appear prolonged. However, these processes are necessary to develop a protocol, allocate resources and ensure patients are monitored to avoid treatment-related deaths. An experimental treatment should only be prescribed after informed consent is obtained.

Letter to the Editor: QUM and COVID-19 in young adults

“…It is increasingly clear that the natural history of COVID-19 reflects risk factors whereby younger age and fewer comorbidities are favourable. [1][2][3] For example, despite a high number of cases of adults under 50 years of age in Australia, only 7% were hospitalised and 0.03% died. 4 In India, mortality has been reported as 0.4% in those under 40 years of age.…”

“…I read the editorial on COVID-19 and the quality use of medicines 1 with great interest and found it very balanced and rational. I liked the approach of the editorial.…”

“…Randomised controlled trials are needed to quantify the efficacy of antiviral treatments for reducing COVID-19 disease progression. 6 To our knowledge there are no trials in young adults with mild disease. However, death and other adverse effects to antivirals in COVID-19 have been reported, but mostly in patients with severe disease so the observation may be confounded by indication.…”

Editorial: Immunosuppression for COVID-19: repurposing medicines in a pandemic

“…12 However, these drugs need the same caution as any off-label and experimental prescribing in COVID-19 until they are validated in clinical trials. [13][14][15] Not all immunosuppressive drugs hold the same promise. While systemic corticosteroids are effective immunosuppressants, previous and current outbreaks suggest that their broader physiological effects lead to uncertain benefit and potential harm.…”

“… 12 However, these drugs need the same caution as any off-label and experimental prescribing in COVID-19 until they are validated in clinical trials. 13 - 15 …”