Large-scale study finds Turkey’s favoured COVID-19 treatment linked to sudden death

A multinational study of 96,032 COVID-19 patients has found that treatments that include hydroxychloroquine and the closely related chloroquine were associated with an increased risk of in-hospital mortality.

The study, published in medical journal the Lancet, examined four treatment regimens, combinations of chloroquine/hydroxychloroquine with or without a macrolide, a component used in pharmaceutical drugs that has antibiotic properties.

The study was “unable to confirm a benefit of hydroxychloroquine or chloroquine,” while each of the analysed treatment regimens was found to be “associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.”

The hydroxychloroquine alone increased risk of mortality by 34 percent and serious arrhythmia by 137 percent, the study found. The combination of hydroxychloroquine and a macrolide, which U.S. President Donald Trump endorsed and Turkish authorities announced as the preferred method for treatment in Turkey, increased risk of mortality by 45 percent, and serious arrhythmia by 411 percent.

“It’s one thing not to have benefit, but this shows distinct harm,” Eric Topol, a cardiologist and director of the Scripps Research Translational Institute, told the Washington Post. “If there was ever hope for this drug, this is the death of it.”

Experts have been divided on the efficacy of chloroquine/hydroxychloroquine since the virus took hold around the globe, but Turkish authorities had touted their widespread use as one of the reasons behind Turkey’s relatively low death toll despite being one of the countries with the biggest number of COVID-19 cases.

“There is no other country in the world (that uses hydroxychloroquine) the way we do,” Turkish Health Minister Fahrettin Koca had said during a news briefing on April 15, as he announced that Turkey had stocked more than a million boxes of the drug to be distributed for COVID-19 treatment at no charge in Turkish hospitals.

The minister had previously, on March 23, announced the arrival of an unnamed “Chinese drug” to be distributed to 40 out of Turkey’s 81 provinces to be used against the coronavirus in ICUs. On the same day, the Turkish Medical Association had warned that almost half of Turkey’s medical professionals had received no training on how to deal with the deadly virus.

On April 26, two days after the U.S. Food and Drug Administration warned against the use of both drugs citing reports of “serious heart rhythm problems,” Koca said Turkish doctors had been administering chloroquine treatment on symptomatic patients as they waited for their test results. The other drug Koca spoke of during the same speech, azithromycin, is one of the macrolides the study linked to extremely high risks of death and arrhythmia.

Turkish pharmaceutical company Abdi İbrahim on March 16 had renewed its licence for an antimalaria drug that contained chloroquin phosphate, and on April 5 the company announced that it had begun delivering boxes of the drug to the Health Ministry at no charge.

A month later, on May 9, Turkey’s Presidential Communications Director Fahrettin Altun announced that a local pharmaceutical company had been issued a permit to manufacture a drug for COVID-19 treatment.

"We began our journey and our research to not only meet the country's medicine needs but also to contribute to the country's economy,” the state-run Anadolu Agency quoted Cem Koçak from Koçak Pharma as saying.

Koçak Pharma, at the time of writing for this article, still celebrated being the holder of the first licence in Turkey to manufacture the generic version of hydroxychloroquine sulphate.


Announcement by Koçak Pharma
Announcement by Koçak Pharma


“A desperate disease demands desperate measures,” lead author of the newly published study, Prof Mandeep R. Mehra from the Harvard Medical School and Brigham and Women’s Hospital, said in an interview, “but we have learned a hard lesson from the experience about the importance of first doing no harm.”

Due to a lack of established treatment, doctors ended up using chloroquine and hydroxychloroquine in COVID-19 treatment for the first wave of patients, Geoffrey Barnes, a cardiovascular specialist at the University of Michigan, told the Washington Post. The drug had been considered generally safe for years as it was used for malaria and lupus treatment, but COVID-19 patients turned out to be more susceptible to cardiovascular complications, Barnes said.