Hydroxychloroquine for COVID19: The curtains close on a comedy of errors

Hydroxychloroquine-Chloroquine, QT-Prolongation, and Major Adverse Cardiac Events: A Meta-analysis and Scoping Review

OBJECTIVES

We aimed to evaluate the high-quality literature on the frequency and nature of major adverse cardiac events (MACE) associated with either hydroxychloroquine (HCQ) or chloroquine (CQ).

DATA SOURCES

We searched Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Central from 1996 onward using search strategies created in collaboration with medical science librarians.

STUDY SELECTION AND DATA EXTRACTION

Randomized controlled trials (RCTs) published in English language from January 1996 to September 2022, involving adult patients at least 18 years of age, were selected. Outcomes of interest were death, arrhythmias, syncope, and seizures. Random-effects meta-analyses were performed with a Treatment Arm Continuity Correction for single and double zero event studies.

DATA SYNTHESIS

By study drug, there were 31 HCQ RCTs (n = 6677), 9 CQ RCTs (n = 622), and 1 combined HCQ-CQ trial (n = 105). Mortality was the most commonly reported MACE at 220 of 255 events (86.3%), with no reports of torsades de pointes or sudden cardiac death. There was no increased risk of MACE with exposure to HCQ-CQ compared with control (risk ratio [RR] = 0.90, 95% CI = 0.69-1.17, I2 = 0%).

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

These findings have important implications with respect to patient reassurance and updated guidance for prescribing practices of these medications.

CONCLUSIONS

Despite listing as QT-prolonging meds, HCQ-CQ did not increase the risk of MACE.

Evaluation of Global Post-Outbreak COVID-19 Treatment Interventions: A Systematic Review and Bibliometric Analysis of Randomized Controlled Trials

Purpose

The outbreak of COVID-19 has led to a global pandemic with millions of cases and deaths. Many randomized controlled trials (RCTs) were conducted to establish effective therapies. However, the methodological quality of these trials is paramount, as it directly impacts the reliability of results. This systematic review and bibliometric analysis aim to assess the methodological approach, execution diversity, global trends, and distribution of COVID-19 treatment RCTs post-outbreak, covering the period from the second wave and onward up to the present.

Methods

We utilize articles from three electronic databases published from September 1, 2020, to April 1, 2023. Inclusion and exclusion criteria were applied to identify relevant RCTs. Data extraction involved the collection of various study details. Risk of Bias (RoB) 2 tool assessed methodological quality, while implementation variability was evaluated against registration information. Bibliometric analysis, including keyword co-occurrence and country distribution, used VOSviewer and Tableau software.

Results

Initially, 501 studies were identified, but only 22 met the inclusion criteria, of which 19 had registration information. The methodological quality assessment revealed deficiencies in five main domains: randomization process (36%), deviations from intended interventions (9%), missing outcome data (4%), measurement of the outcome (18%), and selection of reported results (4%). An analysis of alignment between research protocols and registration data revealed common deviations in eight critical aspects. Bibliometric findings showcased global collaboration in COVID-19 treatment RCTs, with Iran and Brazil prominently contributing, while keyword co-occurrence analysis illuminated prominent research trends and terms in study titles and abstracts.

Conclusion

This study offers valuable insights into the evaluation of COVID-19 treatment RCTs. The scarcity of high-quality RCTs highlights the importance of enhancing trial rigor and transparency in global health emergencies.

ChatGPT and the rise of large language models: the new AI-driven infodemic threat in public health

Large Language Models (LLMs) have recently gathered attention with the release of ChatGPT, a user-centered chatbot released by OpenAI. In this perspective article, we retrace the evolution of LLMs to understand the revolution brought by ChatGPT in the artificial intelligence (AI) field. The opportunities offered by LLMs in supporting scientific research are multiple and various models have already been tested in Natural Language Processing (NLP) tasks in this domain. The impact of ChatGPT has been huge for the general public and the research community, with many authors using the chatbot to write part of their articles and some papers even listing ChatGPT as an author. Alarming ethical and practical challenges emerge from the use of LLMs, particularly in the medical field for the potential impact on public health. Infodemic is a trending topic in public health and the ability of LLMs to rapidly produce vast amounts of text could leverage misinformation spread at an unprecedented scale, this could create an "AI-driven infodemic," a novel public health threat. Policies to contrast this phenomenon need to be rapidly elaborated, the inability to accurately detect artificial-intelligence-produced text is an unresolved issue.

Rational and irrational vaccine hesitancy

In the paper published recently in this journal, Kumar et al. explained why the key to improved COVID-19 vaccine uptake is to understand societal reactions leading to vaccine hesitancy. They conclude that communications strategies should be tailored to the different phases of vaccine hesitancy. However, within the theoretical framework provided in their paper, vaccine hesitancy should be recognized as having both rational and irrational components. Rational vaccine hesitancy is a natural result of the inherent uncertainties in the potential impact of vaccines in controlling the pandemic. In general, irrational hesitancy is based on baseless information obtained from hearsay and deliberately false information. Risk communication should address both with transparent, evidence-based information. Rational concerns can be allayed by sharing the process in which dilemmas and uncertainties are dealt with by the health authorities. Messages on irrational concerns need to address head on the sources spreading unscientific and unsound information. In both cases, there is a need to develop risk communication that restores trust in the health authorities.

Hydroxychloroquine to prevent SARS-CoV-2 infection among healthcare workers: early termination of a phase 3, randomised, open-label, controlled clinical trial

OBJECTIVE

To assess the effectiveness and safety of hydroxychloroquine (HCQ) prophylaxis for the prevention of SARS-CoV-2 infection in healthcare workers (HCW) on duty during the COVID-19 pandemic.

RESULTS

A total of 68 HCWs met the eligibility criteria were randomly allocated to receive HCQ (n = 36) or not (n = 32). There were no significant differences between groups in respects to age, gender, or medical history. Eight participants met the primary efficacy endpoint of SAR-CoV-2 infection during the study period; there was no difference in incidence of SARS-CoV-2 infections between both study arms (HCQ: 5 vs Control: 3, p = 0.538). The relative risk of SARS-CoV-2 infection in the HCQ arm was 1.69 compared to the control group (95%CI 0.41-7.11, p = 0.463); due to poor participant accrual, the resulting statistical power of the primary efficacy outcome was 11.54%. No serious adverse events occurred; however, two (2/36, 5.6%) participants no longer wished to participate in the study and withdrew consent due to recurring grade 1 and 2 adverse events.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04414241. (Registered on June 4, 2020).

Visible-Light-Mediated Solvent-Switched Photosensitizer-Free Synthesis of Polyfunctionalized Quinolines and Pyridines

A solvent (2,2,2-trifluoroethanol (TFE) vs ethyl alcohol (EtOH)) switched synthesis of quinolines and pyridines is illustrated from (E)-2-(1,3-diphenylallylidene)malononitriles via a Pd(II)-catalyzed photochemical process. The active catalyst [L₂Pd(0)] generated serves as an exogenous photosensitizer. The process offers predominantly Z-alkenylated quinolines and pyridines in TFE and EtOH, respectively. Furthermore, large-scale synthesis and a few interesting post-synthetic modifications have been demonstrated.