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GPs ‘strongly discouraged’ from prescribing antimalarials for Covid-19

GPs are ‘strongly discouraged’ from prescribing antimalarial drugs to treat Covid-19 while clinical trials are ongoing, NHS England has said.

Both chloroquine and hydroxychloroquine are now included in the Chinese guidelines on the management of Covid-19.

But, rather than prescribing these drugs off licence, NHS England has urged GPs to help enrol patients into three newly-launched UK trials into Covid-19 treatments.

This includes the Principle trial, which is evaluating the use of antimalarial hydroxychloroquine in a primary care setting; as well as the Recovery trial in a hospital setting; and the Remap-Cap trial in an intensive care setting.

In a bulletin to practices, NHS England said: ‘While it is for every individual clinician to make prescribing decisions, we strongly discourage the use of off-licence treatments outside of a trial, where participation in a trial is possible.

‘Use of treatments outside of a trial, where participation was possible, is a wasted opportunity to create information that will benefit others. The evidence will be used to inform treatment decisions and benefit patients in the immediate future.’

In another recent letter, NHS England said clinical trials are ongoing and in development to assess the benefits of ‘a number of different medicines’ – including hydroxychloroquine and chloroquine – in treating Covid-19.

The letter said: ‘Hydroxychloroquine and chloroquine should be used only as part of a clinical trial for the treatment of Covid-19, and we ask pharmacists and GPs to support this message and restrict prescriptions and supply to those with current clinical need for licensed indications or as part of a clinical trial.’

It added that suppliers of drugs that are undergoing testing ‘have been asked to monitor requests and restrict orders in line with historic ordering requirements’.

GP and professor of primary care at Imperial College London Professor Azeem Majeed told Pulse it is ‘sensible advice’.

He said: ‘There is currently very limited evidence about the benefits of hydroxychloroquine and chloroquine in Covid-19 infection. GPs should await the results of well-designed clinical trials.’

However, Professor Majeed added that he has ‘not heard of them being prescribed by GPs’ to treat coronavirus.

He said: ‘As this would not be a licenced use of these drugs and the benefits and risks are unclear, I can’t see many – if any – GPs in the UK prescribing them. I would not prescribe.’

A rapid review from researchers at the University of Oxford, published in BJGP Open on 8 April, concluded that there is currently ‘insufficient evidence’ to determine whether either antimalarial drug is ‘safe and effective’ as a treatment for Covid-19.

The authors ‘urgently’ called for ‘high-quality, adequately-powered randomised clinical trials’ in primary care as well as secondary care settings.

The RCGP told Pulse that the Principle trial, which it is leading from its Research and Surveillance Centre based at the University of Oxford, will focus on hydroxychloroquine.

RCGP vice chair for external affairs Dr Gary Howsam said: ‘The Principle trial will initially test whether hydroxychloroquine, given within a week of onset of a likely Covid-19, reduces hospital admission or mortality.

‘This is vital work that could reduce the duration and severity of Covid-19. Hydroxychloroquine has been chosen, based on some evidence from SARS, MERS, and the recent Covid-19 experience in China.’

The DHSC said last week that almost 1,000 patients were already recruited to its trials, which it has funded with £2.1m. Aside from antimalarials they will test  HIV-treatment Lopinavir-Ritonavir and Dexamethasone.

‘Thousands more’ patients are expected to join the trial and results are expected ‘within months’, it added.

The antiviral drug remdesivir is also to be trialled as a treatment for Covid-19 on a small number of patients in England and Scotland, according to the BBC.

The DHSC is ‘carefully considering all available evidence’ about potential uses of existing medicines for treating the virus, NHS England said.

Further medicines may also be trialled if there is evidence that this is appropriate, it added.