Sir, readers will be aware of the autoimmune disease systemic lupus erythematosus (SLE), owing to the associated oral, head and neck manifestations. The efficacy of hydroxychloroquine in reducing the risk of severe lupus flares is well documented.

Given that the emergence of a suitable vaccine against the 2019 coronavirus disease (COVID-19) may be a seemingly distant prospect, several clinical trials are underway to evaluate a potential role for existing drugs. Hydroxychloroquine is one such drug with hypothesised mechanisms of action and in vitro evidence supporting the inhibition of severe acute respiratory syndrome coronavirus 2.1

However, in an almost desperate attempt to lessen the burden of the pandemic, physicians are sporadically prescribing the drug with little evidence informing whether they are appropriate for treating COVID-19.2 Propagated in part by President Trump's endorsement, the sudden demand for hydroxychloroquine has created a shortage in its availability to patients requiring this medication.3 The impact of withdrawing the medication for just a fortnight can exacerbate flares and heighten disease activity in otherwise stable SLE patients.4 The drug is vital and unique in its ability to prevent further systemic complications and increase chance of survival.5

The attention drawn to the COVID-19 pandemic risks compromising the provision of care to those with chronic conditions. The case for patients with SLE could represent one of many interruptions to treatment. Evaluating the severity of each compromise is essential. The decision to champion hydroxychloroquine so hastily raises yet more questions on the decision-making approaches, which currently show considerable disparity. Several recent clinical studies have investigated hydroxychloroquine for COVID-19 patients but these have been at high risk of bias, hence the need for large randomised placebo-controlled clinical trials to determine the potential benefits and harms before any role can be recommended. This story highlights the importance of an evidence-based approach that we increasingly recognise in the practice of dentistry.