Can Anti-Malaria Drug Chloroquine Really Help Treat Coronavirus?
Even as excitement around the anti malaria drug has gone up as treatment for COVID-19, it remains experimental.
There has been a rush of trials, pretrials and preclinical trials for a host of already existing medicines that may help treat COVID-19, the disease caused by coronavirus. And we are not even talking about vaccines here.
The drug to receive the most attention, from US President Donald Trump himself, is the anti-malaria drug chloroquine and its derivative hydroxychloroquine. While briefing the press, the US President did a hard-sell, saying,
"A drug called chloroquine, and some people would add to it hydroxychloroquine, now this is a common malaria drug. The nice part is, it's been around for a long time, so we know that if things don't go as planned it's not going to kill anybody. It's shown very very encouraging early results."
He then went on to say the FDA had approved the drug for COVID-19.
"We're going to be able to make that drug available almost immediately, and that's where the FDA has been so great. They've gone through the approval process, it's been approved. And they took it down from many, many months to immediate. So we're going to be able to make that drug available by prescription or states."
There's only one problem. The FDA has only approved the drug for testing.
No, FDA Has NOT Approved Hydroxychloroquine For Markets
During the same press briefing, US Food and Drug Administration director Dr Stephen Hahn clarified that the drugs will be used in a clinical trial.
"What’s also important is not to provide false hope. We may have the right drug, but it might not be in the appropriate dosage form right now, and it might do more harm than good.”Dr Stephen Hahn, Director, US FDA
The source of this hope around chloroquine is a small French study yet to be published in a medical journal. Researcher Didier Raoult from Aix-Marseille University in France released encouraging results of a preliminary trial involving a total of 36 COVID-19 patients. Most of these patients had mild to moderate symptoms. Between 1st to 15th March the researcher and his team treated 20 of these patients with 600 milligrams of hydroxychloroquine daily. An antibiotic called azithromycin was added to the treatments for specific symptoms. 16 patients were not given the drug.
The result? There was a significant reduction in viral load in the patients treated with hydrooxychloroquine. 70 percent of those given the drug showed up COVID-19 negative in six days.
Among the control group the number was just 12.5 percent. While the paper has yet to be published, the study considered too small to be significant, the results were released in the hope of starting larger, more scientific drug trials. The US FDA is now planning to do just that.
To be fair, there have been other studies that have linked the drug to coronavirus treatment. The medical journal Clinical Infectious Diseases reported on 9 March that a brand-name version of hydrooxychloroquine was effecting in killing coronavirus in laboratory experiments. Plaquenil is an already approved drug for malaria and arthritis. However, even this data was not considered enough by experts to draw out major conclusions.
Anti-HIV Drugs, India and Coronavirus
In the absence of a vaccine, a number of repurposed drugs, meaning already existing drugs that are deemed safe for some treatments, have been used on 'compassionate grounds' for treating coronavirus patients.
The ones the made the most noise here in India is the combination of anti- HIV and anti viral drugs that were used to treat an Italian couple in Jaipur's SMS hospital. Six states have already reached out to the hospital to seek treatment modalities. But Indian Council of Medical Research itself warned that these remain 'experimental' till proper trials are carried out.
While both tested negative after the treatment, the 69-year-old man died of other co-morbidities 5 days later on 20 March.
The Health Ministry is India refused to call the death COVID related.
"The tourist had a history of heart disease, was a chain smoker and had underlying conditions. He was treated for COVID-19 and recovered from the virus. While under treatment for other co-morbidities in a private hospital, the nearly 70 year old man had a heart attack," Lav Agarwal, Joint Secretary, Ministry of Health and Family Welfare.
However doctors FIT spoke with said while the patient may have tested negative for COVID-19, the damage done by the virus could have led to the eventual cardiac event.
"The virus may clear the body, but the virus initiates the release of chemicals that can damage other organs. An infection stresses the body. This is precisely why COVID-19 is so dangerous for heart patients. If you see the trajectory of deaths linked to cardiac disease, it is much higher than any other underlying conditions."Dr Sumit Ray, Critical Care specialist
Earlier, The Drug Controller General of India (DCGI) had consented to the ‘restricted use’ of a combination of anti-HIV drugs for treating those affected by 2019-nCoV, after the Indian Council of Medical Research had sought an emergency approval for the use of the two drugs — ‘lopinavir’ and ‘ritonavir’.
However, here's a problem. The combination of lopinavir and ritonavir turned out to be ineffective in treating severe illness in COVID-19 patients. A paper published in The New England Journal of Medicine, at a sample of 199 patients, on which 99 were given the combination drugs in Wuhan, China. The treatment showed NO observable benefits. There was no clear way to tell if the patients improved a a result of standard care or due to this drug combo.
Another antiviral drug, called remdesivir, which had initially been developed to fight Ebola, was used to treat the first patient affected by the Wuhan coronavirus in the US. IANS reports that the Wuhan Institute of Virology has applied for a patent in China for the use of this antiviral therapy.
China had also recently approved the use of Swiss drugmaker Roche's anti-inflammation drug Actemra for patients with severe complications of COVID-19, according to Reuters.
SO, Should We Be Excited About All the Reports Coming Out on Repurposed Drugs?
Most experts we speak with clearly say these drugs do help, have minimal risk as they have been cleared for treatments, but are not absolute treatments for coronavirus. Since these drugs are already available, doctors are free to use these to attack specific symptoms.
But not all drugs are made equal. For e.g., the anti-malaria drug chloroquine is not safe for patients with heart arrhythmia and kidney and liver disease. But the excitement around the drug means it is already running on short supply in the US. Nigeria, where malaria is endemic, is also running out of the drug.
Remdesivir, mentioned above, was made for Ebola but proved to be not very effective.
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