Dubai: Do anti-malarial drugs chloroquine and hydroxychloroquine hold the key to beating coronavirus?
Dr Farida Al Hosani, official spokesperson from the UAE Ministry of Health and Prevention said on Saturday that both were being used in the UAE to treat COVID-19.
So can these two drugs be used in a widespread manner as they are in India? The hesitancy in using these drugs unequivocally across all spectrum of patients is owing to the fact that so far there is no peer reviewed study on their exact efficacy against COVID-19 so far.
On March 28, the US Food and Drug Agency declared issued an Emergency Usage Authorisation (EUA) which meant that although the drug had not yet been FDA approved, it’s use in special cases was authorised.
Integral part of treatment protocol
Dr Trupti Gilada Baheti, a graduate in infectious diseases from Harvard University and physician in infectious diseases at the Prince Aly Khan and Masina Hospitals, Mumbai told Gulf News: “So far what we have is only anecdotal evidence on the efficacy of the two drugs. However, despite that, we have been administering it to all patients of COVID-19. These include, mild, moderate and severe categories as per the guidelines issued by the Ministry of Health and Family Welfare in India. Both Chloroquine and Hydroxychloroquine have been found to be effective in lowering the viral load and helping in recovery of patients. We administer 800-mg of Hyrdroxycholoquine (which has found to be more effective with minimum side effects) on the first day of the admission of the patient, giving a dose of 400 mg morning and evening. On the subsequent two days we administer 400-mg of the drug divided in two doses of 200 mg each. This is administered along with other antivirals and antibiotics where we monitor the cardiac activity of the patient closely as one of the side effects of this drug is irregular heart rhythms that can be fatal in some cases.”
Dr Gilada-Baheti added, “What we have now is just anecdotal evidence and no published evidence about these drugs, but we have included it in our treatment protocol. We have had over 500 recoveries in India and I can say that many others are also on the road to recovery but they would be counted in the recovered only after three swab tests prove negative.” she said.
The world is rushing to stockpile these two drugs that are inexpensive and have been available in several countries familiar with the mosquito driven malaria epidemic. India is the largest manufacturer of these drugs.
What is chloroquine and hydroxychloroquine?
These two are similar medicines – salts of the compound chloroquine with the latter having an additional hydroxy molecule. As per research conducted by Frank Touret and Xavier Lamballerie that was published in the science journal Elsevier while chloroquine was prescribed for malaria, hydroxychloroquine was prescribed for auto-immune disorders involving the joints such as Rheumatoid Arthritis and Lupus. Both can have serious side effects if used indiscriminatley but have shown to be effective in combating some kinds of viruses when administred in therapeutic doses under strict medcial direction. A 1960 invitro research found the two drugs to be effective in lowering viral dose and inhibiting pneumonia as well as shortening the course of recovery. Trials carried out with these two drugs since 1960, found them to be effective in treating malaria as well as some of the illnesses called by other corona viruses. But it was not found effective in reducing the rate of recovery in Influenza or Dengue fever.
Usually drugs undergo several phases of clinical trials from animal testing to invitro examinations (laboratory controlled petri dish and test tube tests) to finally Phase 3 double blind trials where a group of volunteers are divided into two categories – one who receive the drug and one group that receives a placebo
Despite a lack of phase 3 double blind clinical trials that would have established the efficacy of the drug beyond doubt, the entire world is looking at chloroquine and hydroxychloroquine as wonder drugs to treat COVID 19 effectively.
Can these two drugs be used to treat COVID-19 patients?
Jennifer Tran, a PharmD and a managed care pharmacist there reported in a US based medical journal GOOD RX the trials carried out so far with the two drugs, as recently as in March 2020. While the reports look positive there has been no followup with peer reviewed research papers on the same therefore the evidence is largely considered anecdotal.
In one study conducted on March 16, 2020 , researchers from China reported in a letter that over 100 people with COVID-19 have been treated with chloroquine. These patients had less severe disease and a shorter illness duration compared to those who did not receive chloroquine.
In a second study, held in France on March 20, 2020, 26 patients were administered 600 mg of Hydroxycholoquine and it was reported they had a lower viral load in their body but the study compared patients from two different hospitals and there were too many variables that could have influenced the outcome. A small percentage of these people had to stop the treatment because of nausea worsening of their condition and even death and some who did better also received the antibiotic azithromycin.
In another randomised trial conducted on 62 hospitalised patients on March 31, 2020 in Wuhan, China, it was found that cough and fever improved a day earlier for those who got 400 mg of hydroxychloroquine for 5 days compared to those who did not get any. Additionally, pneumonia improved in 25 of 31 patients who received hydroxychloroquine (compared to 17 of 31 in the group who didn’t). Larger clinical studies are still needed to better understand the type of patients who may respond best to this treatment, pointed out Tran. In addition to these there have been some trials on the negative impact of these drugs which have several side effects such as causing irregular heart-beat, irreversible vision damage, causing lower blood sugar and worsening conditions like psoriasis.
However in the Indian state of Kerala, cholroquine and hydroxychloroquine are not being administerd to COVID-19 patients at all. This is one Indian state where the first COVID 19 cases was diagnosed on January 30, 2020 and since then has managed to effectively reduce the incidence of the disease with steadily declining numbers. Speaking to Gulf News, Professor (Dr) R Sajith Kumar, Chief of Infectious Diseases, Government Medical College in Kerala, and President of Association of Physicians of India Kerala chapter said: “These two drugs are part of our preventive protocol and are given as prophylactic to families of positive patients or to medical personnel who have had exposure to COVID 19. As per the Indian Council of Medical Research (ICMR) recommendations, both these drugs are known to have strong immune strengthening response and are effective in building immunity. We do not include them in our treatment protocol. I believe that 70-80 per cent of COVID 19 patients recover on their own with mild medication, moderate to severe require some anti retrovirals and antibiotics. This has been our protocol here. So far there is not enough evidence on these two drugs and when we have that, we might include it in our treatment protocol.”