Hydroxychloroquine Requires More Testing in Coronavirus Patients

It has been known in the scientific communities for quite some time now that hydroxychloroquine and other antimalarial therapies do show some antiviral properties.

With health care systems overwhelmed everywhere due to the current coronavirus pandemic, many doctors are using these drugs as a last-ditch effort to help people who are too far gone. The point to note is that these treatments are still highly experimental and only allowed for people who have very little chances of surviving anyway. This is an off-label use of the drug.

President Donald Trump also keeps on propagating the myth that this drug is a proven method for coronavirus treatment. It actually is not. Right now, the drug is only used as a strategy to clear out the virus from the patient’s body before it can do serious damage. That role is also under fierce debate.

The Case for Hydroxychloroquine

Hydroxychloroquine is an anti-malaria drug used to prevent and treat malaria. It works by regulating the immune system in the human body.

The Food and Drug Administration (FDA) has provided hydroxychloroquine with an ‘emergency use authorization’ to use on coronavirus patients in some circumstances. New York is testing the drug on at least 4,000 people right now.

The use of hydroxychloroquine is based on early evidence of its effects in cell cultures and early clinical trials. People who develop pneumonia related to COVID-19 are being given chloroquine and hydroxychloroquine. The Chinese authorities have even updated their guidelines for the management of the coronavirus infection and included these drugs as treatment options.

An in vitro study has found that hydroxychloroquine did have an anti-coronavirus effect. The drug decreased viral replication in a time and concentration dependent manner. This means that the drug decreased with longer incubation times providing higher intracellular concentrations and a better antiviral effect. Hydroxychloroquine was more effective than chloroquine and inhibited viral growth at both entry and post entry stages. The scientists suggest its usage two times a day in 400 mg quantities each.

Another study found that hydroxychloroquine cleared the virus out of the system with 6 days of treatment, either alone or with another drug called azithromycin. Both these treatments also showed negative nasopharyngeal samples among treated patient at 70% and 100%, respectively, compared with 12.5% in untreated patients.

Another observational study found that patients who were given hydroxychloroquine and azithromycin showed that the virus left their systems (93% cleared nasopharyngeal viral load) by the 8th days of treatment. The health care professionals are suggesting that this therapy may be given to people before they develop serious respiratory problems, but after they test positive for coronavirus.

Why CDC is not Suggesting that People Use Hydroxychloroquine

Health agencies are telling people to not hoard and use these drugs because there has been no evidence as of yet that suggests that this drug can provide a prophylactic effect in COVID-19. So, people considering taking this drug as a preventive measure should avoid it. One American man from Arizona actually died after taking this drug and his wife was hospitalized with serious complications.

Many clinical trials are now looking to explore the effects of this drug on coronavirus patients. Chief among them are the New York trial and two European studies (identifiers: NCT04303507 and NCT04304053) that will assess the effects of hydroxychloroquine and chloroquine on health care workers or high risk groups without any symptoms of coronavirus.

If the drug does show a prophylactic effect, health communities will inform people and provide guidance on dosage.

However, firstly, the studies that show the drug’s effectiveness are not randomized controlled trials, the best way of proving efficiency of a drug.

The side effects of hydroxychloroquine reported previously have been mild or moderate. The most serious side effect has been damage to kidneys that can be prevented by weight adjusting daily dose of the drug along with cumulative effect with any other prescribed antimalarial.

In many cases, secondly, the drug has shown side effects. In Sweden, hospitals stopped using it when patients complained of blurry vision and seizures. A study in France found that the drug was ineffective as many patients had to be transferred to intensive units or developed a heart problem.

Not everyone will be able to use this drug anyways even if it does prove to be an effective COVID-19 treatment. People inhibited from using this drug include pregnant and breast feeding women, people with history of allergy to the drug, patients with retinopathy, people with QTc  prolongation  in  electrocardiograms, and people who have deficiency of glucose-6-phosphatase.

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