Breaking down the hype around Hydroxychloroquine: The Antimalarial Drug’s Role in the Global Pandemic

NSoJ reviews the effectiveness and use of Malaria drug, Hydroxychloroquine, in the fight against COVID 19


Current studies on the use of hydroxychloroquine to combat Covid-19 have not proved the effectiveness of the drug

Jaya Gomathi Mirra R and Muskan Yousaf

Every year India accounts for around 1 - 1.5 million cases of Malaria caused by parasites 'Plasmodium Vivax and Plasmodium falciparum'. India is endemic to this disease and is among the 15 countries worst hit by it. The nation is also the largest producer of the drug 'Hydroxychloroquine', the most readily available and affordable antimalarial agent. Recently, this drug has become the pivot of global attention as it is hailed to be one of the possible cures for COVID-19.

Hydroxychloroquine (brand name Plaquenil) is in the news today, gathering tremendous focus after the US President Donald Trump backed the drug as a potential cure for the novel coronavirus despite lack of sufficient scientific evidence on this front. He also urged India to lift bans on the export of Hydroxychloroquine tablets, of which there is a shortage reported in the United States of America according to the American Society of Health-System Pharmacists (ASHP).

The use of hydroxychloroquine as a cure for the COVID-19 can be traced to the case of a doctor in Lebanon. Dr Rob Richardson began treating eight veterans using the drug with an additional antibiotic, azithromycin (Z-PAK) following which he discovered encouraging signs in early tests. Among the eight patients that Dr Richardson treated, a 90-year-old passed away. Richardson couldn't produce any conclusive evidence as to how effective the drug was in slowing the pace of the illness.

Most of the current studies coming close to validating the success of hydroxychloroquine are in-vitro and hence the range of effectiveness in human bodies is yet to be proven.

Dr Naresh Trehan, India's leading cardiologist and founder of Medanta hospital, stated in an online video that hydroxychloroquine works as an “immune modulator”. “Immune modulators help reduce the effect of a virus or white cells in our body by reducing immunity. It might work when someone is infected by the virus but if used prophylactically it could render a person more vulnerable to the infection.”

“The study was conducted on a very small sample of patients and multiple other studies are being conducted. However, social distancing and personal hygiene are the only known effective precautions against coronavirus,” he added.

The Center for Disease Control and Prevention states clearly that there are no drugs or other therapeutics approved by the US Food and Drug Administration to prevent or treat COVID-19. CDC adds in its issue of Emergency Use Authorization for the drug that the basis of this authorization is only to encourage the conduct and participation in randomized controlled clinical trials that ‘may’ provide evidence concerning hydroxychloroquine’s effectiveness against COVID-19.

When explaining whether this drug might benefit patients with COVID 19, US Food and Drug Administration highlights that these drugs (chloroquine phosphate or hydroxychloroquine sulphate) have been shown to prevent the growth of the virus in few reports of patients with COVID-19 but it is presently unknown whether it was the drug that led to the improvement or whether there were other factors involved.

FDA emphasizes that self-medication using the drug can pose many risks ranging from heart rhythm problems and low blood sugar, particularly among people with diabetes; anaemia and other blood pressure problems; worsening of seizures and other neurological problems and retina damage that can cause issues with vision.

The National Task Force for COVID-19 established by the Indian Council of Medical Research provides detailed guidelines regarding the use of hydroxychloroquine for possible prevention of SARS-CoV-2 infection. It recommends the drug only for the high-risk population which includes healthcare workers in the proximity of suspected or confirmed cases of COVID-19 and household contacts of laboratory-confirmed cases. The guidelines repeatedly highlight that intake of the medicine should not instil false security which is highly likely. The exclusions mentioned state that the drug is not to be administered to children below 15 years of age and to persons with known cases of hypersensitivity to hydroxychloroquine.

Concern looms large in India as the nation is prone to the Malaria epidemic. While India has opened up exports of the drug to nations badly hit by Covid-19, it is imperative for India to have enough stocks of the hydroxycholoquine to combat the Malaria epidemic in India. An epidemic that has far more serious consequences for India than the novel Coronavirus.

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