A recent research in China and France including the use of hydroxychloroquine and its close relative chloroquine touted as a way to treat people with severe Covid-19 has sparked hopes around the world but has also created a shortfall of the drug for lupus patients.
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Hydroxychloroquine and chloroquine are both used to treat acute cases of malaria as well as certain autoimmune disorders like lupus. But scientists have long speculated that both drugs have a broad antiviral effect. Earlier research in the lab had specifically shown these drugs could kill the SARS virus, closely related to the new coronavirus known as SARS-CoV-2.
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Most recently, reports from doctors in China and France treating severe Covid-19 patients reported success with using hydroxychloroquine, sometimes in combination with the antibiotic azithromycin. The mayor of the French city of Nice, Christian Estrosi, said on television Monday that he was on his sixth day of treatment and has “the sense I’ve been cured.”
The reports in China and France prompted President Donald Trump to call chloroquine and hydroxychloroquine as potential “game-changer”, spurring a rush by some individuals – and countries, including Algeria and Indonesia – to stockpile these drugs. India, meanwhile, has announced it will ban the export of the drug.
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Such is the interest in chloroquine and hydroxychloroquine, that the World Health Organization identified them as one of four potential therapies to include in a global trial known as Solidarity, along with three other potential drug therapies.
However, Trump’s own public health experts and outside researchers have warned that more thorough research was needed to assert any promising treatment for Covid-19 before its common use. Dr Anthony Stephen Fauci, a leading member of the White House Coronavirus Task Force, told reporters there is no solid evidence that hydroxychloroquine would be an effective therapy for COVID-19.
“The evidence that you’re talking about is anecdotal evidence,” he said during a briefing last week. “As the commissioner of FDA and the president mentioned yesterday, we’re trying to strike a balance between making something with a potential of an effect to the American people available at the same time that we do it under the auspices of a protocol that would give us information to determine if it’s truly safe and truly effective. But, the information that you’re referring to specifically is anecdotal. It was not done in a controlled clinical trial, so you really can’t make any definitive statement about it.”
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Chloroquine Related Death
Tragically, a Phoenix-area man died and his wife is in critical condition after taking chloroquine phosphate, an additive used to treat parasitic infestations in aquarium. The cleaning agent has the same active ingredient as the medicine chloroquine but is formulated differently (chloroquine can easily be toxic in a very high dose).
The woman said she had seen a televised briefing wherein Donald Trump discussed the potential benefits of chloroquine as a treatment Covid-19. “We saw his press conference. It was on a lot, actually,” she said. “Trump kept saying it was basically pretty much the cure.” “We were afraid of getting sick.”
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They mixed a small amount of the substance with liquid to drink. Within 20 minutes, both fell ill. “I started vomiting,” she said. “My husband started developing respiratory problems.”
Last week, Nigerian health officials also issued a warning regarding the drug’s misuse after hospitals in Lagos, the nation’s capital, began reporting patients suspected of chloroquine poisoning. At least three people are believed to be hospitalised.
Despite President Donald Trump’s praise and the interest in chloroquine as an anti-viral treatment, it has proved to be a dead-end before in human trials for other viruses, including dengue and chikungunya.
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Inconclusive Evidence
But given the early success of these drugs, doctors have already started carrying out their own small, controlled clinical trials. According to a study published in the Journal of Zhejiang University in China, results were inconclusive that hydroxychloroquine can treat Covid-19.
The sample size was very small and secondly, the study didn’t test the combination of azithromycin, which researchers theorize can have an added anti-inflammatory effect and help treat severe Covid-19 cases where people are infected by bacteria along with the coronavirus.
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In the trials, 50 per cent patients out of a total of 30 that had been hospitalized with Covid-19 were given standard care while the other 50% received hydroxychloroquine for five days alongside this care. The patients also had their throats routinely swapped for the genetic presence of the virus with a negative result indicating that the active infection had passed.
By day seven, most people in either group had negative throat swabs, with no clear advantage seen for those on hydroxychloroquine. There was also no significant difference in the amount of time it took patients in either group to stop having symptoms such as a high fever (one person’s condition in the hydroxychloroquine group worsened severely, but all had improved by the end of the trial).
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The French study that attracted the most attention also suggested the same. Doctors gave hydroxychloroquine to 26 people with confirmed coronavirus infections, including some with no symptoms. Six also were given the antibiotic azithromycin.
After six days, no patients given hydroxychloroquine plus azithromycin had virus detected in swabs from the back of the nose, versus 57% of those given the malaria drug alone and 12.5% of some other patients who received neither drug.
That’s encouraging, but many things could have affected the outcome, such as how sick people were, when they were treated, what other treatments they received, as well as their age, gender and underlying health conditions. The results do not mean a complete dead end for hydroxychloroquine and chloroquine, but it is a clear lesson regarding why any experimental treatment shouldn’t be hyped too early.
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Researchers, however, have not lost hopes and yet another study that is currently underway is one led by the University of Minnesota throughout the U.S. to see if hydroxychloroquine can prevent people exposed to the virus from getting sick or reduce the severity of illness.
But Trump’s proclamation has prevented many lupus patients from getting the necessary drug leaving them with even more uncertainty and fear. The autoimmune disease afflicts about 1.5 million Americans, predominantly women and African Americans for whom the clock is ticking.
Hydroxychloroquine is used to treat a number of ailments and diseases, including malaria attacks, rheumatoid arthritis and most commonly, systemic lupus erythematosus (SLE). Those who suffer from SLE use the drug to protect their kidneys and heart and to prevent flare-ups associated with the autoimmune disease.
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Chloroquine has been used to treat malaria since the 1930s. Hydroxychloroquine came along a decade later and has fewer side effects. The latter is sold in generic form and under the brand name Plaquenil for use against several diseases.
The drugs can cause heart rhythm problems, severely low blood pressure and muscle or nerve damage. Plaquenil’s label warns of possible damage to the retina, especially when used at higher doses, for longer times and with certain other medicines such as the breast cancer drug tamoxifen.
That’s where the evidence comes in — and, so far, there is not much. Hydroxychloroquine curbed coronavirus’ ability to enter cells in lab tests, researchers reported last week in the journal Nature Medicine. That doesn’t mean it would do the same in people or that they could tolerate the doses tested in the lab.
