Hydroxychloroquine - Can it be a game changer?

The number of people tested Corona positive has just hit the 1 million mark. In India, almost 2000 people have tested positive to date. The entire country is observing a 21 days lockdown and hoping that social distancing along with testing will help to stop Corona completely. The important point to note here is that lockdown and distancing are quite effective at slowing down the virus spread rate and the consequent fatalities but these measures are not a permanent cure for Corona. These measures are just buying us the time to up our health infrastructure so that if there is a surge later, we can handle it without facing any nightmares. Imagine, after a 3-month lockdown one corona vector who was not diagnosed, spreads this infection to others in the community and from there on subsequently to the entire locality (like #TabilighiJamat incident), effectively leaving us at the same place where we are currently in.

PM Modi announced a 21 days lockdown ending 15th April

#Corona can be permanently tamed using Vaccines, drugs or by achieving herd immunity (which can wipe out 5-10% of the global population).

                                         Vaccine trials have started in humans directly with Jennifer Haller (left)

This post is about the drugs currently available in the market, which are clinically tested and approved for some other infection/diseases. Since these drugs are already clinically tested and proven to be safe for human intake, they can be made available to the entire world just in few weeks once their effectiveness against Corona is scientifically proven by randomized trials. Most of these drugs are cheap to make and can be manufactured quickly in large volumes.

The two most hyped drugs claimed to be a panacea against Corona are Hydroxychloroquine and Ritonavir.

Hydroxychloroquine has been around in use for some 50 years. It is used against Malaria and some autoimmune diseases (arthritis, lupus etc).

                                                             Tablet sales have gone up in the past few days

The effectiveness of hydroxychloroquine has been the subject of debate after President Donald Trump said the drug could be “one of the biggest game-changers in the history of medicine. “Pre-clinical studies in animals, as well as the first data from clinical studies, show that hydroxychloroquine kills the coronavirus,” Novartis Chief Executive Vas Narasimhan.

These claims further gained traction when Professor Didier Raoult of France (MD, PhD) announced new clinical results that revealed 78 out of 80 patients recovered within five days. The reports from Professor #Raoult drew criticism because they didn't include control groups to compare treated versus untreated patients.

       

No large-scale clinical trials have taken place in humans to prove whether they're effective against COVID-19 or not. Meanwhile, in one study done in Renmin Hospital of Wuhan University with 62 patients (including controls), half of them were treated with the drug while the other half (control) received just the normal care. 

This is what NY Times reported about the test results: "Coughing and fever eased a day or so earlier in the patients who received hydroxychloroquine, and pneumonia improved in 25 of 31, as opposed to 17 of 31 in the controls.Dr. Schaffner cautioned that the results applied only to patients with relatively mild illness, like the ones in the study, and could not be generalized to advanced cases."

Wall Street Journal (WSJ) in one another post reported this about some other Chinese claims: "During the initial Chinese outbreak, Wuhan doctors observed that patients with lupus—a disease for which Hydroxychloroquine is a common treatment—did not seem to develop Covid-19. Of 178 hospital patients who tested positive, none had lupus and none were on Hydroxychloroquine. None of this Wuhan hospital’s dermatology department’s 80 lupus patients were infected with the novel coronavirus."

                                                               Professor Didier Raoult of France(MD, PhD)

These claims are not founded on rigorous and definitive testing. Many studies didn't have the control group while testing and most of the patients admitted had some other medical/disease history as well.

There is a big variation in trial results across the globe. Two biggest reasons for this wide discrepancy in results across the globe are the variation in the amount of dosage and the combination of drugs used. No one knows what amount of drug is optimum for a patient in early stage, middle stage or someone in an advanced stage. Many are prescribing only Hydroxychloroquine while some physicians suggest a combo of Hydroxychloroquine and Azithromycin. Further, the age of the patient might also play a role in deciding the quantum of dosage required.

Finally, New York state and France government have started a large controlled clinical trial. The results of these trials will be out in a few weeks and will decide whether Corona panic will extend for some more time or it will crash just like the Indian stock market. Results can be expected in the next 2-3 weeks, about the same time lockdown ends in India. By the way, India is the largest producer of Hydroxychloroquine in the world as we have the highest cases of Malaria in the world. Three Italian patients in Rajasthan were treated using Malaria, HIV, Swine Flu drugs (https://www.ndtv.com/india-news/rajasthan-treats-coronavirus-patients-with-swine-flu-malaria-hiv-drugs-2195009?fbclid=IwAR3ErBuQaG0KUaYatweoFmHF4Gz4oGSR7KMJvGJ3k6iyL8jhMf0gxpc7Nyo).

Will post some other day about Ritonavir and Herd immunity. In my home state Uttarakhand, to date, only 7 people have tested positive. The lower count might be due to the low number of tests done (Below 600, 1st April). Hopeful that things will get sorted.

Figure from Gautret et al. (10.1016/j.ijantimicag.2020.105949)

These are the links of WSJ, NYTimes, CBS and Bloomberg coverage on Hydroxychloroquine. Do give them a read, if interested in more details.

1. https://www.bloomberg.com/news/articles/2020-04-01/coronavirus-in-young-people-ny-patients-skew-younger-some-die?fbclid=IwAR07fpjZAxAMUrmErPM48yfuySmITKkSPeqt9ukRpr7LHX4EnQqyf9iYwDs (Bloomberg)
2. https://www.nytimes.com/2020/04/01/health/hydroxychloroquine-coronavirus-malaria.html?referringSource=articleShare&fbclid=IwAR21dQpmrgisQq4RHTvd3yY7TIVUsXCbq6IYPggHiR6KfEJBpbVQJEEG_Lg (NYTimes)
3. https://detroit.cbslocal.com/2020/04/01/france-sanctions-drug-after-nearly-all-patients-recover-covid-19/?fbclid=IwAR1xoxlJxMN9C7j9HfOrWbhHV996bpF4X3h8IOTUbaWtvvSbjwQs0pjDPxw (CBS Local)
4. https://www.wsj.com/articles/an-update-on-the-coronavirus-treatment-11585509827?fbclid=IwAR0kttHqaH6GYM1sdMPVNybLLVlfS6_VCreI_SJI_K-3dOwm5FJVYQjWUl8 (WSJ)

Feel free to contact me on vaibhav.kabdwal@gmail.com