Are anti-malaria drugs really a game changer for coronavirus patients?
The novel coronavirus ravaging the planet currently has no cure. The virus, which evidence suggests originated in a wet market in Wuhan, China, belongs to the same coronavirus family which caused SARS (severe acute respiratory syndrome) in 2002 and is attributed to 15% of flu cases. The SARS-CoV-2 strain which causes COVID-19, however, has never been seen before which means that no therapy has been developed specifically for it. As stated by the WHO, currently no treatment or cure directly addresses COVID-19 - all medical intervention is currently focused on easing and fighting symptoms. Developing new drugs is a technological and bureaucratical task which can take years - but the world needs answers right now.
Previously developed drugs, among them broadspectrum anti-virals, HIV drugs, and those developed for Ebola and SARS have seen a surge of interest and clinical trials are underway to gauge their effectiveness in treating COVID-19.
Interestingly, anti-malaria drug chloroquine, and its derivative hydroxychloroquine, has entered the fold as well. President Trump insists that it could be a game-changer, and several countries, including India as of yesterday, have given a nod to the drug.
What is the evidence in favour of the drugs?
The fact is that evidence so far is limited and based on anecdotal reports from doctors combating the disease. Many clinical trials are currently underway, and it will be a while before any consensus emerges from them.
A highly cited French study is being used to prop up chloroquine’s effectiveness. The unblinded, 25 participant study showed that those treated with the drug had a decrease in viral load; positive cases went from 90% to 25%. Supplemented with azithromycin, a broad-based antibiotic, the decrease in viral load was even greater.
However, this is a highly flawed study; the sample size is tiny, and an examination of supplementary data shows that only 4 participants underwent PCR testing to assess viral loads - the rest of the data was qualitative. A poorly designed, small study is hardly the benchmark for basing national drug policies.
Previous in-vitro studies have shown that chloroquine and hydroxychloroquine reduce the spread of the virus strain that caused SARS (SARS-CoV-1). Since SARS-CoV-1 and SARS-CoV-2 are very similar, these findings have raised hopes in the medical community.
However, Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases who appears regularly alongside President Trump, has maintained that the evidence for the drug’s effectiveness remains unconvincing. While it may play a role in treating COVID-19, clinical trials, which are currently underway, will have the final say in the matter.
What is chloroquine?
Chloroquine is an oral prescription drug, derived from the naturally occurring quinine, which was discovered in 1820. Quinine is the active ingredient in antimalarials and has helped to dramatically reduce the number of malaria-related deaths. Tonic water has some quinine in it - it has been suggested that the combination of gin and tonic was consumed widely in colonial India to ward off the mosquito-based infection.
Hydroxychloroquine is used for treating lupus and rheumatoid arthritis.
Why may the drug be useful against COVID-19? Previous research with SARS-CoV has shown that the drug inhibits the ability of the virus to replicate.
Health officials urge not to self medicate
At least three cases of overdoses have been reported in Nigeria and one in the US as well. While the advantages of the drugs are that they are easily available, cheap and well-tolerated, side effects do exist - such as nausea, altered state, and diarrhoea. Dangerous interactions have also been noted in medical literature, so it is advised to not take the drug on your own volition.
In approving hydroxychloroquine, ICMR emphasized that it was only for health workers and caregivers treating sick family members.
While times are unpredictable and scary, it is always a bad idea to self-medicate, especially when prescription drugs are involved. Until stronger studies and clinical trials are able to corroborate current suspicions, preventive measures remain the best course of action.
For more tips, read our article on Coronavirus.
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Updated Date: Mar 24, 2020 16:25:07 IST
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