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Chloroquine and HydroxyChloroquine have emerged as the prevailing drugs in contemporary times. In the following discussion, we will address four fundamental inquiries pertaining to Chloroquine and HydroxyChloroquine.
Essentially, can these drugs be employed as a preventive measure or means of safeguarding against COVID-19? Ultimately, I will conclude with my final opinion or recommendation concerning the usage of these medications.
1. What is Chloroquine and HydroxyChloroquine?
These two medications have gained significant attention following President Donald Trump’s assertion and announcement that they have received FDA approval for combating COVID-19 or administering to COVID-19 patients. However, it is essential to clarify that these drugs are not FDA approved for treating COVID-19 or for usage in COVID-19 patients.
Nonetheless, it is important to note that these two drugs have obtained FDA approval for alternative purposes such as treating rheumatoid arthritis and certain tumors. This implies that doctors have the discretion to administer HydroxyChloroquine and Chloroquine to COVID-19 patients based on their professional judgment. However, it should be acknowledged that such usage would be considered off-label, as both Chloroquine and HydroxyChloroquine are primarily anti-malarial drugs that have been in existence since the 1930s.
These drugs have been utilized worldwide in the fight against malaria for nearly a century, starting from the 1930s. Hence, we have accumulated almost a century’s worth of experience with these two medications. They have demonstrated remarkable effectiveness in combating malaria and have also found application in treating autoimmune diseases. Notably, they have received FDA approval for conditions such as lumps and rheumatoid arthritis.
2. What’s the difference between Chloroquine and HydroxyChloroquine?
These two drugs essentially represent different variants of the same medication, with HydroxyChloroquine garnering more popularity due to its comparatively lower toxicity, estimated to be around 30 to 40 percent less toxic than Chloroquine. As an illustration, Rheumatologists routinely prescribe HydroxyChloroquine on a daily basis, issuing approximately 5 to 10 prescriptions to patients with autoimmune diseases each day.
Next, let’s examine the evidence supporting the utilization of HydroxyChloroquine and Chloroquine in COVID-19 patients. Moreover, what are the general requirements set by the FDA and other approval agencies worldwide to determine the effectiveness of a drug for a specific condition? I will now present some compelling evidence for your consideration.
On March 20th, 2020, Dr. Phillip Cadre conducted a notable French study. The study involved a comparison between two groups: one comprised of 20 patients who received HydroxyChloroquine at a dosage of 200 milligrams three times daily, and the other comprised of 16 patients who did not receive the drug. Among the 20 patients who received HydroxyChloroquine, 6 of them were additionally administered a commonly used antibacterial medication called azithromycin, commonly known as a z-pack, at a dosage of 500 milligrams on the first day, followed by 250 milligrams for the subsequent four days, once daily.
This graph represents the mean results of the study as you can see on the y-axis we have a percentage of patients.
In our study, we have plotted the percentage of COVID-19 positive patients on the y-axis against the number of days since the administration of HydroxyChloroquine on the x-axis. The graph reveals three distinct lines: the green line represents the combination therapy of HydroxyChloroquine and Chloroquine, given to 6 patients; the blue line represents the group of 14 patients who solely received HydroxyChloroquine; and the black line represents the control group comprising patients who did not receive either of the two drugs.
As observed, the patients who received HydroxyChloroquine in combination with azithromycin exhibited a noteworthy response, with nearly all of them recovering from COVID-19 within approximately five days. Comparatively, patients who solely received HydroxyChloroquine also showed considerable improvement, which was significantly better than those who did not receive HydroxyChloroquine at all. In total, approximately 70% of patients who received either HydroxyChloroquine alone or the combination of HydroxyChloroquine and azithromycin experienced positive outcomes and displayed enhanced recovery, whereas only 12% of patients who did not receive either of these two drugs demonstrated similar improvement.
The majority of patients who received these drugs exhibited symptoms, with approximately 80 to 90 percent of them experiencing symptomatic manifestations. Additionally, some reports suggest that the drug’s effects appear to be more pronounced in patients who were in the asymptomatic stage compared to those in the symptomatic stage, accounting for around 10 to 20 percent of the patients.
The second study I will present today is a narrative account by a Chinese author who reported that the State Council of China had identified chloroprene phosphate as the most effective and safe treatment for COVID-19-associated pneumonia. This conclusion was based on multiple multicenter clinical trials conducted throughout China. According to the study, the data from over a hundred patients indicated that Chloroquine phosphate outperformed the control group in treating COVID-19 pneumonia, leading to viral clearance and a shortened illness duration.
Furthermore, the authors mention recommending the inclusion of this drug in the upcoming guidelines for the prevention, diagnosis, and treatment of COVID-19 pneumonia issued by the National Health Commission of the People’s Republic of China. However, the issue at hand is that the authors fail to provide any data pertaining to the treatment of over a hundred patients with Chloroquine phosphate.
In the third report, a consensus statement was formulated by a group of esteemed doctors and COVID-19 experts in China. The authors reached the conclusion that Chloroquine exhibited a significant enhancement in the treatment success rate, resulting in shorter hospital stays and improved patient outcomes. They further recommended administering Chloroquine phosphate at a dosage of 500 milligrams twice daily for a duration of ten days in patients diagnosed with mild-moderate and severe cases of coronavirus or COVID-19 infection, provided that there are no contraindications to this medication.
The fourth report comes from scientists conducting laboratory experiments, demonstrating the successful inhibition of virus replication by Chloroquine. In addition to these findings, the Dutch Center of Disease Control and the Italian Society of Infectious Diseases have also endorsed the use of Chloroquine and HydroxyChloroquine in patients with COVID-19 infection, following these encouraging reports.
I would like to share a contrasting report with you, which also originates from Chinese doctors and constitutes a controlled trial. This recent study was conducted under the leadership of the Shanghai Public Health Clinical Center in China. The trial involved 30 hospitalized patients diagnosed with confirmed COVID-19 infection, with half of the participants receiving a daily dose of 400 milligrams of HydroxyChloroquine for five days in addition to standard care.
On the other hand, the remaining half of the participants served as the control group and received only standard care. The results showed that, after seven days, 93% of patients in the control group tested negative for COVID-19, while 87% of patients in the HydroxyChloroquine group achieved the same outcome. These findings indicate that there was no significant advantage observed in using HydroxyChloroquine over standard care.
However, there is a crucial aspect to consider. The standard care provided to both the control group and the HydroxyChloroquine group involved not only supportive measures such as ventilator support, oxygen therapy, and fluids but also the administration of an antiviral drug. It is well-known among scientists that demonstrating improvements in an already effective treatment becomes considerably challenging.
Considering that both groups received potent antiviral drugs, it is plausible that the effectiveness of HydroxyChloroquine might not have been evident. However, it is essential to acknowledge that this finding highlights the importance of providing optimal treatment. Moreover, it is crucial to note that these antiviral drugs are not universally accessible in economically disadvantaged countries.
Despite the negative study, it is worth considering that antiviral drugs can be quite costly, whereas HydroxyChloroquine is a more affordable alternative. Therefore, despite the lack of significant findings, these drugs may still hold potential effectiveness for patients with COVID-19, particularly considering the lower economic burden associated with their use and the favorable side-effect profile. It is important to emphasize that the use of these drugs in COVID-19 patients should be done under the guidance of a doctor.
3. What is the risk of taking Chloroquine or HydroxyChloroquine?
Overall, the risk associated with these drugs is minimal, with HydroxyChloroquine being considered safer than Chloroquine. In fact, based on my experience, I often prescribe five to ten daily doses of HydroxyChloroquine and encounter very few difficulties among patients who take it regularly. In a given year, I may issue thousands of prescriptions for HydroxyChloroquine and rarely encounter any complications.
In this scenario, we are discussing a course of treatment that lasts only five to ten days. The common side effects of HydroxyChloroquine include mild symptoms such as headaches, stomach upset, nausea, or occasionally a rash, all of which typically improve upon discontinuation of the drug. The main concern with HydroxyChloroquine, which we inform patients about, is its long-term toxicity, which may develop after approximately 40 years of continuous use.
It is exceedingly rare for the long-term toxicity of HydroxyChloroquine to develop within the short duration of treatment, typically five to ten days. However, a more significant concern lies in the potential for an abnormality in the heart’s electrical signal, known as QT prolongation. It is important to note that this condition is predominantly associated with Chloroquine rather than HydroxyChloroquine. Therefore, patients taking either Chloroquine or HydroxyChloroquine should undergo EKG monitoring, while also assessing for the presence of other medications that could potentially induce an abnormal heart rhythm.
If you are already taking a medication that can cause QT prolongation, which is a specific type of heart electrical abnormality, and then you also take HydroxyChloroquine or Chloroquine, these two drugs can have a cumulative effect and potentially lead to harmful effects on the heart. Therefore, it is standard practice to regularly monitor blood counts and basic chemistry, including electrolyte levels, in patients who are prescribed these medications.
To put it simply, Rheumatologists widely regard HydroxyChloroquine as the safest drug in their repertoire for treating autoimmune diseases. In fact, it is often the initial choice for managing various autoimmune conditions.
When the virus infects our bodies through inhalation, Chloroquine acts as a barrier by preventing the virus from binding to the cell surface. Additionally, Chloroquine raises the pH levels within the cells, creating an environment that is highly unfavorable for the survival of the virus.
A study conducted in 2005 demonstrated that Chloroquine is a potent inhibitor of SARS (Severe Acute Respiratory Syndrome), which is a type of coronavirus closely related to COVID-19. It is important to note that this study was not conducted on human subjects but rather in a laboratory setting. The findings indicated that the drug exhibited effectiveness when administered before or after virus exposure, suggesting its potential use for prophylaxis, prevention, and treatment of coronavirus infections. Ongoing research is currently underway to further explore the utility of Chloroquine in combating the coronavirus.
Another study conducted in 2004 corroborated these findings through laboratory experiments. The study revealed that Chloroquine effectively inhibits the SARS coronavirus, which causes severe acute respiratory syndrome. These results further support the potential effectiveness of Chloroquine in combating SARS-like coronaviruses.
4. Can we use these drugs prophylactically?
These drugs cannot be used prophylactically, meaning they cannot be taken without having the infection, to protect ourselves from possible COVID-19 infection. The answer is a resounding no, and there are several reasons for that. Firstly, there is insufficient scientific evidence that meets the rigorous standards to confirm the efficacy of these drugs against COVID-19 infection. Furthermore, there is no evidence to support the use of these drugs as a preventive measure or for prophylaxis. Secondly, there are associated risks, particularly in relation to cardiac abnormalities. Therefore, when considering the risk-benefit ratio, it does not favor the use of these drugs for preventive purposes.
We are all aware of the news regarding the unfortunate death of an Arizona man who took Chloroquine, a common chemical used for cleaning fish tanks. This incident highlights a crucial point: if we were to start using these drugs for preventive purposes in a large number of individuals, it would create a shortage for those who actually need the medication to treat their infection. Currently, there is already a shortage of this drug in the US and several other countries. Therefore, it is essential to prioritize the availability of these drugs for patients who are genuinely ill with the infection rather than diverting them to preventative use.
I kindly request that you refrain from using these drugs for preventative purposes against the virus. It is important to remember that you can effectively prevent the infection by staying at home rather than taking HydroxyChloroquine or Chloroquine without any indication of infection. If these medications are widely used for prophylaxis, patients who currently rely on HydroxyChloroquine for the treatment of various autoimmune diseases such as lupus or rheumatoid arthritis may face difficulties in accessing their necessary treatment. Let’s prioritize the appropriate use of these drugs to ensure that those who truly need them for their existing medical conditions can continue to receive their prescribed treatment.