The most popular drug nowadays are Chloroquine and HydroxyChloroquine. We will discuss four basic questions regarding Chloroquine and HydroxyChloroquine.
Basically, to prevent or protect ourselves from COVID-19 and in the end, I will give my final take or recommendation regarding the use of these drugs.
1. What is Chloroquine and HydroxyChloroquine?
Well, these two drugs have become very popular since President Donald Trump claimed and reported that these true drugs have been FDA approved against COVID-19 or to be given to patients with COVID-19. So first, I want to clarify these two drugs are not FDA approved. These are not FDA approved drugs for COVID-19 or to be given to patients with COVID-19.
However, these two drugs are FDA approved for some other indication, for example, rheumatoid arthritis and lumps, which means doctors can use HydroxyChloroquine and Chloroquine to be given to patients with COVID-19 based on their best judgment. However, that use will be considered as off-label use both Chloroquine and HydroxyChloroquine are anti-malarial drug which has been around since the 1930s.
So these drugs are used against malaria all around the world since the 1930s. So we have almost a century of experience with these two drugs. These drugs are very effective against malaria, and also these drugs used for autoimmune diseases. It’s been FDA approved for lumps and rheumatoid arthritis.
2. What’s the difference between Chloroquine and HydroxyChloroquine?
They are basically two forms of the same drug, and HydroxyChloroquine is more popular because it’s about 30 to 40 percent less toxic then Chloroquine. For example, Rheumatologist uses HydroxyChloroquine on a daily basis. Maybe it’s giving about 5 to 10 prescriptions of HydroxyChloroquine to autoimmune disease patients on an everyday basis.
Second, what’s the evidence behind HydroxyChloroquine and Chloroquine to be used in COVID-19 patients? What is required generally by FDA or other approval agencies around the world to consider a drug effective for a particular condition? I will present some evidence in front of you.
A French study by Dr. Phillip Cadre published on March 20th, 2020. In this study, they compared 20 patients who were given HydroxyChloroquine at a dose of 200 milligrams three times a day as compared to 16 patients who were not given this drug. The 20 patients who got HydroxyChloroquine, 6 of them in addition, also got a common antibacterial drug called azithromycin, or commonly we call in us a z-pack, which was given at 500 milligrams on a day and one followed by 250 milligrams for the next four days once a day.
This graph represents the mean results of the study as you can see on the y-axis we have a percentage of patients.
We have a percentage of patients who are positive with COVID-19, and on the x-axis, we have a number of days since giving HydroxyChloroquine. As you can also see the Green Line represent HydroxyChloroquine and Chloroquine combination which was given in 6 patients and the blue line represents the patient who only got HydroxyChloroquine which for 14 patients and then the black line represents the controls basically the patients who did not get either of the two drugs.
As you can appreciate, the patients who got HydroxyChloroquine and azithromycin showed a significant response, and almost all of them got free of COVID-19, in about five days as compared to HydroxyChloroquine which was also far better than not getting HydroxyChloroquine. So overall, 70% of patients who got either HydroxyChloroquine alone or a combination of HydroxyChloroquine and as a through mice and improved as compared to only 12%, when they did not get either of these two drugs.
Now, most of these patients who got these drugs were symptomatic about 80 to 90 percent of these patients were symptomatic, and others also claimed that the drug effect seems to be more in patients who are it’s an asymptomatic stage as compared to patients about 10 to 20 percent patients who were in the asymptomatic stage.
The second study I’m reporting today is basically a narrative by Chinese author that reported the State Council of China had indicated chloroprene phosphate to be most effective with acceptable safety in the treatment of COVID-19, associated pneumonia based on multiple multicenter clinical trials conducted across China. This study reported that more than a hundred patients’ data demonstrated that Chloroquine phosphate is superior to control in the treatment of COVID-19 ammonia as well as making patients virus free and shortening the course of illness.
They further report that they have recommended the inclusion of this drug in the next guidelines for prevention diagnosis and treatment of pneumonia caused by COVID-19 issued by the National Health Commission of the People’s Republic of China. However, the problem is that the authors don’t provide any data on those more than 100 patients that were treated with Chloroquine phosphate.
In this study, the third report also comes from China, where various doctors are experts in COVID-19 got together and came up with a consensus statement on this disease. These authors concluded that Chloroquine significantly improved the success rate of treatment shortens the hospital stay and improve patients outcomes. They further recommend that Chloroquine phosphate 500 milligrams twice a day should be given for ten days in patients diagnosed with mild-moderate and severe cases of coronavirus or COVID-19 infection provided. There is no contraindication to this drug.
The fourth report on this comes from scientists working in a laboratory condition; they showed that Chloroquine successfully inhibited the replication of this virus. Now, in addition to these reports, the Dutch center of disease control, Italian society of infectious diseases, also recommends using Chloroquine and HydroxyChloroquine in patients with COVID-19 infection now after these positive reports.
I want to present to you a negative report on this which also comes from Chinese doctors and is also a controlled trial this new study was led by Shanghai Public Health clinical center in China. It involved 30 patients who were hospitalized with confirmed COVID-19 infection, and half of the patients received 400 milligrams of HydroxyChloroquine a day for five days, along with usual care.
Whereas another half only received the usual care which served as a control group now as per the results reported 93% of patients in the control group were tested negative for COVID-19 at seven days as compared to 87% patients in HydroxyChloroquine group demonstrate that there was no significant advantage of using HydroxyChloroquine over the usual care.
But there is a catch first the usual care involved not only supportive care like ventilator oxygen fluids and other supportive care but also included giving the antiviral drug to both the group’s control as well as HydroxyChloroquine group. Now any scientists know that it is very difficult to show improvement in already effective treatment.
So if you are giving strong antiviral drugs tooth the groups, it is possible that even though HydroxyChloroquine was effective. It could not demonstrate that effectiveness given both the groups but otherwise given excellent treatment the point. We need to remember is that these antiviral drugs are not available all across the world in poorer countries.
Antiviral drugs are very expensive, whereas HydroxyChloroquine is cheaper drugs, so even though it’s a negative study. These drugs could be effective in patients with COVID-19 and perhaps given the low a burden economically because it’s a cheaper drug and also a side-effect profile. These drugs are excellent. These drugs could be used under a doctor’s guidance in COVID-19 patients.
3. What is the risk of taking Chloroquine or HydroxyChloroquine?
I would say overall, the risk is rather very small, and the risk of Chloroquine is more than HydroxyChloroquine, so HydroxyChloroquine is rather very safe. In fact, I will say, generally, give about five to ten prescriptions a day of HydroxyChloroquine and perhaps maybe thousands of prescriptions in a year and rarely ever encounter any difficulty with patients who are taking regularly HydroxyChloroquine.
In this case, we’re only talking about five to ten days of a course; common side effects from HydroxyChloroquine include simple things like headache or stomach upset or nausea, or any kind of rash really can happen. Those are rather very mild and get better when you stop the drug the major toxicity of HydroxyChloroquine that we tell patients is toxicity, which, by the way, develops after taking HydroxyChloroquine 40 years.
It rarely ever developed in a short span of time that about giving COVID-19 patients for five to ten days, a much bigger problem is an abnormality in the electric signal of the heart called QT prolongation, which is, by the way, mostly seen with Chloroquine rather than HydroxyChloroquine. So patients taking Chloroquine or HydroxyChloroquine need to be monitored by an EKG as well as checking for the other drugs that the patient might be taking, which could also cause an electric abnormality of the heart.
So if you already on a drug that causes QT prolongation, which is a type of electric abnormality of the heart and you take HydroxyChloroquine a cruel queen, these two drugs can have an additive effect and can cause harmful effects to the heart. We also routinely recommend checking blood counts and basic chemistry or electrolytes on patients while taking these drugs.
The risk by giving you a simple statement that a Rheumatologist considered HydroxyChloroquine as the safest drug that they give amongst all the drugs that they use for autoimmune disease and typically it’s the first drug we use for various autoimmune conditions.
When it infects us, and we inhaled the virus, it prevents the virus binding to the cell surface of our body, and also, this wire of the Chloroquine and hand of the Chloroquine increased the pH of the cells, making it very difficult for the virus to survive.
This study in 2005 showed that Chloroquine is a potent inhibitor of thoughts, which is a severe acute respiratory syndrome, which is also a type of coronavirus very similar to the coronavirus or COVID-19 infection. We have currently ongoing now; this was not a human study or a human test. This was a study in the lab that showed that the drug was effective even if it was given before or after exposure to virus, suggesting either the prophylactic use or preventative use as well as treatment use of this drug in the setting of coronavirus.
He represents another study in 2004, which basically showed the same thing in the laboratory experiment. It was seen that Chloroquine inhibits this severe acute respiratory syndrome or SARS type of coronavirus quite effectively.
4. Can we use these drugs prophylactically?
It can be used these drugs prophylactically, which means without having the infection to protect ourselves from possible COVID-19 infection. My answer is absolutely not for various reasons, first of all, it’s not completely proven by the higher standards of scientific evidence that this drug works against COVID-19 infection and there is absolutely no evidence that this drug could be used as a preventative measure or for prophylaxis. Second, there is a risk of taking these drugs, especially cardiac abnormalities. For that reason, the list benefit ratio does not work in favor of taking this drug for preventative measures.
We all heard the news that Arizona man actually died after taking Chloroquine, which is a common chemical being used to clean the fish tanks. The most important reason is that if we start using these drugs for preventative measures in a large number of patients, then people who are actually sick with this infection may not get the drug there is already a shortage of this drug in the US and several other countries.
So it’s my humble request to you that don’t use this drug for just preventative measures against this virus; remember that you can actually prevent the infection much more effectively by staying at home rather than taking HydroxyChloroquine or Chloroquine without any indication of infection. The patients who are currently all HydroxyChloroquine for various autoimmune diseases, whether it’s lumps or rheumatoid arthritis and so on, then would not get their treatment of their autoimmune disease if everyone starts taking it for prophylactic needs.