New Delhi: US President Donald Trump’s announcement Friday morning about testing positive for Covid-19 is another blow to those who believe in the role of hydroxychloroquine (HCQ) in preventing the disease.
Scientific evidence in this regard also continues to pour in.
Just two days ago, yet another study in an international journal found the inefficacy of the drug as a preventive against Covid infection.
In May, soon after extracting his required volumes of HCQ from India, Trump had famously announced that he had started taking the medicine as prophylaxis (prevention). He had even called the drug a “game changer”.
India, meanwhile, continues to use it both as a prophylaxis and treatment for Covid.
In a study published in JAMA Internal Medicine on 30 September, researchers from the University of Pennsylvania reported: “In this randomised clinical trial, although limited by early termination, there was no clinical benefit of hydroxychloroquine administered daily for 8 weeks as pre-exposure prophylaxis in hospital-based HCWs exposed to patients with Covid-19.”
HCQ is normally used for malaria and rheumatoid arthritis.
The findings are in line with an earlier study published in The New England Journal of Medicine in August that had said HCQ did not prevent Covid when used as a post-exposure prophylaxis.
India recommends post-exposure prophylactic use of HCQ for all asymptomatic healthcare workers involved in containment and treatment of Covid, and asymptomatic healthcare workers working in non-Covid hospitals/non-Covid areas of Covid hospitals/blocks, asymptomatic frontline workers such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in Covid-related activities, and also asymptomatic household contacts of laboratory confirmed cases.
Also read: HCQ shows no use as Covid protective drug for health workers, finds Indian study
No cardiac adverse events
The study, however, did not find any cardiac adverse events reported in the HCQ group compared to the placebo group.
This is contrary to the study that was retracted by The Lancet in June over questions about the quality of data used.
The JAMA study reported: “Similar to other studies of hydroxychloroquine for either viral prophylaxis or Covid-19 treatment, we found that the medication was generally well tolerated, with the exception that patients treated with hydroxychloroquine, 600 mg, for 8 weeks experienced significantly higher rates of grade 1 to 2 diarrhea than patients treated with placebo.
“In addition, we found no significant differences in cardiac adverse events between the hydroxychloroquine and placebo groups. Myocardial inflammation associated with SARS-CoV-2 infection may increase susceptibility to potential cardiac effects of hydroxychloroquine,” it added.
While all participants who contracted the infection had a mild disease and recovered fully, the researchers did not recommend routine use of hydroxychloroquine among healthcare workers to prevent Covid.
However, they conceded it is possible they missed a “modest prophylactic effect” because of the small sample size of the study.
In India, available data from observation of 1,323 healthcare workers show mild adverse effects such as nausea (8.9 per cent), abdominal pain (7.3 per cent), vomiting (1.5 per cent), hypoglycemia (1.7 per cent) and cardio-vascular effects (1.9 per cent).
Data from the government’s Pharmacovigilance programme of India showed that there have been 214 reported instances of adverse drug reactions associated with prophylactic use of HCQ. Of these, seven were serious individual case safety reports.
Conflict of interest disclosures
Among the conflict of interest disclosures in the study, Dr Ian Frank from the Department of Infectious Diseases in the university reported income from Gilead.
Gilead manufactures Remdesivir, one of the top contenders for a Covid drug, and is currently holding clinical trials for it. Indian companies are manufacturing the drug after obtaining compulsory licences from Gilead.
Dr Michael Milone from the Department of Pathology in the university reported royalty income from patents licensed to Novartis that is unrelated to hydroxychloroquine.
“Dr (Ravi) Amaravadi is the scientific founder and holds equity in Pinpoint Therapeutics, Inc. He is co-inventor on patents covering autophagy inhibitors for cancer and a consultant for cancer-related programs at Sprint Biosciences, Deciphera, and Immunaccel. Dr (Benjamin) Abella has received grant funding and honoraria from Becton Dickinson,” read the disclosures section.
Also read: AIIMS Delhi and Raipur doctors question ICMR study that showed HCQ can curb Covid risk
HCQ + Zinc is a successful early treatment for Covid. Back in April and May, a number of patients in FL that were treated with this combination recovered nicely. As an early treatment, its use should have never been stopped by the Healthcare hierarchy. When it was replace, the initial treatments were inferior. That was a big mistake.
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