New Delhi: Among the measures to tackle coronavirus, the Narendra Modi government has been taking stock of the availability of chloroquine, an anti-malaria drug being touted as a potential “game-changer” in treating the infection.
Drug pricing watchdog National Pharmaceutical Pricing Authority (NPPA) had last week asked drug makers to submit details of the available stock of chloroquine in the country.
“We have enough stock of the drug available across the country. In fact, we have alerted the state drug controllers to keep an eye on the stock and inform us for shortages,” NPPA chairperson Shubhra Singh told ThePrint.
In December, chloroquine was among 21 drugs whose prices were revised upwards by 50 per cent. It now costs Rs 1.16 for a 150 mg tablet.
“While it is an essential drug and falls under price control, the recent upward revision of its price also ensures that its production is economically viable,” Singh said.
Given that malaria is part of the national health programmes in India, there are several top suppliers of chloroquine, including Zydus Cadila, IPCA Labs and Mangalam drugs.
“India has a strong foothold in chloroquine’s production as it is one of the oldest molecule… the country, in the past, won the battle against deaths caused by malaria. Also, we are self-sufficient in producing this drug and its raw materials,” said Dinesh Dua, chairman, Pharmaceutical Export Promotion Council (Pharmexcil), which functions under the Ministry of Commerce and Industry.
How chloroquine works
Chloroquine works by increasing the levels of haem or heme — a substance toxic to the malarial parasite — in the blood. This kills the parasite and stops the infection from spreading.
According to a study published in 2005 in medical journal Virology, the drug blocks the replication of the coronavirus and prevents SARS-CoV from plugging into a receptor.
Biotech investor Dr Mike Pellini was the first to use chloroquine as a possible cure for coronavirus.
Tech entrepreneur Elon Musk also tweeted that chloroquine was “maybe worth considering” as a potential treatment.
Last week, during a White House press briefing on coronavirus in the United States, President Donald Trump directed the federal health service, the Food and Drug Administration (FDA), to “eliminate outdated rules and bureaucracy” to help speed up the pace of testing drugs that could help treat symptoms of COVID-19.
FDA Commissioner Dr Stephen Hahn said the regulator is preparing to run clinical trials of the drug with coronavirus patients.
India still cautious
A health ministry official, on the condition of anonymity, said the government is awaiting results of clinical trials of the drug from the World Health Organization (WHO).
“We are monitoring the evolving global scenario. Several drugs have shown hope. Let’s wait for WHO-based clinical trials to show final results. Till then, off label use is allowed in India where this drug can be used by doctors to save lives.”
Dr Yatin Mehta at the Institute of Critical Care and Anaesthesiology, Medanta, said, “We have been using chloroquine to treat patients in India. However, the evidence right now is anecdotal.” Dr Mehta is currently treating the 14 Italian patients who tested positive for COVID-19 earlier this month.
The research currently emerging on the use of chloroquine is limited as clinical trials of a much larger scale needs to be conducted to conclusively determine the effectiveness of the drug. Moreover, long-term follow-ups are also necessary to study the possible side-effects of the treatment before it is widely adopted.
An overdose of chloroquine can cause acute poisoning and death. In the past years, malaria-causing parasites developed resistance to this drug, and chloroquine began to go out of clinical practice.
Its production and market supply was greatly reduced, at least in China. On the other hand, hydroxychloroquine, first synthesised in 1946, was a safer derivative and is more easily available at present.
Several clinical trials are ongoing in China to test the effectiveness of hydroxychloroquine against COVID-19, which is a less toxic metabolite of chloroquine used to treat rheumatic diseases.
The Modi government Monday released an advisory for consumption of hydroxy-chloroquine for prevention of COVID-19 among high-risk population — including asymptomatic household contacts of laboratory confirmed cases and asymptomatic healthcare workers.