The drug that's leading the fight against coronavirus

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​So what are these drugs?
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​So what are these drugs?

Among the several treatments being proposed to fight Covid-19 are drugs used to attack parasites. One such candidate that has been much in the news is hydroxychloroquine (a later version of the more toxic chloroquine), used to treat malaria and other inflammatory conditions.

Here are some facts you need to know...

They are synthetic forms of quinine, which has been used to treat malaria for centuries. Chloroquine has been used to treat malaria since the 1930s. Hydroxychloroquine (HCQ) came along a decade later and has fewer side effects; it is also commonly used to treat other inflammatory conditions such as rheumatoid arthritis and lupus.

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​Why are anti-malarials suddenly in limelight?
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​Why are anti-malarials suddenly in limelight?

Because among the array of existing drugs being evaluated, they showed anecdotal evidence in improving outcomes.

According to the US Centre of Disease Control and Prevention, the drugs demonstrated in-vitro -- that is, in lab experiments outside of human organisms -- activity against SARS-CoV-2 (called Covid-19) and other coronaviruses, with hydroxychloroquine having relatively higher potency.

A Chinese study also reported that HCQ can efficiently inhibit SARS-CoV-2 infection in vitro.

These preliminary studies sparked intense interest after Trump tweeted that hydroxychloroquine plus an antibiotic (azithromycin) could be “one of the biggest game changers in the history of medicine“ and should “be put in use immediately.“ He also cited a French study that gave the combo to six patients.

French doctors and politicians also are pushing to expand hydroxychloroquine’s use.

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​What is the evidence of HCQ’S efficacy so far?
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​What is the evidence of HCQ’S efficacy so far?

Hydroxychloroquine curbed coronavirus’ ability to enter cells in lab tests. That doesn’t mean it would do the same in people or that they could tolerate the doses tested in the lab.

A China report claimed chloroquine helped more than 100 patients at 10 hospitals, but they had various degrees of illness and were treated with various doses for different lengths of time. They also might have recovered without the drug — there was no comparison group.

The French study attracted most attention.

Hydroxychloroquine was given to 26 people with confirmed infections. Six also were given the antibiotic azithromycin. Six days later no patients given hydroxychloroquine plus azithromycin had virus detected versus 57% of those given the malaria drug alone and 12.5% of some other patients who received neither drug. But there were other issues with the study.

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​Are they known to have severe side effects?
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​Are they known to have severe side effects?

Chloroquine is an extremely toxic drug with a terrible side-effect (heart rhythm problems, severely low BP, blurred vision and muscle or nerve damage) profile. Hydroxychloroquine is far safer, but its side effects (nausea, light sensitivity etc) are still significant. In the CDC study, physicians have suggested a dosage of 400mg dose twice a day and then daily for 5 days.

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​What do experts say?
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​What do experts say?

Dr. Anthony Fauci, US’ top infectious disease expert, has been tempering expectations about prospects of HCQ. According to Fauci, it was too early to say and that any “anecdotal evidence” still needs validation in randomized clinical trials. French health minister Olivier Veran said his government was against prescribing hydroxychloroquine or using it foranything other than severe cases.

In pic: Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health Dr. Anthony Fauci talks to reporters in Washington.

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​ICMR says...
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​ICMR says...

It advises use of HCQ for health workers and the asymptomatic household contacts of lab-confirmed cases to shield them from the infection. The treatment protocol recommended by ICMR’s National Task Force has been approved by the Drug Controller General of India for restricted use in emergency situations. The ICMR has also said this should not be used with a sense of “false security”. DGCI has restricted the sale of this drug without prescription to prevent hoarding.

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​Where are the clinical trials happening?
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​Where are the clinical trials happening?

France is expecting preliminary results in two weeks from a clinical test of HCQ. This testing of hydroxychloroquine and three other drugs (remdesivir, lopinavir and ritonavir in combination) began on Sunday, medical research institute Inserm said, as part of a European programme involving 3,200 COVID-19 patients. Trump has said US clinical trials of possible coronavirus treatments (hydroxychloroquine plus antibiotic azithromycin) to start in NY on Tuesday.

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​Indian and foreign firms ready to ramp up production...
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​Indian and foreign firms ready to ramp up production...

*Mangalam Drugs & Organics said it is geared up to step up production of hydroxychloroquine sulphate and chloroquine phosphate APIs in case thse are okayed for Covid-19 treatment.

* FDA has lifted import restrictions on an Indian pharmaceutical company Mumbai-based Ipca Laboratories; Ipca said USFDA “has made exception to the import alert” for three of its facilities, allowing it to supply tablets as well as raw materials for making chloroquine phosphate and hydroxychloroquine sulphate.

* Foreign firms Mylan, Teva Pharmaceutical Industries and Amneal Pharmaceuticals Inc are ramping up production of their own versions of hydroxychloroquine. Novartis and Bayer AG have said they will donate their own versions of that drug.

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