Malaria drug holds out treatment hope amid coronavirus outbreak
To be sure, the US Food and Drug Administration was quick to clarify that extensive studies were needed to understand the efficacy of these drugs in combating Covid-19.Updated: Mar 21, 2020 05:51 IST
As scientists scramble to find a cure for the coronavirus disease (Covid-19), the widely used anti-malarial drugs chloroquine and hydroxychloroquine have emerged as promising candidates.
To be sure, large controlled clinical trials are needed to provide evidence of how well these drugs work, but anti-malarials have been among the medley of drug regimens clinicians in China, South Korea, France and Italy have been using at scale with some success to treat people severely ill with Covid-19, which has affected close to 250,000 people and killed at least 10,000 around the world.
US President Donald Trump referred to the drugs on Thursday and went as far as to indicate that a treatment using chloroquine/ hydroxychloroquine will possibly be rolled out first in New York, which has been roiled by the infection. As of Thursday, New York City had around 4,000 cases of people infected with the virus and seen 26 deaths.
Trump said about the treatment: “I think it’s going to be very promising. It could be a game changer. And maybe not. Based on what I see, it could be a game changer. They’re very powerful.”
To be sure, the US Food and Drug Administration was quick to clarify that extensive studies were needed to understand the efficacy of these drugs in combating Covid-19. Interestingly, on Thursday, a French study published in the International Journal of Antimicrobial Agents found that a combination of anti-malarial drugs and an antibiotic may be effective against Covid-19.
Chloroquine, discovered in 1934 by Hans Andersag, who was, at the time, working for Terman drugmaker Bayer, is a synthesized version of quinine, itself derived from the Cinchona plant.
To date, no drug has been approved to treat the new coronavirus, which causes potentially fatal complications in about 5% of the people infected. The treatment strategy has been based on hit-or-miss combinations.
Close to a dozen drugs are in various stages of clinical trials in China. Only one antiretroviral called remdesivir, which was in trials against Ebola and the Mers coronavirus that causes the Middle East Respiratory Syndrome, is on trial in the US. Chloroquine is a generic drug that is safe and cheap and has been used to treat malaria since World War II. It works like quinine, which the British added to tonic in the belief that it would give them blanket protection against malaria, which is still endemic in many states in India. It is an inexpensive drug and widely available.
India has so far approved the combination of two antiviral drugs used to treat HIV, lopinavir and ritonavir (400 mg and 100 mg, respectively) to treat Covid-19. The first major study of Covid-19 treatments found it did not work on severely ill patients in China.
“Treatment with lopinavir-ritonavir was not associated with a difference from standard care in the time to clinical improvement,” said the report on a randomised, controlled trial on 199 hospitalised patients in China that was published in The New England Journal of Medicine (NEJM) on Wednesday.
“A new NEJM paper found antiretrovirals are not working, so we urgently need additional options to treat critically-ill people. We need to go with repurposed drugs as much as possible and then look for new molecules and treatment,” said Gagandeep Kang, director, Translational Health Science and Technology Institute, Faridabad.
Several countries asked people to avoid ibuprofen for fever and pain after a study in The Lancet Respiratory Medicine said an enzyme boosted by anti-inflammatory drugs such as ibuprofen could facilitate and worsen Covid-19 infections. “Ibuprofen could be a factor in worsening the infection,” said France’s health minister Olivier Veran in a tweet in French, and recommended those with fevers to use paracetamol.
While the World Health Organisation (WHO) on Wednesday said that “based on currently available information, WHO does not recommend against the use of ibuprofen”, limited clinical data available on Covid-19 treatment and disease progression has led clinicians to caution against self-medication, saying it is best to use paracetamol for pain and fever, as is in done to treat symptoms of dengue fever.
More evidence-based treatment must be fast-tracked to save lives. “Given the sharp increase in the number of cases and deaths, we need multi-centric drug trials on the most effective drug combinations. With adequate recruitment of patients, a multi-country study can be completed in six months,” said Dr K Srinath Reddy, president, Public Health Foundation of India.
As of now, the malarial drugs hold out hope – and only that.