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Hydroxychloroquine: The Most Sought-After Medicine

On 4th of April, Saturday morning, the phone rang in PMO India. It was a call from US President Donald Trump requesting for a big consignment of an age old anti-malarial drug-Hydroxychloroquine, which is seen as a possible treatment of COVID-19 and he also mentioned that this drug is a game changer in the fight against COVID-19.

Novel Coronavirus which originated in Wuhan in China around December 2019 is a great threat to mankind infecting over 1.3 million people across more than 180 countries and nearly one lakh reported dead.

Indian Government immediately lifted a ban on export of this drug and sent 35.82 lakh tablets of hydroxychloroquine to the US along with nine metric tons of Active Pharmaceutical Ingredients (API) required in the manufacturing of the drug. The event was well tweeted by India’s Ambassador to the US, “Supporting our partners in the fight against COVID-19”. India being the largest manufacturer of this drug having 70% stake, 20 more countries have sent their request to India.

Hydroxychloroquine proved its importance against this pandemic. Hydroxychloroquine (HCQ) has proved its antiviral activity, ability to modify the immune system and has established safety profile at appropriate doses. Hydroxychloroquine is very similar to Chloroquine and is generally used to prevent and treat Malaria, Lupus Erythematous and Rheumatoid Arthritis. Again the drug is not without risk as even short-term use can cause Cardiac Arrhythmias, Seizures, Dermatological & Allergic reactions and Hypoglycemia. Hydroxychloroquine is there in the World Health Organization’s List of Essential medicines needed in a health system.

Hydroxychloroquine has been identified by the Food and Drug Administration as a possible treatment for the COVID-19 and an emergency approval was given on 28 Mar 2020 for testing on more than 1500 Coronavirus patients in New York. Meanwhile, according to a new French study on 1061 hospitalized COVID-19 patients showed a 91.7% cure (Viral Shedding) within 10 days of Hydroxychloroquine treatment along with antibiotics.

But top US infectious disease expert Dr.Anthony Fauci said in an interview that more testing is required before it is clear that this anti-malarial drug works against the Coronavirus and is safe for COVID-19 patients. Taking clue from this statement the obvious question comes to one’s mind ‘then why use malaria drug to treat Coronavirus?’ The possible reason maybe – these drugs may stop the immune system from going overboard in its attack on the virus. Some patients with severe COVID-19 have experienced organ failure and death, apparently because their immune system kept attacking long after the virus was defeated. Hydroxychloroquine helps calm the immune response. That’s why it works so well for autoimmune conditions like lupus.

But it is not yet clear how well hydroxychloroquine works in patients with COVID-19. The drugs appear to protect laboratory-grown cells from coronavirus, but scientists are only beginning to test the drugs for this condition in human clinical trials. As of 3 April 2020, there is limited evidence to support the use of hydroxychloroquine for coronavirus disease 2019 (COVID-19). Studies are ongoing with the benefits versus harms of treatment being unclear. The US National Institutes of Health (NIH) began a clinical trial to assess whether hydroxychloroquine is safe and effective to treat COVID-19 and outcomes related to COVID-19 treated with Hydroxychloroquine among in-patients with symptomatic disease (ORCHID). One non randomized trial which claimed benefit has been withdrawn by the journal that published it, while another small randomized trial in China found no benefit.

Doctors are not sure what dose is best for patients with COVID-19. The drugs are being prescribed at a higher dose and for a shorter period of time for COVID-19 than for other conditions.

For now, seeing the alarming increase in the number of COVID-19 patients worldwide, the only option left is Hydroxychloroquine, the most sought after drug for fight against this pandemic. Several State pharmacy boards in the US where the death toll rises above 22 thousands, reported that some doctors and dentists were writing prescriptions for hydroxychloroquine and a related drug, chloroquine, to themselves, family members, and staff. The US Food and Drug Administration (FDA) issued an emergency use authorization (EUA) to allow hydroxychloroquine sulfate and chloroquine phosphate products donated to the Strategic National Stockpile (SNS) to be distributed and used for certain people who are hospitalized with COVID-19. In a virtual overnight decision, the Bengal Chemicals & Pharmaceuticals Limited (BCPL) was issued a license to manufacture Hydroxychloroquine, an anti-malarial drug that is being used in the treatment of COVID-19 on 10 Apr 2020.

We expect positive results in favor of Hydroxychloroquine and eventually win the battle against Novel Coronavirus in immediate future.

- written by Oishani Sengupta

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