In India and at the global level, the debate over the merits of hydroxychloroquine (HCQ) as a treatment for COVID-19 continues.
Last month, the World Health Organization (WHO) cited safety concerns as it announced a moratorium on clinical trials of hydroxychloroquine. HCQ is used as a treatment for a number of conditions including malaria and lupus. However, it is not yet widely accepted as a prophylactic or treatment for COVID-19.
Fears over adverse side effects have been expressed. The US Food and Drug Administration has cautioned that “hydroxychloroquine and chloroquine can cause abnormal heart rhythms such as QT interval prolongation and a dangerously rapid heart rate called ventricular tachycardia.”
A Lancet paper (one which precipitated the WHO’s decision) asserted
“We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.”
However, this study was controversial itself. An open letter to The Lancet noted that the study’s “impact has led many researchers around the world to scrutinize in detail the publication in question. This scrutiny has raised both methodological and data integrity concerns.” The letter was signed by more than 120 “clinicians, medical researchers, statisticians, and ethicists from across the world.” Concerns were raised after “Guardian Australia revealed that the Australian data in the study…did not reconcile with health department records or databases.” The Lancet has acknowledged “important scientific questions” to have been raised.
The decision by the WHO to pause clinical trials has polarised opinions in India. However, the Indian Council of Medical Research (ICMR) continues to embrace the drug in the COVID context.
Following the WHO’s decision, ICMR Director-General Dr Balram Bhagarva said “COVID-19 is an evolving field and we do not know which drug is working and which is not working. Lots of drugs are being repurposed for COVID-19, whether for prophylaxis…or for treatment of the disease….we got some data in India, mainly observational studies and some case control studies.
“We found there were no major side affects [sic] except for nausea, vomiting, palpitation occasionally. Hence in our advisory, we’ve recommended that it should be continued for prophylaxis as there is no harm. Benefit may be there.”
Bhagarva added that “looking at the risk and benefits we found that we should not deny it to our frontline and healthcare workers dealing with the COVID-19 patients. At the same time we have also said that the use of PPE [personal protective equipment] should be continued.”
More recently, the ICMR has released data concerning hydroxychloroquine suggesting it may be useful as a preventative measure for healthcare workers. Study co-author, ICMR-National AIDS Research Institute director Dr Samiran Panda said, “the main conclusion that can be drawn after analyzing the data is that HCQ has beneficial effects in infection risk reduction from fourth dose onwards. The first loading dose of 800 mg and then every week a dose of 400 mg for four, six or more weeks as per your physician’s advice will help cut the risk of infection by eighty percent in healthcare workers who are not already sick.”
On May 23rd, the Union Ministry of Health and Family Welfare announced it would scale up the use of hydroxychloroquine. In an advisory, it said “the Joint Monitoring Group and National Task Force have now recommended the prophylactic use of HCQ in the following categories: a) all asymptomatic healthcare workers involved in containment and treatment of COVID-19 and asymptomatic healthcare workers working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks; b) asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities; and c) Asymptomatic household contacts of laboratory confirmed cases.”
Scientific rigour is imperative in the age of COVID-19. The search for vaccines, treatments and prophylactics will be hindered without the same. In India, hydroxychloroquine continues to be embraced. As COVID-19 rages on, debate over the merits of the drug is likely to continue.