COVID-19 Promising Drug Treatment
Chloroquine, Hydroxychloroquine, Remdesivir
Three promising drug treatments for COVID-19 include remdesivir, chloroquine and hydroxychloroquine. These are prescription medications and have other FDA approved indications, with the exception of remdesivir which is not FDA indicated for any indications (not yet on the market). Hydroxychloroquine was on back order; however, the government has taken action to increase the supply of the medication. In the state of California, the board of pharmacy has issued a waiver for 30 days allowing pharmacies to receive medications from pharmacies, wholesalers and third-party logistic providers another state to alleviate shortages. Novartis, Mylan and Teva are some of the largest drug manufacturers and will supply millions of chloroquine to help fight COVID-19. These drugs are showing promise in trials and case studies but none have FDA approval. This may change with further studies. For now, speak to your doctor if you have concerns and want to know if any of these treatments are right for you.
Chloroquine AND Hydroxychloroquine
A little history…
In the 17thcentury the indigenous people of Peru extracted the bark of the Cinchona plant to fight chills and fever. In 1633 Europe then used it for similar reasons as well as to fight against malaria. In 1820 quinine an anti-malarial drug was extracted. This was widely used as anti-malarial drug until World War II, when similar derivatives were discovered with better safety tolerability. Chloroquine was discovered in 1934 by Hans Andersag and co-workers at the Bayer laboratory. Initially when discovered the drug was ignored due to human toxicity concern. It was not until 1947 the US government expanded clinical trials and brought it into clinical practice for prophylactic treatment of malaria. A derivate of chloroquine, named hydroxychloroquine, was later approved in the United States in 1955 to treat malaria.
Studies for COVID-19…
Chloroquine has shown in preliminary studies that it may be effective in treating COVID-19 associated pneumonia. A preliminary study suggests that chloroquine is effective and safe in COVID-19 pneumonia, helping to improve lung function and shortening the disease course. By delaying the need for a ventilator, it helps delay people from going into septic shock, giving the body more time to fight off the infection.
Additional studies have determined that hydroxychloroquine and chloroquine are both effective in inhibiting COVID-19 in vitro (not yet in actual humans). A further study concluded that hydroxychloroquine was more effective with a better safety tolerability. In a recent published study hydroxychloroquine was shown to be less toxic than chloroquine and effective in inhibiting SARS-CoV-2 (COVID-19). This study was in vitro and therefore not in human patients but utilizing African green monkey kidney.
French researchers published a small study that involved 36-patients in which hydroxychloroquine was effective in killing the coronavirus. In addition, a subset of 6 patients tested negative for coronavirus when combined with the antibiotic azithromycin. Keep in mind that the combination of azithromycin and hydroxychloroquine may increase QT prolongation and this should be monitored by your provider.
Although you hear that many are encouraged to receive hydroxychloroquine, experts including Dr. Anthony Fauci an immunologist and key member of the White House Coronavirus Task Force, has urged that more rigorous testing is needed for hydroxychloroquine.
Chloroquine is indicated for treatment and prophylaxis of malaria and the treatment of amebiasis (an intestinal parasitic infection). Hydroxychloroquine is currently approved for malaria prevention and treatment, lupus (SLE), and rheumatoid arthritis. Anti-malarial drugs including chloroquine and hydroxychloroquine should be avoided in people with psoriasis as this can make psoriasis worst and cause outbreaks. Of these two medications hydroxychloroquine has the least side effects for people with psoriasis. Chloroquine has contraindications for people with heart disease or diabetes. If you do need these drugs to treat COVID-19 your provider will most likely assess your risk versus benefit.
Remdesivir
Unlike hydroxychloroquine or chloroquine remdesivir is not FDA approved for any indication.
It is a broad-spectrum anti-viral medication that was developed by a company named Gilead for the treatment of Ebola, although it has not shown to be effective against Ebola. A study demonstrated some success in treating monkeys infected by the coronavirus MERS. It is now being tested to determine if this can be applied as treatment to COVID-19. In the United States, the first US patient confirmed to be infected with COVID-19 was treated with remdesivir and the patient did recover. Further studies are needed to determine its effectiveness for COVID-19 and scientists are working on this.
Stay tune for more updates and other treatments that are currently being studied and developed.
References:
1. Liu, J., Cao, R., Xu, M. et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 6, 16 (2020). https://doi.org/10.1038/s41421-020-0156-0
2. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269–271. doi:10.1038/s41422-020-0282-0
3. https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/Chloroquine.pdf. Accessed on March 21, 2020
4. https://www.psoriasis.org/about-psoriasis/causes. Accessed on March 21, 2020
5. https://www.ncbi.nlm.nih.gov/pubmed/19836374 Access on March 21, 2020
6. https://www.pdr.net/drug-summary/Chloroquine-Phosphate-chloroquine-phosphate-3418. Accessed on March 21, 2020
7. https://www.gilead.com/purpose/advancing-global-health/covid-19. Accessed on March 21, 2020
8. https://www.scmp.com/news/world/united-states-canada/article/3050949/us-coronavirus-patient-who-was-worlds-first-treated. Access on March 21, 2020
