Hydroxychloroquine, the malaria drug touted as a magical Covid-19 cure by former US President Donald Trump last year, has been found effective in a prophylactic study published in the Journal of The Association of Physicians of India (JAPI) last week.
The study showed that hydroxychloroquine, popularly known as HCQ, could prevent SARS-CoV-2 infection in varying degrees depending on its dosing regimen. The highest prevention rate of 72 per cent was found among those given hydroxychloroquine over six weeks or a longer duration.
The study said, “[W]hen adjusted for other risk factors, HCQ dose as per government recommendations, 2-3, 4-5, 6 or more weeks reduced the probability of Covid positivity by 34 per cent, 48 per cent and 72 per cent.”
The study was conducted May-September last year when HCQ was still part of the Union health ministry’s recommendation in treatment protocol for Covid-19.
BACK AND FORTH ON HCQ
The study began against the backdrop of contesting claims made by authorities and experts including Donald Trump and his advisor Dr Anthony Fauci, the US’s top infectious disease expert.
In March 2020, Donald Trump declared that hydroxychloroquine was a “game changer” drug in the fight against Covid-19. Dr Fauci dismissed the claim citing lack of study and evidence. Despite Fauci’s counter-positioning, Trump continued to be vocal about taking HCQ as prophylactic drug.
Incidentally, the Union health ministry on June 6 dropped hydroxychloroquine from Covid-19 treatment protocol. In its nine-page guidelines released on Sunday (June 6) by the directorate of health services, hydroxychloroquine, ivermectin and favipiravir find no mention.
The government’s decision came on the back of criticism by experts who pointed out a lack of study-based evidence to recommend hydroxychloroquine in Covid-19 cases. The government’s revised guidelines, however, contradicts the recommendations made by the Indian Council of Medical Research as released on May 17.
The ICMR guidelines prescribed the use of hydroxychloroquine in mild cases of Covid-19.
WHY THIS STUDY MATTERS
The authors of this prophylactic (relating to prevention of a disease) study said that this “is the largest multicenter study on HCQ prophylaxis on HCWs (healthcare workers), covering over 12,000 HCWs at the risk of Covid-19”.
The study was conducted in May-September last year across 44 hospitals in 17 states involving hundreds of doctors, who received doses of hydroxychloroquine.
HERE’S WHAT A RESEARCHER SAID
One of the co-authors of the study, Dr Raj Kamal Choudhry said, “In the 1985-86 edition of Harrison’s Principles of Internal Medicine [a highly recommended book for students studying medicine in medical colleges], Dr Fauci wrote that HCQ worked as an anti-viral agent despite being an anti-malarial drug. There was no Covid-19 back then. HCQ’s anti-viral properties were known.”
Dr Raj Kamal Choudhry, who was the nodal officer for the prophylaxis study of HCQ in Bihar’s Bhagalpur medical college, said, “We had given about 2,700 doctors and paramedical staff, laundry and kitchen people the prophylaxis of HCQs in the dose of HCQs 400 mg 1×2 for first day then 1 tab daily for 4 days.”
“We did not give to those who had palpitations and had QT prolongation [a measure of heart ailment]. Those who took this drug did not have Covid excepting 5 and 6. The effect was tremendous. Later, we gave this drug to all who had mild cases. Only those patients who were in ICU were not given.”
“Of 2,700 people who were given HCQs, 700 were doctors. Only five or six got infected with SARS-CoV-2 in Bhagalpur but none developed serious complications, and nobody died of Covid-19,” Dr Raj Kamal Choudhry told Indiatoday.in.
Incidentally, Donald Trump, who tested positive for Covid-19 in October, recovered fast from the coronavirus infection without showing any serious complication.
In their conclusion, the researchers said, “HCQ is effective in reducing risk of Covid-19, at 800 mg loading and 400 mg weekly dose with more than 2 weeks dosing.”
They said the HCQ was “well-tolerated” among the participants. As policy implications of the study, the authors said, “Vaccine has its own limitations, and therefore an alternative strategy of prophylaxis such as HCQ is important, especially in low resource settings.”
The outcome of the study is significant given that India is facing acute shortage of vaccine doses, and it is still likely to take a few months before availability of vaccines improves in the country. However, the decision on who could be advised to go for HCQ prophylaxis would require a relook by the Union health ministry and the ICMR.