Over four months had passed since the Covid19 pandemic started, anti-malarial drugs such as chloroquine (CQ) and hydrochloroquine (HQ) plus azithromycin antibiotic (macrolide) are being repurposed and used as one of the regimen for the treatment of Covid19 patients admitted in the hospitals. The above mentioned investigational drugs posed danger when given to Covid19 patients but its safety and efficacy is not yet proven by large credible scientific studies and there are even anecdotal reports of its off-labelled used as a prophylaxis against Covid19 disease in some countries. The anti-malarial drugs was even touted by US president Donald Trump and even supported by Fox news and Tesla owner Elon Musk. But many medical experts especially in the United States are skeptical in using anti-malarial drugs for Covid19 patients because of its less beneficial effects to the patients.


 

Study : An Observational Multinational Registry Analysis-The Lancet  

And because of its worldwide used which started last December of 2019, China and Italy initially published some studies that proved anti-malarial drugs are effective and safe to be given to patients with Covid19 disease but the sample size of the study included  a small number of patients and was not peer reviewed. So their studies naturally will not give us a good over-all picture with regards to the efficacy and safety profile of anti-malarial drugs in patients with Covid19 disease. Thus inorder to know the efficacy and safety profile of the used of anti-malarial drugs to Covid19 patients, a Multinational registry observational analysis study was done involving 93,262 patients, all SARS Cov-2 laboratory positive from 671 hospital in six continents admitted from December 20, 2019 and April 14, 2020.

Study Profile:


 

 

Study Results:

The results of the study revealed that the used of anti-malarial drugs such as chloroquine and hydrochloroquine with or without a second generation macrolide ( clarithromycin and azithromycin ) added was associated with increased risk of ventricular arrhythmias( non-sustained or sustained ventricular tachycardia and ventricular fibrillation ) to Covid19 patients and a high risk of in-hospital death in Covid19 patients.

 

 

The diagram shows in blue arrows that patients who received oral hydrochloroquine and chloroquine with or without macrolide antibiotic had an increased risk of developing ventricular arrhythmias during their hospital days.

 

 

 

RISK FACTORS:

The most common risks factors that increases mortality in the study group are…older patients, men, obese, black or hispanic races, diabetes, existing hypertension, hyperlipidemia, patients with coronary artey disease, congestive heart failure, previous history of arrhythmias, patients with chronic obstructive pulmonary disease and patients who are current cigarette smoker. And please note that as you observe down below, as indicated with a blue arrows are the common risks factors that leads to the increased risk of in-hospital mortality or death of Covid19 patients given with the two oral anti-malarial drugs ( chloroquine and hydrochloroquine) with or without second generation macrolides.


 

Conclusion of the study: ” These findings suggest that these drug regimens ( anti-malarial drugs) should not be used outside of clinical trials and urgent confirmation from randomised clinical trials is needed.”

 

The study provides real world evidence involving large number of patients coming from different locations all over the world. In a nutshell, based from the findings of such particular study it suggests that every physician will be cautious enough or even refrain of using or giving anti-malarial drugs as treatment for Covid19 patients because the risks outweighs the benefits. The anti-malarial drugs must only be reserve to patients with malaria, rheumatoid arthritis, SLE, other autoimmune diseases and as a travel chemoprophylaxis for malaria. If the anti-malarial drugs are repurposed for patients with Covid19 disease,then the possibility of anti-malarial drug shortages for patients with malaria and autoimmune diseases is inevitable in the near future. Likewise I hope that it can offer and  give a clear message to all of us in the medical profession since chloroquine and hydrochloroquine are still included in some interim guidelines and protocols as an investigational drugs in treating Covid19 patients in the hospital settings. Anyway there are still ongoing trials involving anti-malarial drugs in other parts of the world as of today.


Recent updates for Covid19

And intravenous form of remdesivir by Gilead will be available in the few weeks from now as a treatment for Covid19 patients but a plan of oral tablet form and intranasal form of remdesivir was also contemplated. Last February 21, 2020 Adaptive Covid19 Treatment Trial or ACTT2 a randomized double blinded,well controlled trial began as unveiled by Dr. Anthony Fauci Director of National Institute of Allergy and Infectious Diseases USA, the study includes the giving of remdesivir 200mg i.v. as loading dose then 100mg i.v. daily for ten days duration plus an anti-inflammatory drug Baricitinib( olumiant-ELI LILLY and INcyte ), is use for moderate to severe rheumatoid arthritis drug ttreatment . In the study Baricitinib 4 mg oral tab or to be crushed and given via NGT or nasogastric tube daily to in-hospital patients with Covid19 disease .The purpose of the study is, if ever an anti-inflammatory drug such as baricitinib is added to intravenous remdesivir regimen will give additional over-all benefits and further improve mortality outcomes since severe Covd19 patients are prone to develop acute respiratory distress syndrome ( ARDS ) in the midst of in-hospital sitting as a result of overwhelming innate inflammatory of immune responses or ” cytokine storm “.

Remdesivir from Gilead, while waiting for the discovery of a new definite drug treatment for the novel coronavirus, was given and granted an emergency use authority ( EUA) by US-FDA last march 2020 for the treatment of Covid19 patients admitted in the hospital with severe signs and symptoms of the disease but is not yet officially approved for the definite treatment of patients with Covid19 disease . The only officially approved treatment for patients admitted in the intensive care units with severe signs and symptoms of Covid19 disease is convalescent plasma. And the early used of anti-malarial drug treatment for Covid19 patients in the United States was just a product endorsement of some wealthy and powerful politicians in the country. Hopefully the drug remdesivir by Gilead will be cost effective enough to be available to everybody for the treatment of Covid19 disease. Since the initial production of the drug is limited and others will have to wait for another batch of drug production.

Keep safe, Stay healthy and Look Cool Always !!!

Laertes B. Amihan MD

Your valuable comment is needed…I am happy to accept your decent and constructive comments. You can ask questions and queries too…

Kindly READ this VERY IMPORTANT MESSAGE !!!…Updated today. June 5, 2020
The author of this write-up published this article last May 29,2020.Some of the content of this article was based from the article entitled ” Hydrochloroquine or Chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis” published in thelancet last May 22, 2020…but sad to say to all of the readers and would be readers in the future, I will have to remind you that thelancet RETRACTED its PUBLICATION of the above mentioned article just a few days ( June 4 or 5, 2020 ) ago after my write-up was published.Please see picture below…

This is the first appearance of the article published in thelancet last May 22,2020.

This is the second appearance of the article published in the  lancet retracted last June 4 or 5,2020. Anyway as I wrote that Anti-malarial drugs are still under investigational studies (COPCOV STUDY) in many countries all over the globe for its possible treatment in Covid19 patients. I really dont know why the lancet retracted their publication???…DO YOU KNOW WHY???…as reported, the data that appeared in thelancet article and the New England Journal of Medicine came from a dubious sources. As it was stated that a Chicago based private company( Surgisphere ) who collected the patient’s data of the study and provides important data to the researchers, refused to give or shared the complete data collected for independent peer review. Thus medical scientist and authorities find the data gathered not credibible. Since it is not yet proven that the anti-malarial drug/s with or without macrolide are that bad for Covid19 patients, then doctors can still continue to give the drugs to such patients in a cautious manner.

Laertes B. Amihan MD