With more than 50,000 confirmed cases of the coronavirus in the U.S. and climbing, Americans are eager for a treatment to stop its spread. In recent days, attention has been fixated on two drugs that may have the potential to be beneficial for patients with COVID-19: an anti-malaria drug known as chloroquine (or hydroxychloroquine) and an anti-bacterial drug called azithromycin.
But in the wake of news that an Arizona man died after consuming chloroquine phosphate, an aquarium cleaner that he believed was the chloroquine being touted by the White House, many are expressing concerns that endorsements of the medicine are coming too soon. Christopher Plowe, a professor of global health at Duke University and a world-renowned expert on malaria drugs, is one of them.
“People with the public platform that the White House has need to be aware that everything they say is going to be very influential to people,” Plowe tells Yahoo Lifestyle. “And try to not get out too far ahead of the evidence.”
The evidence thus far of the drugs’ efficacy is limited to a single study, published by the International Journal of Antimicrobial Agents on March 20, which concluded that the treatment led to a “significant reduction” in symptoms as well as a faster recovery. The report has been criticized by scientists for its small sample size (26 patients) and lack of adequate controls (the patients were treated in different hospitals, which could influence their recovery).
But in the absence of more research, President Trump touted the treatment plan as a potential “game-changer,” and boasted of “a great early result” against COVID-19 in a Florida patient. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), isn’t as confident, saying that many reports are “anecdotal” and that randomized controlled studies are needed immediately. The Food and Drug Administration has not approved either drug for use in treating COVID-19.
While Plowe says it’s “reasonable to be optimistic,” he’s not ready to endorse the drugs as a treatment yet. As the nation braces to see if the treatment works, here’s what the leading expert on chloroquine thinks.
Yahoo Lifestyle: Given the obvious differences between malaria and COVID-19, were you surprised to see chloroquine being explored as a treatment option?
Christopher Plowe: I was surprised and my first thought was that maybe it was not so much a kind of virus-specific action. Right, cause it has a very specific mechanism of action for the parasite. I think you're absolutely right that that same molecular mechanism [for malaria] wouldn't be there in a virus.
YL: Do you have any experience combining chloroquine with the anti-bacterial azithromycin as the researchers in this study did?
CP: No. Azithromycin does have some antimalarial activity and has been tested both for prevention and as a component of treatment. But its efficacy is modest, and its action is slow, so it has never been widely recommended or used as an antimalarial. Chloroquine (and related derivatives) are typically used as a “monotherapy,” i.e. a standalone drug.
YL: Chloroquine does seem to be a powerful drug and it’s been shown effective in treating other conditions besides malaria. Could that be significant to consider here?
CP: Yes, chloroquine is a pretty good treatment for autoimmune disorders — it has this kind of anti-inflammatory effect. So even when people have a fever for reasons other than malaria, they may take chloroquine and they'll feel better because it's kind of treating their fever and reducing their inflammation. So I was surmising that maybe it's the anti-inflammatory effect that's helping people feel better.
YL: So this would be off-label use of the drug, potentially?
CP: [Yes]. it wouldn't the first time that a compound does one thing in one organism and does something else useful in another organism, meaning dual-use.
YL: From your experience studying chloroquine in malaria patients, is it generally well-tolerated?
CP: Compared to other antimalarial drugs, it’s well tolerated. The most common side effects are gastrointestinal. But the things you have to watch out for with chloroquine are cardiac side effects. It can cause [heart] arrhythmias, especially in people with a history of cardiac disease. So I do worry that if people are using this willy-nilly in older patients with cardiac history that we could run into trouble. Also, for people with a lot of melanin in their skin ... it can cause really profound itching. It's very bothersome but it’s not actually an allergic reaction, just some kind of skin reaction to that drug that can be very unpleasant.
YL: How optimistic are you about the potential for this to treat COVID-19, and is it possible that the positive results shown in this early study may not be replicated?
CP: It's a good drug that has saved a lot of lives. The question is whether it gets efficacious and whether it's safe for this use in these patients. Those are really important questions that — until you've done a randomized controlled trial — you're just not going to have the evidence.
The history of medical treatments is just rife with examples of things where there was a biologically plausible reason to believe the drug would work ... [but] then when the trial was finally done, it turned out there was absolutely no benefit whatsoever ... So when Dr. Fauci says we need to expeditiously to do randomized clinical trials and find out is it safe ... He's absolutely right. There's no other way to have any degree of confidence that it's working. So, it's reasonable to be hopeful, but that's not a reason to start using it.
YL: So you don’t think people should be trying to stock up on this, or self-prescribing it?
CP: Nobody should be stocking up... I don't think we have the evidence for that. An individual physician is always in a position to make a decision ...in a situation that is very dire where a patient is at a relatively low risk of certain cardiac side effects, maybe they will choose it ... but hopefully, we won't be in that situation very long where people have to make these kinds of judgments in the absence of solid evidence ... Until you’ve studied it in a direct way, you're just guessing.
For the latest news on the evolving coronavirus outbreak, follow along here. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC and WHO’s resource guides.
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