When it was announced last week that hydroxychloroquine might offer some benefit against COVID-19, many people got excited. We’ve been told that there are no effective treatments against this virus, so any glimmer of hope spurred tremendous interest. Here is a hydroxychloroquine update.
We will also share some insights into a century-old vaccine called BCG. It was developed to prevent tuberculosis. More recently it has become a key immunotherapy treatment for bladder cancer. Now health care workers in Australia and the Netherlands are getting it in the hopes of preventing or managing the coronavirus.
Hydroxychloroquine Update: Good News & Bad News:
The good news is that this drug has been used for 65 years. Plaquenil (hydroxychloroquine or HCQ for short) was first approved in 1955. Doctors have been prescribing it to treat malaria, lupus and rheumatoid arthritis for many decades. It is also affordable, unlike many newer high-tech antiviral drugs.
You can learn more about this history of both chloroquine and HCQ at this link:
The Inside Story of Chloroquine and Hydroxychloroquine for COVID-19
An old drug for malaria and rheumatoid arthritis could hold promise against the coronavirus. New data looks promising for hydroxychloroquine for COVID-19
Hydroxychloroquine Update from China:
We became interested in HCQ when we read an article in the journal (Clinical Infectious Diseases, March 9, 2020). Chinese researchers reported that the drug had both antiviral and anti-inflammatory activity against SARS-CoV-2 (COVID-19) infection. This was test tube-research, so there was no human data to analyze.
Hydroxychloroquine Update from France:
A small pilot study from France (International Journal of Antimicrobial Agents, online, March 17, 2020) added some human experience to the Chinese in vitro data. HCQ plus the antibiotic azithromycin seemed to help clear the coronavirus from the nose and mouth faster (3 to 6 days) than standard treatment (20 days). The authors did not provide any clinical information about patient improvement, though.
Hydroxychloroquine Update: Disappointment
Amidst the early HCQ excitement there was a disappointing Chinese study (Journal of ZheJiang University, March 6, 2020) The investigators randomized 30 patients who were positive for COVID-19. One group got HCQ. The control group received conventional treatment. Treatment with hydroxychloroquine was no more effective than conventional therapy in viral clearance, body temperature and lung pathology.
Awaiting More Data!
A French team of researchers with close ties to Chinese investigators discuss ongoing clinical trials (International Journal of Antimicrobial Agents, online, March 4, 2020). They note that there are now 20 clinical studies ongoing in China:
“The first results obtained from more than 100 patients showed the superiority of chloroquine compared with treatment of the control group in terms of reduction of exacerbation of pneumonia, duration of symptoms and delay of viral clearance, all in the absence of severe side effects. This has led in China to include chloroquine in the recommendations regarding the prevention and treatment of COVID-19 pneumonia.”
In our opinion, it is too soon to draw any conclusions from the preliminary reports. Until we see well-controlled clinical trials with large numbers of patients, we won’t know if the drug works or how safe it is for people with COVID-19.
One Case Report about HCQ Tolerability:
We were able to locate someone who has been taking hydroxychloroquine for years to treat her rheumatoid arthritis (RA). We wondered what the drug was like from a personal perspective.
“When I was first diagnosed, my internist put me on an NSAID (meloxicam) immediately. She also referred me to the rheumatology department. My rheumatologist suggested methotrexate and hydroxychloroquine. I did not want to start on methotrexate immediately, but I did start taking hydroxychloroquine.
“My appetite had already been poor due to the RA, and for the first few weeks the hydroxychloroquine upset my stomach. To really control my joint pain and swelling, I needed to take methotrexate once a week as well.
“I asked my rheumatologist about discontinuing the hydroxychloroquine. He was much more concerned about the NSAID.
“My new rheumatologist suggested getting me totally off HCQ but instead she cut my dose in half. Expect upset stomach and lower appetite when on it, but otherwise MY experience has not been adverse. I have lab work done every few months to monitor how my liver and kidneys are doing.”
This is just one person’s experience with HCQ. If you would like to learn more about possible side effects of the drug, here is a link:
The Inside Story of Chloroquine and Hydroxychloroquine for COVID-19
We will continue to provide a hydroxychloroquine update whenever there is new clinical data. In the meantime, here is another repurposing of a very old medicine.
Testing BCG Vaccine Against the Coronavirus:
As we mentioned above, BCG (bacillus Calmette-Guerin) is a very old vaccine that has been used for about a century to prevent tuberculosis. In recent decades it has become a key immunotherapy agent against bladder cancer.
Researchers are hoping that BCG can stimulate the immune system so that it can better fight the coronavirus. Dutch scientists are beginning a clinical trial this week involving 1,000 health care workers. They will be randomized to receive either a BCG vaccination or a placebo.
Australian investigators will be following the same protocol. They are recruiting 4,000 health care workers to receive either BCG or placebo. The study starts next week. There is talk that there will be a U.S. study starting soon.
Results are expected within a few months. Science magazine (March 23, 2020) asked a Canadian immunologist about the BCG studies. Here is her perspective:
“Eleanor Fish, an immunologist at the of the University of Toronto, says the vaccine probably won’t eliminate infections with the new coronavirus completely, but is likely to dampen its impact on individuals. Fish says she’d take the vaccine herself if she could get a hold of it, and even wonders whether it’s ethical to withhold its potential benefits from trial subjects in the placebo arm.”
There is only one hiccup in the BCG story. In recent years there have been worldwide shortages of this life-saving medicine for bladder cancer patients. With interest building in using the vaccine against the coronavirus, we worry that shortages may just get worse.
Did you find this information of interest? If so, we hope you will share our hydroxychloroquine update and BCG story with friends, family, neighbors and other interested parties. You might encourage them to sign up for our newsletter, especially in these uncertain times.
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