'No good evidence': 1st Indian review warns against using hydroxychloroquine for COVID-19

"There is absolutely no good evidence to use this medicine in either prophylactic or curative treatment of the infection,” Dr Harmeet Singh Rehan, one of the reviewers, told The New Indian Express

Published: 24th April 2020 06:40 PM  |   Last Updated: 24th April 2020 07:35 PM   |  A+A-

Representative image (Photo | Anil Shakya, EPS)

Express News Service

NEW DELHI: The first review in India of all available data on the use of anti-malaria drug hydroxychloroquine (HCQ) for COVID 19, either for prevention or cure of the disease, has warned against using the medicine for the infectious disease.

The Indian Council of Medical Research has recommended using HCQ in combination with antibiotic azithromycin for severely sick COVID-19 patients and alone for prophylaxis in healthcare workers treating coronavirus patients and high risk contacts of confirmed cases.

But there has been little evidence so far that the medicine works for the infection even though several countries including the US have been using it to treat COVID-19 patients. The drug is also used for treating autoimmune diseases such as lupus and rheumatoid arthritis but is not recommended in people with a history of cardiac issues.

The study carried out by pharmacologists at the Lady Hardinge Medical College in New Delhi after reviewing 71 datasets from abroad -- including some meta analysis and randomized clinical trials -- concluded that while HCQ seems to be efficient in inhibiting SARSCoV-2, the pathogen behind COVID 19, in in-vitro cell lines, there is lack of strong evidence from human studies.

“The in-vitro cell culture based data of viral inhibition does not suffice for the use of hydroxychloroquine in patients with COVID-19,” concluded the researchers. “Currently, the literature shows inadequate, low level evidence in human studies. Scarcity of safety and efficacy data warrants against the widespread use of HCQ in COVID-19 prophylaxis and treatment, until robust evidence becomes available,” they added.

WATCH | What is hydroxychloroquine and why is India giving it to the US?

“We analysed all available strong and weak evidence related to the use of HCQ in COVID-19 patients and found that there is absolutely no good evidence to use this medicine in either prophylactic or curative treatment of the infection,” Dr Harmeet Singh Rehan, head of the department of pharmacology at the LHMC and one of the reviewers, told The New Indian Express.

The findings assume significance as a just published study in the US has shown that several COVID-19 patients in the ICU who were given the HCQ and azithromycin combination died after developing a complication called cardiac arrhythmia in which the rate or rhythm of the heartbeat changes dramatically.

When this correspondent reached out to a senior ICMR official asking for a comment on the scientific review, he said in India too some clinical trials had been initiated to check the efficacy of the medicine for COVID-19 but said that in the absence of a targeted therapy for the condition, the HCQ and azithromycin combination looked the only viable option.

“There was limited evidence from China, US and France on this and that’s why we included the drug in our recommended clinical management plan for the infection,” he said.

Experts in medical ethics meanwhile said that in a pandemic situation -- with no effective clinical intervention available -- situations like the present one are bound to arise.

“Ethics often takes a backseat in situations like pandemics,” said Shantanu Dutta, director of the Centre for Bioethics in the national capital.

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