- Hydroxychloroquine is an anti-malaria and autoimmune prescription drug that has shown effectiveness against viral infections in-vitro.
- That versatility puts hydroxychloroquine at the forefront of a potential treatment for COVID-19.
- Studies done in a lab have shown it can have a fighting chance against coronaviruses but that isn’t the same as its effect in humans, with potentially dangerous side effects.
- Large observational studies began after the FDA allowed emergency use on COVID-19 patients.
- To date, they have mostly shown the drug has no impact on patient survival and improvement.
Following is a transcript of the video.
Narrator: In the past few weeks, we’ve been hearing these six syllables over and over again: Reporters: Hydroxychloroquine. Hydroxychloroquine.
Donald Trump: I happen to be taking it.
Narrator: The malaria drug being called a potential coronavirus cure by some and a potentially harmful solution by others, with the World Health Organisation halting its trials at the end of May. So, what exactly is hydroxychloroquine? And will it help with the fight against COVID-19? This is hydroxychloroquine, a prescription drug and chemical compound modelled after quinine, a once popular natural anti-malaria drug made from tree bark. As the ideal model for synthetic malaria drugs in the early 1900s, quinine first paved the way to chloroquine, used around World War II. But there was a slight issue. Chloroquine had too many side effects to be widely used, including retinal damage and hearing issues. So in 1955 a less risky version was made, hydroxychloroquine, made from this mix of atoms.
Neil Schluger: The only real difference is the addition of a hydroxyl group.
Narrator: That’s Dr. Neil Schluger, the chief of the Division of Pulmonary, Allergy, and Critical Care Medicine at Columbia University. And he says it’s the simple addition of an oxygen bound to a hydrogen that makes the drug less risky.
Schluger: So, those chemical changes are often made either to improve a drug’s activity or to decrease its toxicity.
Narrator: Despite the side effects, chloroquine is still used. In fact, both hydroxychloroquine and chloroquine are considered versatile drugs, a valuable trait in the pharmaceutical industry, which might explain why people thought the drug originally designed for malaria could be a treatment for COVID-19. There are actually two main reasons this theory has become so popular. One: Hydroxychloroquine works by limiting the body’s immune response and stops it from going into overdrive in the first place. The drug has been proven to be effective in treating autoimmune diseases, such as lupus and rheumatoid arthritis, diseases that cause the immune system to inadvertently attack and damage the body. And although it hasn’t been proven, experts say the drug may have some role to play in stopping COVID-19 cases from becoming severe. Two: Both hydroxychloroquine and chloroquine have shown effectiveness against viral infections. In fact, multiple studies have noted hydroxychloroquine’s ability to smother and reduce HIV replication, and, notably, researchers have found chloroquine can actually suppress coronaviruses in cell cultures, inhibiting and limiting replication of the human coronavirus SARS-1, which emerged in 2002. Scientists believe this comes down to the anti-binding ability of chloroquine, specifically its effect on the binding capabilities of the ACE2 receptor on human cells, the entry point for not just the SARS virus, but also the COVID-19 virus. All of this pushed scientists to study the effects hydroxychloroquine and chloroquine have on SARS-CoV-2. And they were somewhat correct. Lab-based studies found that both have abilities to fight the COVID-19 coronavirus, triggering the FDA to approve emergency use of these two drugs on COVID-19 patients and many others to propose them as a preventative medication. But, and this is a major one, how a drug works against a virus in a lab is not the same as inside a human.
Schluger: Things could be inactivated by a variety of systems in the human body. They could turn out to be too toxic. They could turn out not to be able to achieve a high enough level in the blood to be active in human beings. So there’s a whole host of reasons why lots of things that work in test tubes don’t work in human beings.
Narrator: Crucially, Petri dishes don’t experience side effects, but humans do. For hydroxychloroquine, side effects can range from headaches, hair loss, and nausea to something a lot more dangerous.
Schluger: It’s one of a large number of drugs that can affect the electrical activity in the heart in a way that could make people susceptible to developing potentially very dangerous abnormalities of the heart rhythm that could be fatal.
Narrator: Person to person, these side effects vary dramatically, so it’s difficult to know how the drug would individually impact someone, which is why doctors have warned against immediate widespread use and individual use without medical advice first. Because of the FDA emergency approval, however, thousands of COVID-19 patients have taken hydroxychloroquine, which has led to large observational patient studies and some not-so-promising results, bringing us back to Dr. Neil Schluger and his colleagues.
Schluger: We saw no association between receiving the drug and a favourable outcome, or an unfavourable outcome, for that matter.
Narrator: And Schluger’s study wasn’t the only one to come to this conclusion.
Schluger: We analysed data from 1,376 patients. Just a few days after, a very similar analysis on a very similar number of patients was published in JAMA. Almost the identical results.
Narrator: In fact, hydroxychloroquine could actually be making things worse. A substantial study published in late May concluded that both hydroxychloroquine and chloroquine were associated with higher mortality among COVID-19 patients. And while a few small studies showed improvements when tested with humans, experts questioned the reliability of those studies’ methods.
Schluger: So, I think that’s sort of the state of things right now, that these large observational studies have found no evidence of benefit and perhaps some evidence of harm.
Narrator: As a result, the World Health Organisation halted its sizable randomised-trial use of hydroxychloroquine for COVID-19 patients. Still, this probably isn’t the last we’ll hear of the drug. A large-scale study testing the potential preventive effect of the drug is currently ongoing in the UK, and organisations and researchers are looking into other treatments, such as the drug remdesivir, which has shown promising potential in early stages. But those positive studies have not concluded that this is a cure for the disease. So as of late May 2020, there is no proven treatment for COVID-19.
Schluger: A lot of good ideas in medicine just don’t pan out. The only thing you can do is do the best studies and let the best drug win.
EDITOR’S NOTE: This video was originally published in June 2020.
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