The debate regarding the anti-malaria drug hydroxychloroquine is in the spotlight again after President Donald Trump advertised the drug’s potential in Sunday’s White House briefing.
Trump interrupted Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, during a tense moment in the news conference when Fauci was asked by a reporter about the drug’s effectiveness in treating coronavirus patients.
The day before, Fauci and White House trade adviser Peter Navarro reportedly got in an argument over the drug during a task force meeting, according to Axios and the New York Times.
However, against the opinion of many public health experts, the White House has agreed to surge the supply of hydroxychloroquine to coronavirus hot zones.
Here’s a look at why there’s so much disagreement.
Why are Donald Trump and Peter Navarro pushing a malaria drug?
The Trump administration is citing small studies in China and France as scientific evidence that hydroxychloroquine helps treat COVID-19 patients.
The most recent study came from China and found that the anti-malaria drug helped speed the recovery of a small number of patients who were mildly or moderately ill, though notes that the evidence is limited. Authors of the report said that cough, fever and pneumonia went away faster and that patients’ illness were less likely to become severe.
The study comprised of 62 patients where half the subjects were given the usual care and the other half were given the usual care plus hydroxychloroquine.
They were treated for five days, and their fevers and cough were monitored. Pneumonia improved in 25 of the 31 patients who were given the drug versus 17 patients in the control group. However, authors concluded that more research is needed.
The was posted on medRxiv before it was accepted by the International Journal of Antimicrobial Agents with limited to no peer review.
Trump has also cited another small study from France of just a couple dozen patients that found that the drug, combined with common antibiotics, was effective in fighting COVID-19. A subsequent study of 80 patients in France found clinical improvement in all but one.
What we don’t know and why there’s resistance?
Many public health experts and researchers dub these small studies as anecdotal and not statistically significant enough to be considered scientific.
Some of these small studies don’t have control groups, don’t consider the stage of the patients’ illnesses and what they’ve done to get better outside the study. Other experts criticize the studies’ design and lack of information on drug side effects.
“We often see antiviral therapies (that are promising) in the test tube and animal models. But before we give it to patients with confidence, we really need to see the data in humans,” said Jeffrey Klausner, a professor of medicine and public health at the University of California-Los Angeles.
Not only are medical experts afraid of dispersing false hope in a drug that hasn’t been proven as a treatment, but they’re also concerned about its potential side effects especially in a combination with other drugs.
Raymond Woosley is a doctor and pharmacologist who formed a Food and Drug Administration-funded nonprofit two decades ago that tracks drug safety. Hydroxychloroquine, the related drug chloroquine, and the antibiotic azithromycin are among a group of about 60 drugs he said can cause subtle heart changes and increase a person’s risk of developing arrhythmia.
Though it rarely occurs, Woosley said, people can black out or die because of these drug-induced abnormalities.
“We definitely don’t want to harm people by using drugs that have known side effects in ways that we know are dangerous,” he said.
Beyond potential heart trouble, experts are afraid that advertising the drugs’ potential may encourage others to bypass doctors and use malaria drugs on their own as a preemptive strike against COVID-19.
In Phoenix, a couple in their 60s ingested chloroquine phosphate, commonly used to clean fish tanks. The unidentified man died and the woman was in critical condition.
Daniel Brooks, medical director of the Banner Poison and Drug Information Center, said people are trying to find ways to prevent COVID-19 but “self-medicating is not the way to go.”
“The last thing that we want right now is to inundate our emergency departments with patients who believe they found a vague and risky solution that could potentially jeopardize their health,” he said.
What does it do against malaria, other diseases?
According to the Centers for Disease Control and Prevention, hydroxychloroquine is an arthritis medicine that can also be used as a prevention or treatment of malaria. It’s available in the U.S. under prescription only.
In addition to malaria, choroquine and hydroxycholoquine are used to treat rheumatoid arthritis and lupus.
The Johns Hopkins Lupus Center said these drugs can help control lupus by “modulating the immune system without predisposing you to infection.” It can also protect against UV light and sometimes even improve skin lesions that don’t respond to ointments.
World Health Organization Director-General Tedros Adhanom Ghebreyesus warned untested drugs can provide false hope and cause a shortage of proven treatments needed for other disease.