- As the coronavirus pandemic rages on, some drugs are showing promise in treating patients with COVID-19, the disease caused by the novel coronavirus.
- There are no approved treatments or vaccines for COVID-19, but researchers are testing a slew of existing drugs to see if they could work.
- One of those drugs is called chloroquine, a widely used anti-malaria pill that was first approved in the US in 1949.
- Countries including China, South Korea, and Belgium have added it to COVID-19 treatment guidelines as anecdotal reports have suggested that it might work.
- There is no peer-reviewed clinical data showing that chloroquine works against COVID-19. But that hasn't stopped doctors from using it or US prescriptions from spiking. Even President Donald Trump and Tesla CEO Elon Musk have touted its potential.
- Visit Business Insider's homepage for more stories.
In the scramble to find drugs to treat COVID-19, the illness caused by the novel coronavirus, one drug has rapidly gained the public's attention, despite a little evidence showing it works.
The drug is chloroquine, an anti-malaria pill that was first approved in the US in 1949. A much more widely prescribed version called hydroxychloroquine is also being tested against the virus. Early laboratory research and anecdotal reports about using it for people with COVID-19 have shown encouraging signs that it may work to fight the virus.
As dozens of drug companies rush into research projects to develop antibodies and other next-generation therapeutics, chloroquine stands out as a potentially simple, cheap, and scalable treatment, though we haven't yet seen data from any randomized clinical trials, the gold standard of medical research.
"If clinical data confirm the biological results, the novel coronavirus-associated disease will have become one of the simplest and cheapest to treat and prevent among infectious respiratory diseases," a group of French researchers wrote in a paper published on February 15 in the International Journal of Antimicrobial Agents.
One of the three authors of that article was Didier Raoult, a prominent infectious-disease expert who ran a small clinical trial in France testing hydroxychloroquine in a few dozen COVID-19 patients. It's one of many clinical studies around the world testing chloroquine or hydroxychloroquine.
Early reports of Raoult's trial were positive, with Raoult saying chloroquine appeared to shorten the time that people with COVID-19 are infectious.
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When combined with the antibiotic azithromycin, it also reduced the viral load in these patients, he added. Azithromycin helps fight lung infections that can come with COVID-19 and may play a role in fighting the virus, Medscape reported.
This French study is one small, low-quality study that needs to be replicated on a larger scale. It tested a very small group with no long-term follow up data, and six patients dropped out early and were excluded from the main analysis. The French goverment is expanding this testing to see if the results hold up.
Adding to that skepticism, another tiny trial of 30 COVID-19 patients in China published on March 24 showed no difference between hydroxychloroquine and placebo.
While experts caution against anyone reaching conclusions about the drug's utility in COVID-19, President Donald Trump has repeatedly touted chloroquine by name as a promising potential treatment. On Thursday, US Food and Drug Administration Commissioner Stephen Hahn said chloroquine and hydroxycholoroquine will be made available to patients under a compassionate-use program as more data is collected.
Compassionate-use programs are generally for terminally ill patients who have no other treatment options. They allow doctors to give patients treatments that have not proven to be safe and effective.
Hydroxychloroquine isn't a benign drug either. It can cause severe side effects if not taken properly, including vision loss, low blood sugar, and heart problems. A 2018 review article also cautioned hydroxychloroquine can cause neurological side effects for some, with the frequency unknown of serious complications like psychosis and suicidal tendencies.
Self-medicating can be fatal. An Arizona man died after deciding to take a non-pharmaceutical version of chloroquine used to clean fish tanks.
Chloroquine is now a leading experimental treatment for COVID-19
Steven Seedhouse, a biotech analyst at Raymond James, said chloroquine was just as promising as any treatment option for COVID-19. That includes remdesivir, an antiviral drug being developed by the giant biotech company Gilead Sciences that World Health Organization officials have called "the most promising candidate" for COVID-19 treatment.
He recently analyzed the early evidence for three top drugs being tested for COVID-19 — remdesivir, chloroquine, and Kaletra, an HIV drug sold by AbbVie — and concluded that chloroquine was the most promising candidate.
"If we had to pick one of the three at this point that actually seems most likely to have the biggest impact on treating COVID-19 in the coming months/years, it would be chloroquine," he said.
Early reports about chloroquine's effectiveness have also caught the attention of Elon Musk. The Tesla CEO tweeted on Monday that it might be worth considering chloroquine for COVID-19, saying the drug saved his life when he faced a serious case of malaria.
—Elon Musk (@elonmusk) March 16, 2020
Repurposed antiviral drugs aren't likely to be cure-alls, but they are the only near-term treatment options. It will take months, if not years, to determine whether a new drug or vaccine is safe and effective.
Vaccines in particular are seen as the gold standard for infectious diseases because they protect people from infections in the first place.
But if drugs like chloroquine and remdesivir work, they could bring major relief to healthcare systems around the world that are feeling the weight of a pandemic.
In the US, there are widespread concerns about the likelihood that hospitals will run out of beds and ventilators as the virus spreads, forcing doctors into difficult rationing decisions. That's already happening in Italy.
Remdesivir, given as a 10-day intravenous infusion, could shorten hospital stays and lower ventilator use if it can help patients with serious COVID-19 cases recover faster.
Chloroquine is being tested to treat COVID-19 and prevent people from catching it
As a simple pill, chloroquine could prevent some COVID-19 patients from worsening to the point of needing hospitalization. But there is no high-quality clinical data showing if it works to halt COVID-19.
Seedhouse said that even in the face of a pandemic, it is essential to stick to evidence-based approaches.
"All we have is some preclinical rationale and some mechanistic rationale, but no hard randomized clinical data yet," Seedhouse said. "I think it's appropriate to be cautious on chloroquine and anything else."
Bigger, higher quality trials are now gearing up, including an NYC-based trial planning to test 1,600 people who live with someone diagnosed with COVID-19. Those researchers are testing to see if hydroxychloroquine works in people at high risk of infection compared to a placebo treatment.
There's also randomized controlled trials in Mexico testing both 500 COVID-19 patients with severe respiratory disease as well as 400 healthcare workers as a prophylaxis treatment.
Researchers also plan to test chloroquine to see whether it can help prevent healthcare workers from getting the virus in the first place.
US prescriptions are spiking, straining the supply of the medicine
While peer-reviewed results are the standard in medicine, the lack of that data hasn't prevented the world from acting.
China has found that chloroquine is effective against COVID-19, the state-owned Xinhua news agency reported on February 17. Countries including China, South Korea, and Belgium have added chloroquine to their treatment guidelines.
US physicians don't appear to be waiting for data either. Prescriptions for chloroquine and hydroxychloroquine have skyrocketed, straining the supply chain.
Doctors in the US have broad authority to prescribe approved medications for so-called off-label uses, or conditions that the drug isn't approved to treat.
Early reports of success 'should be taken seriously'
Andrea Savarino is an Italian scientist who has worked at the Italian National Institute of Health, the country's top medical research body, since 2006. He has been studying chloroquine and its potential uses for even longer than that, starting as a virologist in 1994.
During the 2003 outbreak of SARS — also a coronavirus — Savarino showed in laboratory research that chloroquine may be a useful weapon against it. But by the time his research was published in The Lancet in November 2003, the outbreak had dissipated and there were no human cases available to test.
"There has been a number of press releases, unfortunately not yet papers, but even the local experiments are things that should be taken seriously," Savarino told Business Insider. "Chloroquine plus the HIV inhibitors has produced interesting results, at least curative results, both in China and Australia."
In Australia, researchers at the University of Queensland have said a combination of chloroquine and Kaletra led to the recovery of some of the first COVID-19 patients in Australia.
"It's a potentially effective treatment," David Paterson, the director of the university's Centre for Clinical Research, told the Australian news site News.com.au.
Savarino said he had heard anecdotal accounts from other countries as well, including Japan, India, and Thailand.
"Given these promising results, I am of course optimistic, but I cannot give percentages of success as of now," Savarino said. He emphasized the need to collect more data before reaching conclusions.
Savarino said he was developing an online platform to collect hydroxychloroquine data on COVID-19 patients across Italy and eventually other countries. He said he hoped to get the site going in the next few days and would make the data widely available as soon as possible.
Ultimately, Savarino thinks a combination of two or three drugs will be found to be the most effective treatment for COVID-19, like how therapies using multiple drugs have become the standard for treating HIV, he said.
"""Kama janga la coronavirus linavyoendelea, dawa zingine zinaonyesha ahadi katika kutibu wagonjwa wa COVID-19, ugonjwa unaosababishwa na coronavirus mpya." Hakuna matibabu au chanjo zilizokubaliwa kwa COVID-19, lakini watafiti wanajaribu dawa nyingi zilizopo ili kuona ikiwa zinaweza kufanya kazi. Chlorine ni dawa ya kupambana na malaria iliyotumiwa sana nchini Marekani mwaka 1949. Nchi kama vile China, Korea Kusini na Ubelgiji zimeongeza dawa hiyo katika miongozo ya matibabu ya COVID-19 kwa sababu ripoti za kihistoria zimedokeza kwamba inaweza kufanya kazi. Hakuna data ya kliniki iliyochunguzwa na wenzao inayoonyesha kwamba chloroquine inafanya kazi dhidi ya COVID-19. Lakini hilo halijawazuia madaktari kuitumia au dawa za Marekani kutoka kwa spiking. Hata Rais Donald Trump na Mkurugenzi Mtendaji wa Tesla Elon Musk wametangaza uwezo wake. - Tembelea ukurasa wa nyumbani wa Business Insider kwa hadithi zaidi. Katika jitihada za kutafuta dawa za kutibu COVID-19, ugonjwa unaosababishwa na virusi vya corona, dawa moja imevutia umma kwa haraka, licha ya ushahidi mdogo unaoonyesha inafanya kazi. Dawa ya Cloroquine, ambayo ni dawa ya kupambana na malaria, ilianzishwa mnamo mwaka wa 1949. Toleo linaloagizwa sana linaloitwa hydroxychloroquine pia linajaribiwa dhidi ya virusi hivyo. Utafiti wa awali wa maabara na ripoti za anecdotal kuhusu matumizi yake kwa watu walio na COVID-19 zimeonyesha ishara za kutia moyo kwamba inaweza kufanya kazi kupambana na virusi. "Kama makampuni ya dawa ya kuvutia katika miradi ya utafiti ya kuendeleza antibodies na matibabu mengine ya kizazi kijacho, chloroquine inaonekana kama matibabu rahisi, ya bei nafuu, na scalable, ingawa bado hatujaona data kutoka kwa majaribio yoyote randomized kliniki, ""kiwango cha dhahabu cha utafiti wa matibabu.""" "Ikiwa data za kliniki zitathibitisha matokeo ya kibiolojia, ugonjwa mpya unaohusiana na coronavirus utakuwa moja ya rahisi na ya bei nafuu kutibu na kuzuia kati ya magonjwa ya kupumua ya kuambukiza, ""kikundi cha watafiti wa Ufaransa waliandika katika karatasi iliyochapishwa Februari 15 katika Jarida la Kimataifa la Wakala wa Antimicrobial." Mmoja wa waandishi watatu wa makala hiyo alikuwa Didier Raoult, mtaalamu mashuhuri wa magonjwa ya kuambukiza ambaye aliendesha jaribio dogo la kliniki nchini Ufaransa kujaribu hydroxychloroquine kwa wagonjwa kadhaa wa COVID-19. Utafiti huo unajumuisha utafiti wa kliniki wa kwanza wa klorokini au hydroxychloroquine. "Raoult alisema kuwa ""chloroquine inaonekana kupunguza muda ambao watu walio na COVID-19 ni wa kuambukiza.""" Kamwe usikose habari za huduma za afya. Jisajili Dispensed, jarida la kila wiki la Business Insider juu ya dawa, biotech, na huduma za afya. Wakati uliunganishwa na antibiotic azithromycin, pia ilipunguza mzigo wa virusi katika wagonjwa hawa, aliongeza. Azithromycin husaidia kupambana na maambukizi ya mapafu ambayo yanaweza kuja na COVID-19 na inaweza kuwa na jukumu katika kupambana na virusi, Medscape iliripoti. Utafiti huu wa Kifaransa ni utafiti mmoja mdogo, wa ubora wa chini ambao unahitaji kuiga kwa kiwango kikubwa. Utafiti huo ulijumuisha kikundi kidogo sana bila data ya kufuatilia kwa muda mrefu, na wagonjwa sita waliondoka mapema na kutengwa kutoka kwa uchambuzi kuu. Serikali ya Ufaransa inaongeza majaribio haya ili kuona ikiwa matokeo yanaendelea. Kwa kuongezea shaka hiyo, jaribio jingine dogo la wagonjwa 30 wa COVID-19 nchini China lililochapishwa mnamo Machi 24 halikuonyesha tofauti kati ya hydroxychloroquine na placebo. Wakati wataalamu wanahoji dhidi ya mtu yeyote kufikia hitimisho juu ya matumizi ya dawa hiyo katika COVID-19, Rais Donald Trump amekuwa akitangaza mara kwa mara chloroquine kwa jina kama matibabu ya uwezekano wa kuahidi. "Kama ilivyotangazwa na Kamishna wa Idara ya Chakula na Dawa ya Marekani, Stephen Hahn, ""Hidroksi-Klorokina na chloroquine zitapatikana kwa wagonjwa chini ya mpango wa matumizi ya huruma"" baada ya data zaidi kukusanywa." Kwa kawaida programu za kutumia dawa kwa huruma hutumiwa kwa wagonjwa wasioweza kupona ambao hawana njia nyingine za matibabu. Hizo huruhusu madaktari kuwapa wagonjwa matibabu ambayo hayajaonekana kuwa salama na yenye matokeo. Hydroxychloroquine si dawa mbaya pia. Inaweza kusababisha athari mbaya za upande ikiwa haichukuliwe kwa usahihi, ikiwa ni pamoja na kupoteza maono, sukari ya chini ya damu, na matatizo ya moyo. "Kulingana na ripoti ya utafiti wa mwaka 2018, hydroxychloroquine inaweza kusababisha athari za neva kwa baadhi ya watu, na ""frequency haijulikani"" ya matatizo makubwa kama vile psychosis na mwelekeo wa kujiua." Kujitunza kwaweza kuwa na matokeo mabaya. Mwanamume mmoja wa Arizona amefariki baada ya kuamua kutumia dawa ya chloroquine inayotumiwa kusafisha mabwawa ya samaki. Chloroquine sasa ni tiba inayoongoza ya majaribio ya COVID-19 Steven Seedhouse, mchambuzi wa biotech katika Raymond James, alisema chloroquine ilikuwa kama matumaini kama chaguo lolote la matibabu kwa COVID-19. "Remdesivir ni dawa ya kupambana na virusi inayotengenezwa na kampuni kubwa ya teknolojia ya kibiolojia ya Gilead Sciences, ambayo maafisa wa Shirika la Afya Ulimwenguni wameiita ""mchaguliwa wa kuahidi zaidi"" kwa matibabu ya COVID-19." Hivi karibuni alichambua ushahidi wa mapema wa dawa tatu za juu zinazochunguzwa kwa COVID-19 - remdesivir, chloroquine, na Kaletra, dawa ya HIV inayouzwa na AbbVie - na kuhitimisha kuwa chloroquine ilikuwa mgombea wa kuahidi zaidi. """Ikiwa tunapaswa kuchagua moja kati ya tatu kwa wakati huu ambayo kwa kweli inaonekana kuwa na athari kubwa zaidi kwa kutibu COVID-19 katika miezi au miaka ijayo, itakuwa chloroquine,"" alisema." Ripoti za mapema kuhusu ufanisi wa chloroquine pia zimemvutia Elon Musk. Mkurugenzi Mtendaji wa Tesla aliandika kwenye Twitter Jumatatu kwamba inaweza kuwa na thamani ya kuzingatia chloroquine kwa COVID-19, akisema dawa hiyo iliokoa maisha yake wakati alikabiliwa na kesi kubwa ya malaria. Elon Musk: Dawa za kupambana na virusi hazina uwezekano wa kuwa tiba ya kila kitu, lakini ni chaguzi pekee za matibabu ya muda mfupi "Itachukua miezi, au hata miaka, kuamua kama dawa mpya au chanjo ni salama na yenye ufanisi.""" Chanjo ni moja ya njia bora za kuzuia magonjwa ya kuambukiza, kwa sababu ni njia ya kwanza ya kuwalinda watu. "Lakini ikiwa dawa kama vile chloroquine na remdesivir zinafanya kazi, zinaweza kuleta misaada kubwa kwa mifumo ya huduma za afya ulimwenguni kote ambayo inahisi uzito wa janga hilo. """ Katika nchi hiyo, kuna wasiwasi mkubwa kuhusu uwezekano wa hospitali kukosa vitanda na vifaa vya kupumua kwa sababu ya kuenea kwa virusi, na hivyo kuwafanya madaktari kufanya maamuzi magumu ya kugawa chakula. Hilo tayari linafanyika nchini Italia. Remdesivir, inayotolewa kama infusion ya ndani ya mshipa wa siku 10, inaweza kufupisha kukaa hospitalini na kupunguza matumizi ya mashine ya kupumua ikiwa inaweza kusaidia wagonjwa wenye kesi kali za COVID-19 kupona haraka. Chloroquine inapatikana kwa ajili ya matibabu ya COVID-19 na kuzuia watu kuambukizwa kama dawa rahisi, inaweza kuzuia baadhi ya wagonjwa wa COVID-19 kutoka kuwa mbaya hadi hatua ya kuhitaji kulazwa hospitalini. Hata hivyo, hakuna data ya kliniki ya ubora wa juu inayoonyesha ikiwa inafanya kazi kuzuia COVID-19. Seedhouse alisema kwamba hata katika hali ya janga, ni muhimu kushikamana na mbinu zinazotegemea ushahidi. "Tuna tu baadhi ya pre-kliniki nadharia na baadhi ya nadharia mechanistic, lakini hakuna data ngumu randomized kliniki bado", Seedhouse alisema. "Nafikiri ni jambo la kufaa kuwa mwangalifu juu ya chloroquine na chochote kingine". Majaribio makubwa zaidi na ya ubora zaidi sasa yanajitayarisha, ikiwa ni pamoja na jaribio la msingi la NYC, ambalo linapanga kupima watu 1,600 ambao wanaishi na mtu aliyegunduliwa na COVID-19. Watafiti hao wanajaribu kuona ikiwa hydroxychloroquine inafanya kazi kwa watu walio na hatari kubwa ya maambukizi ikilinganishwa na matibabu ya placebo. Majaribio ya randomized na kudhibitiwa ya COVID-19 ya wagonjwa 500 na wagonjwa 400 wa afya ya afya nchini Mexico yanaonyesha kuwa kuna uwezekano wa kuambukizwa. Watafiti pia wanapanga kujaribu chloroquine ili kuona ikiwa inaweza kusaidia kuzuia wafanyikazi wa huduma za afya kupata virusi hapo awali. """Utekelezaji wa dawa za kulevya unaongezeka, na kusababisha usambazaji wa dawa, wakati matokeo ya ukaguzi wa wenzao ni kiwango katika dawa, ukosefu wa data hiyo haujazuia ulimwengu kuchukua hatua." China imegundua kuwa klorokini ni bora dhidi ya COVID-19, shirika la habari la serikali la Xinhua liliripoti Februari 17. Nchi kama vile China, Korea Kusini, na Ubelgiji zimeongeza chloroquine katika miongozo yao ya matibabu. Wataalamu wa afya wa Marekani pia hawajaanza kusubiri taarifa. Maagizo ya dawa za klorokini na hidroksiklorokini yameongezeka sana, na hivyo kusababisha mkazo katika mlolongo wa ugavi. "Daktari wa Marekani wana mamlaka ya kuagiza dawa zilizokubaliwa kwa matumizi ya ""off-label"" au hali ambazo dawa haikubaliwi kutibu." "Kama ilivyoelezwa hapo juu, ""Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti." Chloroquine imekuwa ikitumiwa kwa muda mrefu zaidi ya miaka miwili tangu mwaka 1994 wakati alipokuwa mtaalamu wa virusi. Wakati wa mlipuko wa SARS - pia coronavirus - Savarino alionyesha katika utafiti wa maabara kwamba chloroquine inaweza kuwa silaha muhimu dhidi yake. Hata hivyo, wakati utafiti huo ulipochapishwa katika jarida la The Lancet mnamo Novemba 2003, ugonjwa huo ulikuwa umepungua na hakukuwa na kesi za binadamu zilizopatikana kwa ajili ya kupima. "Kuna taarifa kadhaa za vyombo vya habari, kwa bahati mbaya bado si karatasi, lakini hata majaribio ya ndani ni mambo ambayo yanapaswa kuchukuliwa kwa uzito, ""Savarino aliiambia Business Insider." "Chloroquine pamoja na dawa za kuzuia UKIMWI zimetokeza matokeo yenye kupendeza, angalau matokeo ya kuponya, katika China na Australia". Watafiti wa Chuo Kikuu cha Queensland nchini Australia wamesema mchanganyiko wa klorokini na kaletra umesababisha kupona kwa baadhi ya wagonjwa wa kwanza wa COVID-19 nchini Australia. "Hiyo ni matibabu yenye ufanisi,"" David Paterson, mkurugenzi wa Kituo cha Utafiti wa Kliniki cha chuo kikuu hicho, aliliambia tovuti ya habari ya Australia News.com.au." Savarino alisema kwamba alikuwa amesikia hadithi za hadithi kutoka nchi nyingine pia, kutia ndani Japani, India, na Thailand. "Kwa kuzingatia matokeo haya ya kuahidi, bila shaka nina matumaini, lakini siwezi kutoa asilimia ya mafanikio kwa sasa", Savarino alisema. Alisisitiza uhitaji wa kukusanya data zaidi kabla ya kufikia hitimisho. Savarino alisema kuwa alikuwa akitengeneza jukwaa la mtandaoni kukusanya data ya hydroxychloroquine juu ya wagonjwa wa COVID-19 kote Italia na hatimaye nchi zingine. Alisema anatarajia kuanzisha tovuti hiyo katika siku chache zijazo na atafanya data hiyo ipatikane kwa wingi haraka iwezekanavyo. Savarino anasema mchanganyiko wa dawa mbili au tatu utapatikana kuwa matibabu bora zaidi ya COVID-19, kama vile tiba za kutumia dawa nyingi zimekuwa kiwango cha matibabu ya UKIMWI.