|Year : 2022 | Volume
| Issue : 2 | Page : 19-20
Evolving pharmacotherapeutics for the Covid-19 pandemic
Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India
|Date of Submission||06-Mar-2022|
|Date of Decision||16-Mar-2022|
|Date of Acceptance||17-Mar-2022|
|Date of Web Publication||20-May-2022|
Dr. Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta H. Evolving pharmacotherapeutics for the Covid-19 pandemic. J Prim Care Spec 2022;3:19-20
“In the race against COVID-19 none of us cross the finish line until we all do.”
– Dr. Soumya Swaminathan, Chief Scientist, World Health Organization, October 21, 2021
The world has been reeling under a novel coronavirus pandemic for more than 2 years. When cases increase in an area and its transmission becomes rampant among people due to some causes; images of patients getting treated in hospital lobbies, corridors, makeshift buildings, or even parking lots become routine/desensitizing ones making us numb and put a question mark on our collective ability to provide optimum care to everyone around. When the mutant virus raises its ugly head in a geography, ICUs get filled with respiratory disease patients and routine care too gets disrupted – leading to breakdown of the system in a way we have never seen in our living memory. The pandemic affects not only those in the grip of coronavirus but also those who want to visit a facility otherwise to get a medical expert's opinion.
Nevertheless, scientific community too responded with guts, launched clinical trials of several drugs rapidly so that at least a few hit the target and soon. Under these pressing conditions, trialists looked for the use of the immunomodulatory drugs in the treatment or prophylaxis against the viral infection. As we faced sudden challenges when the number of patients phenomenally started to overwhelm the healthcare system, our reply too was hurried and then all the decisions may not be found to be correct when we review them in retrospect.
Bhatia et al. have reviewed the use of chloroquine and hydroxychloroquine (HCQ) in COVID-19 patients in their article published on March 3, 2022, in the Journal. If we look at its background, we find that in the early spring of 2020, when European, and later on American, hospitals started to overflow with patients, several drugs were suggested to provide some relief. It should be remembered that although some regulatory bodies sent alarms about consumption of the drugs, desperate patients – sometimes hoping against hope for some miracle – were trying these untested medicines when results of the trials were still (then) not out publicly.
A graph on this BBC Reality Check article shows how the number of prescriptions of HCQ soared then, which derives its data from US insurance claims. Then, safety fears led to some fall in its sales, but later on, that was found to be fake. Simultaneously, the World Health Organization launched its Solidarity Trial for assessing effectiveness of repurposed antiviral drugs – which included the HCQ. Its interim results appeared in February 2021, and the immunomodulatory drug was not found to be effective against the SARS-CoV-2. Hence, after publication of this trial result, the drug went out of favor of scientific community.
The authors mention the tablet strength of chloroquine phosphate as 500 mg. Further, they specify its toxic effects therein. What we need to recall is that due to this pharmacodynamics, we need to calculate its dose carefully considering various factors – which include bodyweight of the patient. For this reason, the tablet is also available in a strength of 250 mg.
I also want to mention here that when a critically ill patient is brought to our hospital who is unconscious or cannot consume an oral drug, we give him/her parenteral chloroquine, if indicated. Therefore, the authors should underscore that pharmacokinetics they highlight in the article belong to oral formulation alone.
The authors specify that several patients of COVID-19 may develop arrhythmia while describing its clinical symptoms. Here, I want to underline that the rhythm disorder has been described with several viral infections, including those causing viral myocarditis. Furthermore, besides directly stimulating the cardiac muscles; hypoxia, electrolyte abnormalities, comorbidities – including diabetes and hypertension, medications to control these biochemical abnormalities, and inflammatory syndrome may be the risk factors for the development of abnormal rhythm. We need to probe all these factors depending upon case scenario of the patients so as to make an accurate diagnosis.
When a new disease appears on the world – stage, and suddenly starts to kill and maim a large number of subjects – generating fear in our collective psyche – its imperative to rapidly find a treatment to reduce human suffering is desired. However, as the process sometimes may be less than perfect, occasionally, final results of a drug trial may be contradictory to initial hypothesis and discovered benefits – which are initially hyped and may be found to be modest at the most. Meanwhile, some unscrupulous elements appear on the horizon to earn quick bucks and muddle the water. Our job should be to make a distinction between genuine lack of knowledge at a particular point in time, leading to committing honest mistakes in good faith versus those trying to profiteer from the situation, reeking of adulterated enterprise having sole motto of milking the system to grab a larger pie – sometimes putting patients at a loss.
It is necessary to segregate the situation as science by design progresses by trial-and-error method, whereas greed knows no rules or boundaries since the beginning. While at the initial stages, our endeavor was to get some drug helping us to improve chances of survival; at the same time, some sections of community were out trying to earn dividends when we knew little about the novel virus. Besides use of corticosteroids in severe COVID and oxygen to keep saturation up to 94, all the other drugs for all the other indications continue to generate intense debate having different points of view. We should learn that in this saga, HCQ is not alone.
| References|| |
Bhatia A, Bains SK, Tajinder B, Kuldeep SS, Jaideepa. Use of chloroquine and hydroxychloroquine in COVID-19 patients: A dilemma. J Prim Care Spec 2022;3:3-7. [Full text]
Goodman J, Giles C. Coronavirus and Hydroxychloroquine: What do We Know? BBC Reality Check; July 27, 2020. Available from: https://www.bbc.com/news/51980731
. [Last accessed on 2022 Mar 06].
Ledford H. Safety fears over drug hyped to treat the coronavirus spark global confusion. Nature 2020;582:18-9.
WHO Solidarity Trial Consortium; Pan H, Peto R, Henao-Restrepo AM, Preziosi MP, Sathiyamoorthy V, et al.
Repurposed antiviral drugs for COVID-19 – Interim WHO solidarity trial results. N Engl J Med 2021;384:497-511.
White NJ, Watt G, Bergqvist Y, Njelesani EK. Parenteral chloroquine for treating falciparum malaria. J Infect Dis 1987;155:192-201.
Babapoor-Farrokhran S, Rasekhi RT, Gill D, Babapoor S, Amanullah A. Arrhythmia in COVID-19. SN Compr Clin Med 2020;2:1430-5.
Brophy JM. Molnupiravir's authorisation was premature. BMJ 2022;376:o443.