The other day we wrote about a French study that showed the effectiveness of a combination of hydroxychloroquine (marketing name "Plaquenil") and azithromycin in the treatment of COVID -
on forty participants . 70% of patients at the Marseille Hospital-University Institute for Mediterranean Infections (IHU Méditerranée Infection) infected with SARS-CoV-2 and treated with these two drugs were shown in the tests on the sixth day of therapy Coronavirus positive negative results. The luck of French scientists made many happy. And after Ilon Musk and Donald Trump tweeted about hydroxychloroquine and azithromycin, interest in these two drugs has grown significantly around the world, people sweep them away in pharmacies, creating a shortage, and bombard search engines with queries like: "Hydroxychloroquine and azithromycin from coronavirus how to take a dosage" . In fact, so far everything is not very rosy, and there are no officially approved recommendations for doctors on prescribing these drugs for a new coronavirus infection (let alone take such serious drugs on your own, do not self-medicate). The work of French researchers met with well-reasoned criticism; The media also drew attention to a Chinese study of hydroxychloroquine, which showed a not so successful result.
The desire to try on COVID - 19 these drugs did not come from the ceiling . Hydroxychloroquine (a derivative of the older drug, chloroquine) is usually prescribed for the prevention and treatment of malaria, a disease caused by plasmodia spread by mosquitoes. Azithromycin (also known under the commercial name "Sumamed") is a broad-spectrum antibiotic of the azalide subclass. The properties of these drugs, which determine their initial, “direct” purpose, are fairly well understood. However, there is also some scientific evidence of certain antiviral and immunosuppressive properties. By virtue of the latter, hydroxychloroquine is particularly approved for the treatment of certain autoimmune diseases. Why can this be important in the treatment of COVID - ? Because one of the most serious complications of this infection may not be due to the direct action of the virus, but to an excessive reaction of the immune system to its presence in the body - the so-called hypercytokinemia, or cytokine storm. And there is some evidence that hydroxychloroquine inhibits the ability of cells to secrete cytokines, blocking this overreaction of the immune system. The use of azithromycin is primarily due to the need to combat the bacterial complications of a viral infection, but its likely antiviral activity was also kept in mind. It was assumed that the peculiar synergistic effect of the combination of these drugs would be very beneficial: viruses will be destroyed, and serious complications prevented or suppressed.
And, it seems, a study on forty patients confirmed all assumptions, proving that everything is so. But some experts don’t think so. In particular, they note that the study was not “double blinded,” that is, the doctors knew which patients received the real drugs and which did not, which could affect the objectivity of the perception of the results.
Dr. Gaetan Burgio, geneticist of infectious diseases from Australian National University (The Australian National University), noted on his Twitter that for the majority of patients in the control group the corresponding procedures were not conducted viral load division and only four of them had sufficient viral load for such a study.
Dr. Alfred Kim, rheumatologist researcher and director of the Lupus Clinic Washington University Lupus Clinic noted that six patients dropped out of the study. All from the group that received hydroxychloroquine. Among them, three were transferred to intensive care, one died, one left the hospital, and one stopped treatment due to nausea. Kim suggested that at least part of these six cases can be considered as failure of the drug in its work against the virus.
Bloomberg in a short note from 25 March also drew readers to a small a study by Shanghai scholars published in Chinese. These researchers divided the group of 25 patients with COVID - in a 1: 1 ratio and hydroxychloroquine was given to one subgroup, while the other received antiviral drugs included in the temporary recommendations for combating coronavirus infection (lopinavir and ritonavir), and antibiotics, if required. Both groups observed bed rest, received oxygen inhalation and standard hospital care. As a result, one patient from the group receiving hydroxychloroquine developed a severe form of the disease during treatment, and four patients from this group also had diarrhea and impaired liver function (versus three in the control group).
The German Heart Research Foundation (Deutsche Stiftung für Herzforschung) is also concerned about the notorious combination of hydroxychloroquine and azithromycin due to the statements of the American president. German cardiologists recall that each of these drugs can lead to malignant arrhythmias (ventricular fibrillation) and, in some cases, death. Which, according to Thomas Meinertz, a member of the scientific council of the German Heart Foundation, actually prohibits combination therapy using both of these drugs. “Only if the efficacy far outweighs the incidence of side effects, which could well be,” said Dr. Meinerz, “the clinical use of such therapy is warranted." In any case, this ratio should be checked in serious randomized trials in comparison with other drugs.
All this does not mean yet that hydroxychloroquine in itself or in combination with azithromycin, is not suitable for the treatment of COVID - 19. It does not mean the opposite. Two studies in small groups of patients are too few for unambiguous answers. We need tests on thousands of patients. And such tests will be carried out. WHO recently announced the start of large-scale studies for which it hires patients from Argentina, Iran, South Africa, France, Spain, the UK, Germany, Belgium, the Netherlands, Luxembourg and other countries. The most promising of the existing drugs will be tested. Including chloroquine and hydroxychloroquine, remdesevir, a combination of ritonavir and lopinavir, as well as the last two with interferon beta.
There is hope that the results of these multicenter large studies date the answers that the world is waiting for. In the meantime, you do not have to rush to the pharmacy for medicines that can be of no use, but can be harmful.