In chloroquine’s shadow

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While a drug currently being tested in Rochester could hold out the best hope of immediately slowing COVID-19’s advance, its promise has largely been eclipsed by drugs that scientists see as far less likely candidates to spearhead the coronavirus campaign.

University of Rochester Medical Center researchers started local clinical trials of remdesivir last week. Similar studies are underway at 36 other U.S. sites. If those trials and some 30 more the National Institutes of Health hope to launch in coming weeks go well, the drug could be approved for general use by the end of April, predicts Angela Branche M.D., who along with Anne Falsey M.D. is one of two URMC researchers leading the local clinical trial.

As previously reported by the Rochester Beacon, researchers see remdesivir as a prime candidate to fight COVID-19 because of its effectiveness against the Ebola virus and two cousins of COVID-19, Middle Eastern Respiratory Syndrome and Severe Acute Respiratory Syndrome.

Despite remdesivir’s promise, far more attention has been focused on the antimalarial drugs chloroquine and hydroxychloroquine, which rose to sudden prominence after President Donald Trump promoted them in a March 19 press briefing. 

Still, there could be a hitch. 

Says Branche: “We’re not entirely sure they work.” 

Long known to be effective and approved by the U.S. Food and Drug Administration against malaria, chloroquine and hydroxychloroquine are also prescribed off-label to treat lupus and rheumatoid arthritis. They have had only scant testing as anti-COVID-19 drugs, however, and testing so far has not shown much promise.

“They have done some clinical trials in China and a very, very small trial in France,” Branche says. “Studies in the lab showed that it stops the virus from being able to attack cells.” 

Though the few tests of chloroquine’s effect on humans seemed to show the drug slowing the virus’s advance, it did not cure the disease.

In an answer to its own rhetorically posed question as to whether chloroquine or hydroxychloroquine should be used prophylactically against COVID-19, a March 27 Scientific American article definitively states: “Absolutely not. Chloroquine and hydroxychloroquine have not been appropriately evaluated in controlled studies, not to mention that they have numerous and, in some cases, very deadly side effects.”

Spurred by Trump’s touting of chloroquine and hydroxychloroquine, and his promise that the drugs are safe and that no one would die from them, a worried Arizona couple took a non-medical version of chloroquine sold as a fish-tank cleaner. Both were hospitalized, the Intercept reported in a March 24 article. The man died. 

“Viral infections like COVID-19 and parasitic infections like malaria are quite different and whatever limited success might have been observed with chloroquine or its relatives should be treated with great caution,” states the Scientific American article’s author, Katherine Seley-Radtke, a University of Maryland chemistry and biochemistry professor and president-elect of the International Society for Antiviral Research. 

Nevertheless, in the week following Trump’s touting of the antimalarial drugs, pharmacies and pharmaceutical suppliers saw a spike in chloroquine prescriptions sharp enough to cause shortages, the Washington Post reported on March 23. 

A day later, Pro Publica similarly reported that some doctors are hoarding chloroquine and writing possibly fraudulent chloroquine and hydroxychloroquine prescriptions for themselves, family members and friends. 

Citing an anonymous New York official as the source, the Washington Post reported last week that despite concerns over possible side effects including fatal heart arrhythmia and vision loss, New York is launching extensive testing of the antimalarial drugs.

No chloroquine or hydroxychloroquine trials are currently slated or contemplated in Rochester, URMC’s Branche says. However, she speculates that given the White House’s touting of the drugs, the NIH could authorize trials of the antimalarial drugs.

In the meantime, noted Scientific American author Seley-Radtke, in contrast to chloroquine’s and hydroxychloroquine’s highly problematic promise, “remdesivir, developed by Gilead Pharmaceuticals, seems to be highly effective at preventing viruses—including coronaviruses such as SARS and MERS, and filoviruses such as Ebola—from replicating.”

Will Astor is Rochester Beacon senior writer. All Rochester Beacon coronavirus articles are collected here.

5 thoughts on “In chloroquine’s shadow

  1. I’ve seen and heard in many different media reports of many cases of success. In addition, chloroquine is readily available in most states over the counter. That’s the best and quickest option right now. A recent study by National Academy of Science, Stanford university, etc are advocates of chloroquine’s effectiveness in dealing with covid-19.

  2. The national news has not said that chloroquine is the best option that I’ve heard. Where did this info come from?

  3. Of course we’re all pulling for remdesivir. to be the saviour against the Wuhan COVID-19 virus. However, right now chloroquine is the best option and it should be heavily publicized because it’s effective. To use the anomaly of the fish tank story to make a point was weak.

  4. Rochester Beacon is fact driven and that is exactly what we are missing from some of the sycophantic daily broadcasts from the White House. There are no good reasons for half truths in this situation.

    Thanks to you and the e-publication.

  5. I belong to an on-line group for Covid-19 critical care health providers from the US and around the world. The general consensus from comments has been chloroquine and hydroxychloroquine do not seem to have clinical efficacy and, if used, it’s as a last ditch effort in intubated patients who have low chance for recovery. This is the danger of news getting out there with little scientific veracity.

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