Continue hydroxychloroquine as preventive therapy against Covid-19: ICMR

While a global debate rages around the efficacy and safety of hydroxychloroquine (HCQ) as a preventive therapy against coronavirus, India’s apex health research body, the Indian Council of Medical Research (ICMR), has found that consuming HCQ reduces the chances of getting infected with Covid-19.

The conclusion has been drawn after three studies by the ICMR, and as result, it issued an advisory to expand the use of HCQ as a preventive therapy.

The joint monitoring group, under the chairmanship of Director General of Health Services (DGHS), and including representatives from the All India Institute of Medical Sciences (AIIMS), ICMR, National Centre for Disease Control (NCDC), National Disaster Management Authority (NDMA), World Health Organization (WHO) and experts drawn from Central government hospitals, reviewed the prophylactic use of HCQ in the context of expanding it to health care and other frontline workers deployed in non-Covid and Covid areas, respectively.

The drug would now be administered as a preventive therapy to asymptomatic health care workers in both Covid as well as non-Covid blocks of hospitals dedicated to Covid-19 treatment. Even surveillance workers in containment zones, paramilitary and police personnel involved in Covid-19 activities will be given the oral pill.

So far, only high-risk individuals, including asymptomatic health care workers, were given the drug along with household contacts of Covid patients. This will continue.

ICMR undertook investigation at three Central government hospitals in New Delhi, which showed that among health care workers involved in Covid-19 care, those on HCQ prophylaxis were less likely to develop the coronavirus infection compared to those who were not on it.

 

In its advisory, the ICMR stated that the National Institute of Virology, Pune, found that HCQ reduces the viral load of Covid-19 in laboratory studies. Further, an observational study on 334 health care workers at AIIMS showed that 248 of them, who took HCQ as a preventive drug for an average of six weeks, had lower incidence of the infection compared to those who did not.

ICMR also said that it analysed previously collected data (retrospective case control analysis). It found that there was a significant relationship between “the number of doses taken and frequency of occurrence of Covid-19 infection in symptomatic health care workers who were tested for the infection”.

As for the safety profile of HCQ, ICMR said that some mild adverse effects like nausea (8.9 per cent), abdominal pain (7.3 per cent), vomiting (1.5 per cent), hypoglycemia or low blood sugar levels (1.7 per cent) and cardiovascular effects (1.9 per cent) have been observed. "There have been 214 reported instances of adverse drug reactions associated with prophylactic HCQ use," it said. 

Thus, the advisory says that the drug should be discontinued if it causes 'rare' side-effects, especially related to the heart. In rare cases, the drug can also cause blurring of vision. Therefore, the drug has to be administered under medical supervision with an informed consent.

Fact Sheet
 

• Medical journal The Lancet said it found links between use of HCQ and heart ailments in Covid-19 patients
• Study published in The Lancet said that drug should not be used to treat Covid-19 outside of clinical trials
• US President Donald Trump has been a vocal supporter of HCQ
• ICMR advised use of HCQ as preventive therapy for high-risk individuals

Dosage:
 

• Asymptomatic household contacts: 400 mg twice a day on Day 1 and 400 mg/week for 3 weeks
• Asymptomatic health care and front-line workers: 400 mg twice a day on Day 1 and 400 mg/week for 7 weeks

Drug not to be used in case of:
 

• Retinopathy
• Hypersensitivity to HCQ
• G6PD deficiency*
• Cardiomyopathy
• Cardiac rhythm disorders
• Children below 15 years
• Pregnant and lactating women

*A condition causing red blood cells to break down in response to certain medication, infections or other stresses