The devil is in the details. Perhaps that’s one reason doctors and scientists take so much time rolling out new drugs and applications.
Being an expert doesn’t mean being perfect, but it sure does stack the odds in one’s favor.
Hydroxychloroquine Update For April 6
By Derek Lowe 6 April, 2020
There’s a lot of news to catch up on, and to keep things straight I’ll divide the hydroxychloroquine part out into this post, and cover others in the next one. My previous reviews of the clinical data in this area are here.
First up is this study from France. It’s another very small one, and all the usual warnings apply because of that. It’s from a team at the University of Paris and Saint-Louis Hospital there, and they evaluated 11 consecutive patients admitted there with the same course of treatment as the Marseilles group first reported (hydroxychloroquine 600mg/day and azithromycin, 500mg the first day and 250 mg/day thereafter). The mean age of their patients was 58.7 years, and (notably) 8 of the 11 had significant comorbidities (two obese, 5 with various forms of cancer, one with HIV). That’s a tough population, and unfortunately, the HCQ/AZ combination did nothing. One patient died (and two others went on to the ICU) and of the ten remaining, 8 were still positive for the virus by nasal swab on days 5/6 after treatment. One patient had to discontinue therapy on day 4 because of QT prolongation, a known side effect of hydroxychloroquine that can lead to fatal heart arrhythmia.
So while this is a small study and not a perfect match, it provides no evidence to show that the HCQ/AZ combination had any benefit at all. While we’re on the subject of QT prolongation …
Tim, I bet you’ll find this article fascinating:
Chloroquine, Past and Present
By Derek Lowe 20 March, 2020
Now that chloroquine is in the news everywhere, I thought it might be interesting to have a closer look at the compound. The first part of this post will be chemistry-heavy, further down we’ll get into the pharmacology and medical uses.
Chloroquine’s fame is as an antimalarial drug, and the history of antimalarials starts of course with quinine (at right). …
But it still can lead to depression and other effects. Hydroxychloroquine came along in the 1950s, and just has an extra OH group coming off of one of those N-ethyls over at the end of the chain; it’s quite similar to chloroquine itself.
You might wonder how an antiparasitical drug might do that, but the problem is that the mode of action of all these drugs against malaria parasites is still being argued over. And there are almost certainly several modes of action at work, which will go on to have different effects in different human tissues, etc. Both chloroquine and hydroxychloroquine are used off-label for rheumatoid arthritis and for lupus, but how they work in these areas is another shoulder-shrugger, and there are side effects in the eye. It’s been suggested as an adjunct in some cancer therapy regimes, but there are problems there, too, in the kidney. …
189 comments on “Chloroquine, Past and Present” (from looking at the first dozen or two, seems like a well moderated constructive comments section.)