If the combination of hydroxychloroquine and azithromycin is confirmed by larger studies this actually could be “one of the biggest game-changers in the history of medicine”
During this worldwide COVID-19 pandemic, now that states such as California and New York have enacted ‘stay at home’ orders, universities and many school systems have closed, and many workers as possible are working from home, there are four ways this coronavirus nightmare can end, laid out nicely here.
- It wanes with the summer weather (unknown possibility)
- Everyone (or practically everyone) gets infected, so the virus has no new victims (horrible possibility)
- Development of a vaccine to confer protection (while Phase I in humans has started, perhaps 18 months away)
- Development of a new therapy, to provide protection and/or cure of an infected patient
Last week a good friend emailed me the above image, showing at day 5 (green bar) the percent of PCR-positive patients (there were a total of six of them in the study) went to 0% after 5 days, p-value = 0.002. Looking up a few links provided (reported last Wednesday in Forbes and in the subscription-only Medscape), it presents work from a French group headed by Prof. Didier Raolt of the IHU Méditerranée Infection in Marseille.
While the study was not randomized and the total number of treated with the combination or just hydrochlorquine alone is n=20 (Derek Lowe points to this tweet thread with the details on its weaknesses), these results are remarkable.
For those who want to see Dr. Raoult’s presentation (in French) he presents this work here on YouTube (it had 800K views when I first saw it last Thursday and now see it is now over 1M); he also published this paper a week prior as something of a prelude / introduction to the topic of feasibility of hydrochloroquine as an antiviral agent.
Here’s a great roundup of other therapies showing promise, although I haven’t seen dramatic results like these.
The paper explicitly states:
Further works (sic) are also warranted to determine if these compounds could be useful as chemoprophylaxis to prevent the transmission of the virus, especially for healthcare workers.
By chemoprophylaxis, they mean as a protective measure against infection by SARS-CoV-2.
Also last week right about the same time was this paper from a Chinese group in Cell Discovery showing anti-infective capability of SARS-CoV-2 in an in-vitro cell model.
Whatever the politics, the President of the United States has reason to be optimistic. While not approved for use by the FDA for treatment of SARS-CoV-2 infection, it can certainly fall under the umbrella of compassionate use, i.e. under humanitarian grounds, where no other treatment is available.
The beauty of two approved drugs is that they have been extensively studied, are already available and their contraindications and safety profile are well known.
On top of that, hydrochloroquine (first approved in 1955) is manufactured by no less than ten companies and being ahead of the curve, three days ago Teva Pharmaceuticals announced the donation of 6M doses to the US by March 31, with another 10M the following month. From what I’ve read, a monthly dose of 600mg per day wholesale cost is about $25. The other drug is azithromycin, a common antibiotic, costs wholesale $4 for a course of treatment.
While anecdotally I have already heard of front-line physicians self-prescribing hydroxychloroquine (trade name plaquenil) as a prophylactic, I am not a physician and would not recommend any individual to do so. However this is very exciting news that I thought was worth writing up. I am confident expanded studies are underway right now.