Hydroxychloroquine, an Anti-rheumatic and Anti-malarial medicine is proposed by ICMR for treating and preventing Corona. Knowing this there is a risk that many normal people might start taking HCQ and if inappropriate doses are taken it might lead to several medical complications. Hence, at present this is recommended only for frontline health care workers who have high risk of getting COVID-19. That too after thorough evaluation. This is not for everyone and not at all for children at the given moment. India is one of the world leaders in HCQ production. We have supplied to USA and many other countries.

 

Here are the excerpts from the interview with Dr. Raj Kiran, MD

 

Q) Many patients are taking HCQ since many years for diseases like Rheumatoid arthritis and lupus, are they protected from COVID-19?

 

A) Patients suffering with Rheumatic disease can have low immunity by virtue of their disease or because of the anti-rheumatic medicine what they are using. So actually they carry high risk of getting infection and many lupus patients actually die due to infections. They have to be more careful and take all precautions to prevent infections.

 

Global COVID - Rheumatology alliance is looking into this data. They are collecting data of all rheumatic disease patients and carefully observing patients who are on HCQ.  Till now there was no major casualties reported in those patients. Diabetic, BP and cardiac, obese patients are found to have higher risk. But we need to look at complete research data, many factors come into play in sick patients so things are not very clear now.

 

Q) Does HCQ has any effects on heart and eyes?

 

A) For COVID 19 positive patients this is given as treatment daily for 5 to 7 days and to prevent COVID 19 it is suggested to take weekly once for 7 weeks. Those patients who are taking HCQ for many years almost like after 5 years they had developed retina problems, that too less than 5 percent. With this short duration treatment this complication is unlikely. We are using this medicine since many years and prescribing doctors screen for eye problems and give medicine. Patients with kidney disease or diabetics have higher risk.

 

Lakhs of patients all over world are taking HCQ since more than 20 years, in research it has not been identified that HCQ will cause any major heart problems, very few patients had some heart rhythm abnormalities, HCQ has caused increase in QT interval in ECGs of few patients and this can sometimes lead to arrhythmia (abnormal heart rhythm). This risk will increase when you are also taking some other medicines which have similar effects. Doctors will check all these things before prescribing and adequate precautions are taken.

 

So this medicine should be taken only after consulting doctors and should not start by your own.

 

Q) There is scarcity of HCQ due to its diversion for treating corona and not sold freely as it can be misused, patients on long term HCQ treatment are finding difficulties to obtain medicine, how should they manage?

 

A) HCQ has very long half-life it can stay in body for nearly 40 to 50 days. So even if you miss for one or two weeks there shouldn’t be a problem. If available take regularly and if limited supply is there you can continue alternate days till you get stocks. For Lupus this medicine is must and for other rheumatic diseases we can manage with adjusting doses of alternate medicines like methotrexate, sulfasalazine etc.

 

Q) HCQ being anti-malarial and anti-rheumatic medicine how does it work for corona?

 

A) It can act in 3 ways,

 

1) Corona enters into cell thru ACE2 cell surface receptor, HCQ can interfere with glycosylation of these receptor and block entry

 

2) HCQ can increase intra cellular pH, this can prevent viral replication once virus enters into cell.

 

3) HCQ has some immunomodulatory properties and this can stabilise immune response  Many other mechanisms are proposed but these are mostly accepted. Most of them are observed in lab studies (Invitro)

 

In Human research, Chinese and French studies had shown HCQ had significantly reduced viral load in COVID 19 cases when treated for 5 to 7 days.

 

Recently some studies had shown that this medicine is not effective at all. So we don’t have clear picture till know. But since it’s tablet and quite cheap and we are using this for lot of other diseases since many years this is offered to COVID 19 patients currently at least till we get definite curative medicine or vaccine.

 

Note: Other medicines which are used in treatment of COVID 19 are Lopinavir / Ritonavir (this is used to treat HIV) Remdesivir (this was developed to treat Ebola virus) Tocluzimab (this is anti rheumatic medicine) etc.

 

But no medicine is 100% effective and there is no approved medicine till date. Hence we have to depend so much on social distancing, hand hygiene etc.

 

This process of using medicines discovered initially for one disease for treating another disease is called “Repurposing of drugs” when you have rapidly spreading disease and you can’t develop new medicines or vaccines quickly to contain disease this process is adopted after thorough understanding of mechanisms of actions of medicines, and recently AI (artificial intelligence) technology is also used to identify which old medicines can work for new disease.

 

A BRIEF PROFILE OF THE DOCTOR

 

Dr. Raj Kiran Dudam, is a Rheumatology Consultant at Hyderabad Rheumatology Center, Begumpet and a profound medical professional with 15 years of extensive experience in treating Rheumatic Diseases. With MD in Internal Medicine from Gandhi Medical College and a Fellowship in Rheumatology from NIMS Hyderabad, Dr. Raj Kiran is renowned for his impeccable service and exceptional expertise in the domain. 

 

• Life Member - Indian Rheumatology Association
• Life Member - Association of Physicians of India (API)
• President Elect for Rheumatology Association, Hyderabad chapter
• Organising Secretary for South Zone Indian Rheumatology Conference 2017, Hyderabad
• Organising Secretary for Indian Rheumatology Association Conference (IRACON 2021) to be held in Hyderabad
• Speaker in many National Conferences
• Multiple Publications in Various Journals

 

Book Appointment:  Dr. Raj Kiran Dudam, is a Rheumatology Consultant at Hyderabad Rheumatology Center