After some promising results on the efficacy of prophylactic use of Hydroxychloroquine (HCQ) against COVID-19 infection, the Central government has expanded the use of the medicine as prophylaxis to healthcare and other frontline workers deployed in non-COVID and COVID area.
The Union Health Ministry on Thursday revised advisory on the use of HCQ as prophylactic for COVID-19 infection.
The decision came after the National Task Force (NTF) for COVID-19 constituted by the Indian Council of Medical Research (ICMR) reviewed the use of HCQ for prophylaxis of SARS-CoV-2 infection for high-risk population based on the emerging evidence on its safety and efficacy.
Thus, the Joint Monitoring Group and National Task Force (NTF) have now recommended the prophylactic use of HCQ in the following categories- All asymptomatic healthcare workers involved in containment and treatment of COVID-19 and asymptomatic healthcare workers working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks, Asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities and Asymptomatic household contacts of laboratory-confirmed cases.
The NTF reviewed the data on in-vitro testing of HCQ for antiviral efficacy against SARS-CoV-2, safety profile of HCQ reported to the pharmacovigilance program of India, and data on the use of HCQ for the prophylaxis of SARS-CoV-2 infection among health care workers (HCWs).
The National Institute of Virology, Pune reported in-vitro testing of HCQ for antiviral efficacy which showed a reduction of infectivity /log reduction in viral RNA copy of SARs-CoV2.
“The data on assessment of HCQ prophylaxis among 1323 HCWs indicated mild adverse effects such as nausea (8.9%), abdominal pain (7.3%), vomiting (1.5%), hypoglycemia (1.7%) and cardio-vascular effects (1.9%),” stated government document.
However, as per the data from the Pharmacovigilance program of India, there have been 214 reported instances of adverse drug reactions associated with prophylactic HCQ use. Of these, 7 were serious individual case safety reports with prolongation of QT interval on ECG in 3 cases, read the document.
A retrospective case-control analysis at ICMR has found that there is a significant dose-response relationship between the number of prophylactic doses taken and frequency of occurrence of SARS-CoV-2 infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection, it said.
“Another investigation from 3 central government hospitals in New Delhi indicates that amongst healthcare workers involved in COVID-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were not on it,” stated the document.
An observational prospective study of 334 healthcare workers at AIIMS, out of which 248 took HCQ prophylaxis (median 6 weeks of follow up) in New Delhi also showed that those taking HCQ prophylaxis had lower incidence of SARS-CoV-2 infection than those not taking it, it said.
The benefit was less pronounced in healthcare workers caring for a general patient population.
“The drug is contraindicated in persons with known case of: retinopathy, hypersensitivity to HCQ or 4-aminoquinoline compounds, G6PD deficiency, pre-existing cardiomyopathy and cardiac rhythm disorders. The drug is not recommended for prophylaxis in children under 15 years of age and in pregnancy and lactation,” stated the document.
Hydroxychloroquine is an anti-malarial drug that is also used to treat other auto immune diseases. It shot to prominence recently after receiving an endorsement from US President Donald Trump as a potential cure to the coronavirus.
On Monday, President Trump stated that he too had begun taking it prophylactically and seemed to not exhibit any symptoms.
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