THE Pharmaceutical Society Of Zimbabwe (PSZ) has warned the ministry of health child care against distributing Chloroquine (CQ) & Hydroxychloroquine (HCQ) in health institutions for the purposes of COVID-19 Treatment and prevention since the products are still at clinical trial stage and haven’t been approved for use.
By Michael Gwarisa
Early this week, Information minister, Honourable Monica Mutsvangwa said even though there has not been any need for medications and drugs used to treat COVID19 patients in the country to date, in the past week, drugs that were identified in the treatment of COVID19, HQC which was locally produced, and Alpha Interferon which was sourced from Cuba, were distributed to Provincial and Central Hospitals.
In a statement on behalf of the PSZ, Mr Gift T Chareka said the country’s desperation for a COVID-19 cure should not force them use these medicines until conclusive research is finalised.
For management of COVID-19, healthcare professionals should refer to WHO “Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected.” WHO interim guidance re-emphasises that experimental treatments should be issued under ethically approved RCTs. Alternatively, the use of investigational therapeutics should be done under Monitored Emergency Use of Unregistered Interventions Framework (MEURI), until an RCT can be initiated.
“In light of the paucity of literature in support of CQ/ HCQ for the treatment and prevention of COVID19, as well as safety concerns from potential abuse, the Society discourages off-label use of CQ and HCQ until conclusive research is finalised. It is our expert opinion that health professionals should wait for availability studies with stronger research designs before recommending any treatment for COVID19,” said Mr Chareka.
He added that to date, only one clinical study has been published in support of HCQ in combination with azithromycin for reduction in nasopharyngeal viral loads of COVID-19 [1]. This was a prospective non-randomized trial.
“The study reported results for 36 participants: 20 treated with HCQ and 16 controls. The main finding was that COVID-19 nasopharyngeal viral loads were reduced in patients receiving HCQ alone and HCQ + azithromycin when compared to controls.
“Notwithstanding, the combination of HCQ with azithromycin should be avoided due to the risk for QT-prolongation [2]. Of note this study did not report clinical endpoints such as survival. Furthermore, results for 4 participants in whom HCQ was discontinued for reasons which included death and worsening of the condition were not reported.”
He also said other literature in support of CQ/ HCQ for COVID-19 include anecdotes, an in-vitro study. Furthermore, several randomized-controlled clinical trials (RCTs) are underway to establish efficacy . Amongst these is the WHO megatrial SOLIDARITY, which aims to establish efficacy of HCQ, remdesivir, lopinavir/ ritonavir and lopinavir/ ritonavir + interferon beta.
“Pharmacists continue to play an important role in the response to the COVID-19 pandemic. As firstline healthcare professionals, the public rely on us for unbiased and current information on COVID-19 prevention and management.
“In situations of high anxiety and panic the public should be provided with evidence-based recommendations to promote their safety. Recent media attention on chloroquine (CQ) and hydroxychloroquine (HCQ) as treatments for COVID-19 has raised some concern and curiosity in the profession.