Two drugs being tried to fight the coronavirus in ill patients. "The first provides grounds for cautious optimism about Gilead Sciences' experimental drug remdesivir, while the second raises questions about the safety of hydroxychloroquin (HCQ), the drug President Donald Trump has recklessly hyped as a potential remedy to Covid-19," wrote Zeeshan Aleem for Vox. Remdesivir is still in an experimental stage and has not been approved for clinical use by the FDA in the US. It has been provided by Gilead Sciences for clinical trials in coronavirus cases. The company tried to get monopoly rights from the FDA by trying to get the drug classified as an orphan drug. The New England Journal of Medicine (NEJM) published an article in which they analysed the results of remdesivir on 53 patients with Covid-19 whose oxygen saturation had dropped to below 94% on air or on oxygen. 36 of the 53 patients, that is 68% of patients improved on the drug, while 7 patients or 13% died. While recognising limitations of the study, "Still the authors of the study and outside experts have described the results as reason to feel hope," wrote Aleem. "On a less optimistic note, France's drug safety agency has released data indicating that hydroxychloroquine, the anti-malarial drug Trump has pushed as a potential miracle drug for treating Covid-19, appears to have serious side effects on the heart when used for Covid-19 patients, and should be used under medical supervision." The constant referral to President Trump shows that this is political denunciation and an excellent example of how not to report on medical trials. Another article written by Kenny Lin MD wrote, "The caution, however, is that hydroxychloroquine, especially when combined with azithromycin, can be associated with visual and cardiac complications including arrhythmias." It is sad when a doctor allows his politics to color his advice. HCQ has been used extensively to treat rheumatoid arthritis and lupus erythematosus for years and its side effects are described in detail. Azithromycin is a commonly used antibiotic in respiratory infections and is used in typhoid in combination with cefixime. Given that rheumatoid arthritis is not uncommon, many patients on HCQ would have received antibiotic treatment with azithromycin and resultant adverse effects would have been described by now. The British National Formulary (BNF) mentions interactions between HCQ and antacids, cimetidine, peniciallamine and certain other drugs but not with azithromycin. These are serious medicines, and not homeopathy, and taking them without medical supervision can result in serious side effects and even death. In the NEJM study touted by Aleem, 12 patients (23%) had serious adverse events, including multiple-organ- dysfunction syndrome, septic shock, acute kidney injury and hypotension. Many drugs are banned years after being approved for public use when unexpected side effects are reported. Medicine deals with life, politics with power. The twain cannot mix.
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