Hydroxychloroquine poses little risk when administered alone in mild cases or as prophylaxis: AIIMS Director on WHO's suspension of HCQ trials

By Joymala Bagchi
New Delhi [India], May 26 : Dr Randeep Guleria, Director, All India Institute of Medical Sciences (AIIMS), New Delhi, on Tuesday said that 'judicious, and appropriate' use of hydroxychloroquine (HCQ) as a standalone drug should not pose any health risks in COVID-19 cases.
His remarks came after the World Health Organisation (WHO) on Monday suspended clinical trials of HCQ as a potential treatment of COVID-19.
The decision was taken after a study published in The Lancet medical journal published last week observed that HCQ could increase the risk of death among COVID-19 patients.
Dr Guleria told ANI that there were two aspects and when HCQ is given as prophylactic or in mild illness and administered alone, the chances of side effects are much less.
"There are two different aspects to this. There is a high chance that you may have toxicity due to HCQ when it is used as a part of treatment for severe COVID-19 cases because of multiple drugs being used. And we know that there are certain drugs which along with HCQ can increase the chances of cardiac toxicity (damage to the heart due to chemicals). On the other hand, when it is given as prophylaxis or in mild illness and administered alone, the chances of side effects are much less," he said.
"We as physicians have been using hydroxychloroquine for decades and patients have been taking it daily not for a few days or weeks but months and sometimes for over a year without any side effects. So when it is used judiciously, appropriately, and not in combination with other drugs, then data suggests it is useful," he added.
India, as per the guidelines by the Indian Council of Medical Research (ICMR), has advocated the use of HCQ for health workers to keep them safe. India has also exported the drug based on demands from other countries.
"More recently, when it was advised for health workers, a lot of data in terms of pharmacovigilance was done by ICMR and by other agencies to look for and monitor the side effects. The data also suggested that side effects are predominantly mild and they were not really having serious side effects. So I think when used as a single agent, we still need to say that side effects are not that much," Dr Guleria told ANI.
The AIIMS Director said the drug has to be used under a medical prescription. "One has to monitor and one should be aware of the conditions where it should not be used," he said.
WHO's Emergencies Programme, Dr Mike Ryan has said that the decision of temporary suspension of clinical trials has been taken by the executive group of WHO out of "an abundance of caution."
Dr Guleria said an abundance of caution means just to be on the safe side.
"WHO is not saying there are significant side-effects. Based on the data that has come from the other studies they are just being over-cautious. If used in combination with other drugs, and certain antibiotics there is a high chance of side effects. If you are using it as a standalone drug and monitoring carefully then it is a relatively safe drug."
Asked about drug's use in India after WHO's decision, he said that the ICMR guidelines have recommended that healthcare workers and other frontline warriors should take the drug.
The Union Health Ministry had directed all states and Union Territories (UTs) to update the availability and consumption of hydroxychloroquine or HCQ tablets on the national COVID-19 portal as real-time data. The Ministry said that this will help it to chalk out a further action plan and to provide more HCQ tablets when required.
It had earlier this month also issued a revised advisory on the use of HCQ as prophylaxis for COVID-19 infection.