Front Burner - In Brief: anti-malaria drugs vs COVID-19, hype or hope?

Episode Date: April 6, 2020

Chloroquine and hydroxychloroquine - two drugs touted by U.S. President Donald Trump, who says they could be game changing treatments for COVID-19. But around the world health experts have tried to temper expectations for these medications. Today, on Front Burner, we talk to infectious disease specialist, Dr. Isaac Bogoch about these drugs and the testing being done to determine if they hold any promise at all.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Poisson and this is FrontBurner, our nighttime brief edition. Here are some of the latest headlines on the coronavirus. First, a couple of encouraging things. Despite 27 more people dying from COVID-19 in Quebec in the last 24 hours,

it appears the province's social distancing measures are actually working. That's because the number of new hospitalizations there rose by only eight patients in the same time frame, a relatively small increase in the total number of 553 hospitalizations. And in Ontario, nearly 650 ventilators have now arrived. That brings the number of ICU beds equipped with the life-saving devices to nearly 2,000. Modeling figures released by the province on Friday forecast that as many as 1,200 COVID-19 cases will be in need of ICU beds in the coming weeks. And in a not-so-encouraging development, Ontario Premier Doug Ford says the province only has a one-week supply of personal protective equipment for frontline health workers. However, he also said that some 500,000 masks that have been held up by American officials have now been released.

I just was briefed not long ago saying that we're able to get 500,000 N95 masks. not long ago, saying that we're able to get 500,000 N95 masks. Ford says he is hopeful the talks with the U.S. would lead to the continued shipment of much-needed supplies to Canada. Lastly, some breaking news this afternoon. UK Prime Minister Boris Johnson, who has tested positive for the coronavirus and was admitted to hospital on Sunday, has now been moved to intensive care because of worsening symptoms. All right, so moving on, you've probably come across mentions of this drug recently. It's not a vaccine for COVID-19, but some think it could help people who have been infected. It's called hydroxychloroquine. There is

another one too, it's called chloroquine. And there's a lot of debate around these drugs, in part because US President Donald Trump is really pushing their use. So today, what are they? What are they intended to do in the first place? And what are the risks? All right, Dr. Isaac Bogosh, thanks again for joining us. Oh, no problem. Thanks for having me back. Okay, so let's start here. What are these drugs, hydroxychloroquine and chloroquine? What are they normally used for? So there's a lot of hype about these two drugs, hydroxychloroquine and chloroquine-related

medications. Hydroxychloroquine is mainly used in rheumatologic conditions. It's got a few different uses, but we see it used in rheumatologic conditions like keeping things like rheumatoid arthritis under control. Chloroquine is interesting. Its main use is as a malaria prevention drug and a malaria treatment drug for certain types of malaria. I was saying today, I think I've taken this as like a malaria drug. Yeah, yeah. So for those of us who work in rheumatology and

infectious diseases, we're pretty familiar with these medications. But, you know, they're not widely used, but they're certainly not unheard of as well. What kind of side effects do they have? They can have lots of different side effects. And certainly there are issues with toxicity would be the key. First of all, they taste terrible. They're very bitter. So that's one of the problems. But that's not really a side effect.

One of the side effects with overdose is it can have significant troubles with people can have significant difficulties with their heart rhythm. That's a key issue as well. Okay. And what do we know right now about their effectiveness at treating COVID-19? Well, it's interesting because right now we don't know that much. And certainly there have been some, you know, widely touted claims about what these drugs do. And many people, I think, have been, well, quite frankly, I think have been overstating some of the data that's been published to date. And, you know, there was some early data. This really started, there was some early data from France looking at the use of these drugs in the treatment of COVID-19 infections. And, you know, these were very small sample sizes. So I think the whole study had about 30 people in it. You know, some got the medication, some didn't. And, you know, they were measuring outcomes like,

you know, can we detect less virus or is there a reduction in the amount of virus being shed? So they weren't really measuring hard outcomes like, you know, hospitalization or or, you know, death or anything like that. And, you know, basically this the this study was moderately well conducted. And of course, you know, we shouldn't expect miracles. This is a small study and, you know, it showed that maybe if we use these medications, it could reduce the degree of how much virus was being shed. And in addition to that, they also gave another drug called azithromycin, which is a very commonly used antibiotic. We use it here in North America pretty commonly. And it showed that if azithromycin was even added to that,

it would reduce viral shedding even more. And, you know, people kind of jumped on this as being, you know, a possible cure. And really, I think that, you know, the results should definitely cause us to raise an eyebrow. It definitely warrants further investigation. We would say this is hypothesis generating at best, meaning, hey, we should look into this further. But there's no way you could look at that data and make big claims that this is going to help people with COVID-19 infections. You just can't make that leap. Interestingly, since that came out, we saw, you know, obviously, you know, we heard about the president of the United States discussing it, and we saw people starting to stockpile this

medication. And, you know, it caused a lot of problems because people were, you know, obviously eager for good news and jumping on this data and completely either misrepresenting the results or overstating the results. And, you know, since then, there's been a few other studies that have come out, not many, but there was another study from China that came out. And I've got to say, it's tough to parse through it because it's not entirely clear what they did. And the results are not that conclusive, but don't really demonstrate a use or efficacy of chloroquine or hydroxychloroquine in that study. And even more interesting, now there's what we call registry data that's coming out. And registry data is just, you know, here, we're not, it's not a clinical trial.

And registry data is just, you know, here, we're not, it's not a clinical trial. We're not, you know, enrolling people into one group that gets a drug and another group that doesn't get the drug. But there's registry data that comes out, which basically says, hey, we have a group of people that are already on this medication. And these are people with underlying rheumatologic conditions. We have a group of people that are already, they're already taking hydroxychloroquine. And this is kind of interesting. And, you know, let's see how these individuals who are following who are already on this medication fair with COVID-19. And, you know, it doesn't, you know, these are people who are adherent to their medications.

And this study that the data is actually pretty new, didn't show that it didn't, it wasn't really evident that people who are on hydroxychloroquine were somehow protected from either getting this infection or protected from getting a serious infection. Now, does that answer the question? Does this answer the question? Does this mean these drugs are useless or these drugs are amazing based on the limited data we have? No, it doesn't tell us anything.

These are all hypothesis generating. What we really need to do here is, number one, study this medication in a proper manner. And number two, if we're using this medication, it tells us we have to be completely transparent with our patients and discuss this in a very ethical, in a very ethical way. I'm curious, you know, this is a medication for people with arthritis or to prevent or treat malaria. So what conceivably do people think it can do to treat COVID-19? Yeah, so that's a really interesting point. And, you know, there is a term that we often throw around and we say, well, there may be immunomodulatory effects, meaning

maybe this doesn't directly affect the virus, but could this affect the immune system and its response against the virus? The other thing, too, is sometimes there's a lot of off-target effects of medications. And, you know, they may be designed for A, but they're actually used for B. And there is just, like, I don't think we need to go down that rabbit hole now, but if you ever do, there is just a fascinating history of drugs that were developed for something, that were used for something completely different. Right. So, I mean, you said that this needs to be studied properly now. What kind of timeline are we looking at before we would have some sort of definitive answer? Either way,

you know, I know we're talking about a year or more for a vaccine, but will we have a definitive answer on these drugs sooner? Yeah, I think we'll have it much sooner. Like I think we probably will have hopefully early results of some of these trials within the next couple of months. So the other thing, too, is we have to think about outcomes as well. Like, what are the important outcomes to measure? You know, I don't think a secondary outcome, a side outcome might be, yeah, we want to see if the virus is reduced and shedding. But like the real outcomes, we're really interested in, hey, are you going to live or are you going to die? Or how sick are you going to get?

Are you going to be in the hospital for a long time or can this shorten your hospital stay? Or, hey, can we actually reduce the number of people getting into hospital? Or even, you know, I think equally important is, can we give this to a person who's not infected but was exposed to someone who is infected? Can we give this to the non-infected person and prevent them from getting the infection? So those are some of the questions that are being asked. And those are some of the outcomes that are going to be measured. And of course, if we were able to prove at some point that these drugs are a mixture of other drugs worked, this would be a game changer, right? We would be able to treat this disease without maybe having to put so many people in intensive care like this this would be a huge breakthrough in how we deal with COVID-19 around the world right

I think so I think so I still even have to be cautious with that because it's not it's not a light switch it's not like this will work or this won't work a lot lot of it might be, this will work, but to what extent does it work as well? And, you know, I think people think that at the end of the day, they're going to get a cure. And that, you know, you're going to be sick, sick, sick, and all of a sudden, you take this one pill, and that's just going to go away. And it's probably not going to be as simple as that. Okay. And last question before we go today, Isaac, you know, what do you think of doctors who are saying we should just prescribe this anyways? You know, we know that there has been a spike in Alberta prescriptions of high-droxychloroquine and chloroquine, and also the FDA in the U.S. has issued sort of limited use authorization of these two drugs. Like, what about the argument, just prescribe it now, and maybe it will work? Yeah, we have to be careful in those situations. I really think it's important to have an ethical discussion with your patient before prescribing

this. And I mean, obviously, we know that sometimes there can be benefits, but of course, there can also be harms. And it's extremely important to communicate with people exactly what they're getting, what we know and what we don't know. And these are important conversations to have with people. And it's not fair to give people, for example, a false sense of hope if this is really not going to provide that in the end. We just don't have the data to drive it. Now, on the other hand, does that mean don't give these drugs unless you're enrolled in a clinical trial? No, of course not. It just means that we have to

have an honest discussion with people about what we know about these medications. And I wouldn't push them on anybody. I would certainly just have a very open and honest discussion about these medications, as we should be doing with most things that we're uncertain of. Okay. Dr. Isaac Bogosh, thank you so much. Oh, anytime. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization,

empowering Canada's entrepreneurs through angel investment and Industry Connections. All right, that's it for this evening. We have an episode tomorrow looking at Vancouver's downtown east side. I hope that you'll tune in. In the meantime, thank you so much for listening and talk to you soon. For more CBC Podcasts, go to cbc.ca slash podcasts.