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Plaquenil Coronavirus

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Last Updated: 02 July 2021

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General | Latest Info

People WHO take Hydroxychloroquine are increasingly having trouble getting refills from their retail or mail order pharmacy. Doctors are getting questions about this after news about the potential for drugs to help shorten the course of COVID - 19 was broadly reported on March 19. Erin Fox, associate adjunct professor of pharmacology at University of Utah and expert in drug shortages, says four of eight suppliers of Drug report normal supplies. Others report back orders. The drug, originally approved for malaria in 1955, has been approved for decades as a disease - modifying antirheumatic drug to treat rheumatoid arthritis and systemic lupus erythematosus and is used in treatment of juvenile idiopathic arthritis. Fox said that sudden high demand come from people and clinics that want to use Hydroxychloroquine for COVID - 19 prevention or treatment, although the drug is not approved for either indication, and there is limited evidence to support its use in COVID - 19. Researchers are preparing to launch rigorous studies of its safety and effectiveness. Despite that, people and clinicians are putting their hope in Hydroxychloroquine. But that is leaving many people WHO have lupus, RA and JIA without medication they depend on and may have been taking for years. State boards of Pharmacy in Nevada, Ohio, Texas and Idaho have established new rules to control run on drugs requiring diagnosis for indicated disease be written on prescription. If diagnosis is COVID - 19, further restrictions apply, such as 14 - day supply limit, no refills and other measures intended to stop hoarding and maintain adequate supply for patients WHO have been taking the drug for indicated uses. Jenny Wai, chief pharmacist, Ohio Board of Pharmacy, said of her state's new Emergency rule, I hope we have stopped bleeding now. Several manufacturers have pledged to donate tens of millions of doses of Hydroxychloroquine, or Plaquenil, brand version, or chloroquine. Pharmaceutical manufacturer Novartis Sandoz has increased its donation pledge from 20 million doses to as many as 130 million doses, which includes both its current stock and supply expected from increase production through May. Access to donated supplies is controlled by the Department of Health and Human Services. Any requests from new customers go to HHS, say Linda Krystek, from Novartis customer operations Department. She said the company is referring to HHS many requests it is receiving from Health Organizations, hospitals and doctor offices. Michelle Petri, MD, rheumatologist at Johns Hopkins University School of Medicine, in Baltimore, said she would never want her patients to stop Disease - modifying Drug or reduce frequency or doses to conserve pills. Systemic lupus erythematosus patients cannot ration their drug, as that would lead to subtherapeutic Hydroxychloroquine blood levels and loss of efficacy, she say. It should not be forgotten that SLE is the fifth or sixth leading cause of death in African - American and Hispanic - American young women. Hydroxychloroquine is the only SLE treatment shown in multiple studies to improve survival in SLE.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Related Information

President Trump revealed on Monday that he had been taking an anti - malaria drug as a preventive measure against coronavirus, same medicine that he has been promoting for two months with scant evidence of its efficacy and despite several warnings of dangerous side effects. Drug, hydroxychloroquine, has been invoked by Mr. Trump repeatedly since March during White House briefings on the coronavirus pandemic despite reservations of doctors and scientists, including some advising the President. He even calls drug, which has been promoted by some conservative pundits, game changer. Mr. Trump said he started taking once - aday pill about a week and a half ago. It was not immediately clear if Mr. Trump began the regimen in response to two White House staff members testing positive for the virus, one of presidents personal valets and Katie Miller, spokeswoman for Vice President Mike Pence. And last week, federal agency head who had been involved in developing coronavirus vaccine testified to Congress that he had been removed from post because he had pressed for rigorous vetting of hydroxychloroquine. Official, Rick Bright, who leads the Biomedical advance Research and Development Authority, also said he was pressured to direct money toward hydroxychloroquine. Hydroxychloroquine is a prescription medicine that was approved decades ago to treat malaria. It is also used to treat autoimmune diseases like rheumatoid arthritis and lupus. It is sometimes referred to by its brand name, Plaquenil, and is closely related to chloroquine, which is also used to treat malaria. Why has hydroxychloroquine been considered as a possible treatment for coronavirus? There are several reasons. A promising laboratory study, with cultured cells, found that chloroquine could block coronavirus from invading cells, which it must do to replicate and cause illness. However, drugs that conquer viruses in test tubes or petri dishes do not always work in the human body, and studies of hydroxychloroquine have found that it fails to prevent or treat influenza and other viral illnesses. Reports from doctors in China and France have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seems to help patients. But those studies were small and did not use proper control groups patients carefully selected to match those in the experimental group but who were not given drug test. Research involving few patients and no controls cannot determine whether a drug works. And French study has since been discredit: scientific group that oversees journals where it were published says studies do not meet its standards. Study from China include control group and suggest that hydroxychloroquine might help patients with mild cases of Covid - 19, disease caused by coronavirus. But that study had limitations: It was also small, with a total of 62 patients, and they were given various other drugs as well as hydroxychloroquine. Doctors evaluating results know which patients are being treat, and that information could influence their judgment.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Rheumatoid Arthritis (RA)

If youre living with rheumatoid Arthritis, you may be considered to some degree immunocompromised. First, RA itself causes dysregulation of your immune system. Second, many people with rheumatoid Arthritis take medications that affect the immune system to manage their symptoms. Ra patients are thought to have slightly impaired immune systems regardless of whether or not they are on active therapy, says Vinicius Domingues, MD, Rheumatologist in Daytona Beach, Florida. Certainly, this is a challenge under normal circumstances, but it can raise even more questions and concerns during a coronavirus pandemic. People with rheumatoid Arthritis may be considered in the higher - risk group for potential COVID - 19 complications, although there is not yet large enough data on RA patient population to know how patients fare when infected with coronavirus compared to people without RA. Here is what Rheumatology experts want rheumatoid Arthritis patients to know based on what is known so far about staying safe and managing their condition as the coronavirus pandemic continue.


Introduction

Ra patients have documented an increase in incidence of comorbidities like asthma, Chronic Obstructive Pulmonary Disease, Hypertension, and cardiovascular diseases as documented in the COMORA study. Ra patients have increased risk of diabetes as shown in meta - analysis. A Study done on Coronavirus - infected patients show that presence of COPD, diabetes, hypertension, and malignancy were risk factors for admission to Intensive Care Unit, invasive ventilation, or death. Risk increase with the increase in the number of comorbidities. Pre - existing respiratory illnesses, mainly COPD, were associated with increased severity of Coronavirus infection. Smoking, which is also associated with RA, appears to increase the risk of adverse outcomes in COVID - 19 by increasing expression of Angiotensin Convertase Enzyme 2 in Asian smokers. Ra is also associated with ILD, which might theoretically increase the risk of severe infection, but data on this is scarce. Sars - COV - 2 infects cells with ACE2 as a receptor, and reduced infection rate of COVID - 19 in patients with ILD has been proposed to be due to decreased Angiotensin II mRNA activity in lung in ILD. This same study states that although the risk of infection might be lower in patients with ILD, once infect, severity and prognosis are worse in patients with ILD due to aggravated inflammatory responses and coagulopathy. The National Health Service has classified patients of RA with and without ILD and Pulmonary Artery Hypertension at very high risk and increased risk respectively, for contracting infection as compared with the general population. Hence, management of comorbidities and extra - articular features of disease is important in these times. Demographic and clinical characteristics of the first 600 patients of Rheumatic diseases who contracted COVID - 19 were published recently. Data was taken from COVID - 19 Global Rheumatology Alliance physician Registry. The most common Rheumatic Disease was RA and the most common comorbidities were Hypertension, Lung Disease including COPD, asthma, ILD, and others, diabetes, cardiovascular disease, and renal failure. Patients with comorbidities were more commonly admit. However, no association between disease activity and hospitalization was see.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sjogren's Syndrome

Both CQ and HCQ have been used in treatment and prophylaxis of malaria,. As antimalarials, they have mark schizonticidal and gametocidal activity and work against asexual form of malarial parasite in stage of its life cycle within red blood cells. Drugs do not act against intrahepatic forms of parasite. The mechanism of action of CQ and HCQ is related to their lysosomotropic property. Drugs accumulate within food vacuole of parasite and prevent conversion of toxic heme into non - toxic hemozoin. Parasite detoxifies him in food vacuoles via a biocrystallization process in which heme is sequestered into large insoluble crystals, namely hemozoin. Drugs bind and prevent it from being incorporated into crystals. Accumulate free heme lyses membranes and leads to parasite death. Of late, AS result of extensive mass use of these drugs, there has been emergence and spread of resistance and its use has become limited to regions with no known resistance. Chloroquine resistance is due to decreased accumulation of chloroquine in food vacuole. Drug resistance is primarily mediated by mutant forms of chloroquine resistance transporter, which cause efflux of chloroquine from digestive vacuole, and possibly multidrug resistance 1 gene. These drugs are not recommended for treatment of Plasmodium falciparum due to widespread resistance to it. Antimalarial drugs currently have a major therapeutic role in rheumatology. Hcq is preferred to CQ, AS such patients need long - term therapy and HCQ has a lower incidence of retinopathy when compared with CQ. Hcq is used in active rheumatoid arthritis, systemic and discoid lupus erythematosus, Sjogren's syndrome, sarcoidosis, antiphospholipid syndrome, and photosensitive dermatosis,. Drugs have become cornerstone in managing patients with systemic lupus erythematosus. The therapeutic effect of HCQ in rheumatic disorders is related to inhibition of various processes in innate and adaptive immunity. The drug has immunoregulatory effect and downregulates pro - inflammatory cytokines, namely: interleukin 1, interleukin - 6, interferons, tumor necrosis factor, and B - cell activating factor. Drugs are lysosomotropic and accumulate within lysosomes and endosomes and raise their pH. The drug inhibits lysosomal enzymes and inhibits autophagy pathway and endocytosis. This, in turn, downregulates autoantigen presentation, T - cell activation, differentiation, and expression of co - stimulatory molecules and release of cytokines. In endosomes, drug prevents toll - like receptor signaling and cGAS - STING signaling, and downregulates production of proinflammatory cytokines,. Both CQ and HCQ have several effects that can potentially prevent SARS - CoV - 2 infection and also reduce its progression. Drugs may interfere with the entry of viruses into cells. Coronaviruses highjack ACE2 receptors for its entry into cell. The Sars - CoV - 2 receptor binding domain has much more affinity to bind ACE2 compared with SARS - CoV RBD, resulting in much higher infectivity. Both drugs are known to interfere in glycosylation of ACE2. This can make spike protein - ACE2 binding less efficient and impede entry of virus into cells.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

A striking observation

The study, published Friday in Medical journal Lancet, is the largest analysis to date of risks and benefits of treating COVID - 19 patients with antimalarial drugs. Like earlier smaller studies, it delivered disappointing news to the world eager for promising treatments for novel coronavirus as the global death toll grew to more than 335 000. While doctors have refined how they treat disease,ss they have yet to discover magic bullet against pathogens to which humans have no known immunity. Lancet analysis by Mandeep Mehra, Harvard Medical School professor and physician at Brigham and Womens Hospital, and colleagues at other institutions include patients with positive laboratory test for COVID - 19 WHO were hospitalized between Dec. 20, 2019, and April 14, 2020, at 671 Medical centers worldwide. The mean age was 54 years, and 53 percent were men. Those WHO were on mechanical ventilators or WHO received remdesivir, antiviral drug made by Gilead Sciences that has shown promise of decreasing RECOVERY times, were exclude. Nearly 15 000 of 96 000 patients in the analysis were treated with Hydroxychloroquine or chloroquine alone or in combination with a type of antibiotic know as macrolide, such as azithromycin or clarithromycin, within 48 hours of their diagnosis. Study is a retrospective analysis of their medical records, rather than a control study in which patients are divided randomly into treatment groups, a method considered the gold standard of Medicine. But the sheer size of the study was convincing to some scientists. Fda spokesman Michael Felberbaum said Friday the agency generally does not comment on third - party research but that emergency use authorization may be revised or revoked under certain circumstances, such as when there are links or suspect adverse events, new data about effectiveness, or changes in risk - benefit assessment of Drug. Last month, agency warned against use of Drug outside hospital settings or clinical trials, citing reports of serious heart rhythm problems. There have been at least 13 studies in recent months on Hydroxychloroquine or chloroquine as treatment for COVID - 19 patients. They have included randomized control studies and observational analyses encompassing patients on continuum from mild illness to those near death. Evidence of any benefit, such as viral clearance or improved symptoms, has been almost nonexistent. But many find an increased risk of adverse cardiac reactions, especially when combined with the antibiotic azithromycin. Earlier this month, backers of presidents views on antimalarials seized on study out of NYU Langone Health that gives hospitalized coronavirus patients zinc combined with Hydroxychloroquine and azithromycin. Those in the treated group had a higher rate of survival, but researchers emphasized study focus on zinc and whether Hydroxychloroquine would enhance supplement antiviral effects. They emphasize their findings were tentative and could have been due to factors other than drugs, especially because zinc was added to patient regimens later in the pandemic when hospital treatments and procedures had been refine.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Deepening skepticism

Lancet Medical Journal retracted a study on Thursday that found that coronavirus patients WHO take hydroxychloroquine had higher mortality rate and increased heart problems than those WHO DO nothing, stating that authors were unable to complete an independent audit of data underpinning their analysis. Why it matter: results of study, which claim TO have analyzed data from nearly 96 000 patients on six continents, led several governments TO ban use of anti - malarial DRUGs for coronavirus patients due to safety concerns. The World Health Organization also temporarily suspended its tests of hydroxychloroquine due to the TO Lancet study, before resuming them on Wednesday. Big picture: investigation by Guardian found that employees AT Surgisphere, company that Lancet relies on for its data, had little TO no data science or scientific background. Surgisphere came out of nowhere to conduct perhaps the most influential global study in this pandemic. In matter of few weeks, one doctor WHO published results of hydroxychloroquine studies online told the Guardian. It's unclear how Surgisphere was able TO get data - sharing agreements WITH over 600 hospitals worldwide, and many in the scientific community have raised concerns about the reliability of its data. Zoom In: President Trump has frequently touted the use of hydroxychloroquine for COVID - 19, turning debate over anti - malarial DRUG into a political Charge issue in the US, Hydroxychloroquine prescriptions rose dramatically in March after DRUG was brought into the political spotlight by Trump, WITH hydroxychloroquine and chloroquine fills increasing from 2019 levels by 1 977% between March 15 - 21. Trump himself took DRUG last month after two West Wing staffers tested positive for VIRUS. Worth noting: Despite Lancet's retraction, data from a randomize, placebo - Control clinical trial published in New England Journal of Medicine this week found that hydroxychloroquine DO not prevent people from getting COVID - 19 if they were exposed TO VIRUS. The FDA has also issued warning that DRUGs should only be taken in hospitals because of the risk of heart complications.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

What next?

Severe Acute respiratory syndrome coronavirus 2 is a global, rapidly emerging virus causing coronavirus Disease 2019. 1 Current public health strategies to mitigate transmission are rapid identification of cases, isolation, contact tracing, and self - quarantine of those expose. Once a person is expose, observation and quarantine during a 14 - day incubation period is standard of care. To date, no medication has been shown to prevent SARS - COV - 2 transmission. Both chloroquine and the derivative molecule Hydroxychloroquine have in vitro activity against SARS - COV and SARS - COV - 2. 2 3 Hydroxychloroquine is thought to impair terminal glycosylation of angiotensin - converting - enzyme 2 receptor, which is binding site for envelope spike glycoprotein and has been shown to inhibit endolysosome function. 2 4 in addition, Hydroxychloroquine may have greater in vitro activity against SARS - COV - 2 than chloroquine. The majority of clinical studies of chloroquine or Hydroxychloroquine for COVID - 19 have focused on hospitalized patients. 5 - 8 Yet, to alter the trajectory of epidemic, it is necessary to break the chain of transmission. The risk of secondary household transmission has been estimated as 10 to 15%. 9 10 Small, nonrandomized, noncontrolled cohort studies have suggested that use of Hydroxychloroquine might reduce or even eliminate this risk. 11 Whether short - term high - dose Hydroxychloroquine can prevent disease soon after high - risk exposure remains unknown. We hypothesize that Hydroxychloroquine could potentially be used as postexposure prophylaxis, to prevent symptomatic infection after exposure to COVID - 19. In this randomize, double - blind, placebo - Control trial, we investigated the efficacy of Hydroxychloroquine as COVID - 19 postexposure prophylaxis. In this trial, high doses of Hydroxychloroquine do not prevent illness compatible with COVID - 19 when initiated within 4 days after high - risk or moderate - risk exposure. We use a pragmatic approach to recruitment and follow - up of participants through Internet - base Self - referral and online follow - up surveys, and we couriered trial interventions directly to participants ' homes. This approach allows for recruitment across North America, minimizes risk of SARS - COV - 2 Infection to researchers, lowers the burden of research participation, and provides a timely answer to the question of whether postexposure prophylaxis was effective. Moreover, this approach allows broad geographic participation regardless of anyone's physical distance from academic centers, increasing generalizability of findings. One result of our approach was that enrolled participants were generally younger and healthier than those at risk for severe COVID - 19. Although risk of severe COVID - 19 is related to age and coexisting conditions, risk of acquiring symptomatic infection is generally still present among adults, regardless of age. Although PCR or serologic testing for asymptomatic infection would have added to the scientific strength of this trial, this was not possible, and we cannot assess the effect on mild or asymptomatic infections. Although marginal possible benefit from prophylaxis in more at - risk groups cannot be ruled out, potential risks that are associated with Hydroxychloroquine may also be increased in more at - risk populations, and this may essentially negate any benefits that were not shown in this large trial involving younger, healthier participants. We acknowledge that this trial has limitations.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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