Plasma Dropped from COVID Guidelines: What About HCQ, Ivermectin?
Late on Monday, 17 May, an advisory from the Indian Council of Medical Research (ICMR) finally dropped the use of convalescent plasma from the recommended treatment guidelines for COVID-19.
Scientists and public health experts have been egging on the government to revise their guidelines and use “evidence-based treatment options.”
Just last week, Indian healthcare professionals - including Dr Soumyadeep Bhaumik, Dr Gagandeep Kang, Dr Soumitra Pathare and Dr Shahid Jameel - wrote an open letter to the government calling out the “irrational and non-scientific use of convalescent plasma for COVID-19.”
The ICMR was the first in the world to conduct trials that proved plasma’s ineffectiveness in fighting COVID-19 through their PLACID trial, so why did it take them over a year to discontinue it from official guidelines?
A word of caution: While the ICMR’s National Task Force and health ministry experts do update the guidelines on recommended treatment options, they are merely guidelines and no doctor is bound by these.
Why is the Government Not Following the Evidence?
While the ICMR’s decision has been lauded by scientists, there is still confusion as to why hydroxychloroquine and Ivermectin find a place in them.
The guidelines have the two tabs under a column called ‘May Do's’ and they clarify the following therapies are based on “low certainties of evidence.” Why then are these drugs on the recommended guidelines given their low rate of effectiveness? These guidelines pressure doctors into prescribing drugs that they know won't work and relatives into spending excessive amounts of money to buy them.
It’s a vicious cycle, and critical care expert Dr Sumit Ray says that he understands both the families and the doctor's side of things. “The families are desperate and will want to try anything, and doctors are under pressure by the highly publicised nature of these medicines and the general panic in the air.”
Both Dr Ray and Dr Bhaumik say the patients cannot be blamed right now as clear guidelines need to help reduce the panic.
What’s The Problem with Ivermectin & HCQ? Here’s the Evidence
While a definitive cure does not exist for COVDID-19 and it is treated symptomatically, repurposed drugs - drugs already existing for some treatments like Remdesivir, Ivermectin and HCQ are being 'repurposed' for coronavirus. But are these effective for all COVID-19 patients? What are the risks and benefits? And what complications should patients be aware of?
Dr Bhaumik explains how these details should be part of the guidelines.
“We have a paternalistic style of medicine in our country. If we think of it fairly, it’s MY body and if an intervention is being done I need to know. This is what shared-decision making is.”Dr Soumyadeep Bhaumik
He concedes that a detailed discussion with the patient and families might not always be possible in a pandemic scenario, but “basic details like the side-effects and chances of benefits need to be shared. Being in a crisis does not mean we give our rights and ethics away even to a doctor.”
“Putting up a flow-chart with no background documentation or saying which drug or therapy affects which outcome and by how much doesn’t help doctors make decisions. It’s a kind of copy-paste medicine rather than being able to optimise therapy as best for the patients. This is the number one problem with the AIIMS-ICMR guidelines,” he adds.
Ivermectin is a deworming drug used to treat and prevent parasites in animals, particularly in horses. In humans, it is used to treat certain intestinal and topical parasitic worms and skin conditions.
According to the WHO, It is also used in the treatment of scabies, onchocerciasis (river blindness), strongyloidiasis and other diseases caused by soil-transmitted helminthiasis.
In March of 2021, the WHO had previously already said that the current evidence on the use of ivermectin drug to treat COVID-19 patients is inconclusive, and recommended that the drug only be used within clinical trials. Currently, all major health authorities of the world, including the US Food and Drug Administration (FDA), and the European Medicines Agency (EMA) had discouraged the use of Ivermectin for the treatment of COVID.
Dr Chandrakant Lahariya, epidemiologist, and public health and policy expert, explains, "scientifically we know that ivermectin is an antiparasitic drug, whereas COVID 19 is a viral infection. So there is no plausible explanation for how an antiparasitic drug can treat COVID."
On 3 March, WHO put out a statement warning against the use of Hydroxychloroquine (HCQ) to prevent infection in people who don’t have COVID-19.
This ‘strong recommendation’—updated in their latest clinical care covid guidelines—comes after World Health Organisation (WHO) put out a previous recommendation discouraging the use of HCQ for a treatment for COVID altogether.
“The international guideline development panel considers that hydroxychloroquine is no longer a research priority and that resources should be used to evaluate other more promising drugs to prevent.”World Health Organisation (WHO)
A study by The New England Journal of Medicine backed the findings that HCQ did not improve the status of mild-to-moderate COVID-19 patients. Another study published in the peer-reviewed journal, The BMJ, showed that the effect of HCQ in treating Covid, as compared to standard care was very low.
Apart from studies pointing to its lack of efficiency in combatting or preventing covid, the side effects and serious risks associated with the drug make it an even less viable option.
“In light of ongoing serious cardiac adverse events and other serious side effects, the known and potential benefits”The US Food and Drug Administration, in a statement
Besides, the dodgy evidence is not enough to re-allocate the limited HCQ medication for covid treatment when it's indispensable to people suffering from other conditions like Lupus and Arthritis, who started facing a shortage thanks to the initial buzz about the ‘miracle drug’ for covid.
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