A preliminary trials on the use of chloroquine and hydroxychloroquine as prophylaxis for COVID-19 in Nigeria has recorded some level of success.
The study protocol, sponsored by LiveWell Initiative in collaboration with frontline healthcare workers in the country, has undergone hypothesis testing among physicians, researchers and pharmacists with debates on several professional health platforms.
The results are based on preliminary data gathered from physician-patient compassionate use as prophylaxis and off-label use of chloroquine, hydroxychloroquine and quinine in treatment of moderate to advanced COVID-19. It also recognises some self-medicating individuals who took advantage of the non-prescription remedy.
In a statement released by the Chief Executive Officer of LWI, Pharm. (Mrs) Bisi Bright, 123 volunteers were involved in the study of which 110 were on prophylaxis and 13 on treatment.
“The preliminary data also included a few self-medicating members of the public who did so under guidance. Out of the 110 on prophylaxis, there were 76 men and 34 women to corroborate the fact.
“Our LWI Study Protocol recommends quinine for all COVID-19 inpatients (oral for regular inpatients and intravenous for ICU Patients)” she said.
According to her, quinine crosses the blood-brain barrier into the alveoli which gives it an added advantage over chloroquine and hydroxychloroquine in COVID-19 and picks up where CQ/ HCQ stop.
“That, of course, is in advanced COVID-19 treatment especially during Cytokine Storm. The side effects are self- limiting. Reversible ototoxicity is the commonest but the benefit of administering it outweighs the risk of losing a life to COVID-19.
“The terminal disequilibrium caused by COVID-19 is lethal and is better not experienced. The study protocols are currently being used in Kaduna, Bauchi and some other states in Nigeria,” she said.
Bright explained that the study protocol comprises six segments namely pre-exposure prophylaxis, post-exposure prophylaxis, post-exposure prophylaxis, ambulatory care, inpatients care, intensive care unit, post-discharge intermittent and post-discharge intermittent prophylactic therapy.
As part of the empirical data garnered, the Assistant Secretary General of Healthcare Federation of Nigeria noted that the COVID-19 team deployed by LiveWell Initiative in Kaduna received positive feedback from the State Government which has adopted the protocol for trial.
There are reports that Bauchi State also adopted the protocol after debates while a self-isolated traveler in Chevron, Lagos, recovered after she was placed on PEP following her physician’s advice.
In Canada, a patient on admission at an intensive care unit was discharged after fully recovering on injectable quinine instituted by her physician while another patient, self-quarantined nurse in the United Kingdom fully recovered after PEP.
In Oyo Isolation Centre, all 11 patients placed on the 4-Aminoquinolines were discharged after full recovery.
Other designated facilities which have procured the protocols, with ongoing communication with LWI are Lilly Hospital, Warri; FMC, Keffi; FMC, Keffi; Faith Multiplex Hospital, Benin City; Babcock University, Ilishan; Plateau State Government, Jos; Lagos University Teaching Hospital; AKTH Akwa Ibom State and AKTH Akwa Ibom State.
The LWI boss identified the 4-Aminoquinolines deployed for the preliminary study as chloroquine / hydroxychloroquine for PreP and PEP therapy, chloroquine / hydroxychloroquine for ambulatory care, quinine oral for inpatient care, injectable quinine for critical care patient and CQ/HCQ for post-discharge intermittent prophylactic therapy.
“Chloroquine and hydroxychloroquine prophylaxis works effectively for COVID-19 prophylaxis as all the clients recovered fully, after six weeks post-lockdown. None of the 110 patients placed on prophylaxis has progressed into full-blown COVID-19.
“The drug combination is relevant for ambulatory care as the laboratory tested positive healthcare worker on self-quarantine who was treated with chloroquine is fully recovered, up to six weeks post-lockdown with no relapse and having tested negative twice post-treatment,” she said.
Speaking further, Bright observed that there was 100 per cent positive outcome and zero deaths with 4-Aminoquinolines in COVID-19 response, stressing that quinine works in an advanced stage of COVID-19 as the case of the single laboratory tested positive client has shown.
“Although it has been proven that CQ/HCQ is effective in early COVID-19, more studies will be needed due to the small sample size deployed while quinine is effective in advanced stage of COVID-19 including ICU.
“However, post-treatment intermittent prophylaxis is recommended in COVID-19. This explains why I mentioned earlier that more studies are needed,” she said.
According to her, the LWI Study Protocols for COVID-19 response are affordable, scalable, and replicable for all Africans and in the Diaspora.
“Recently it was discovered that some tertiary health institutions are using the LWI Study Protocols for COVID-19 prophylaxis and outpatient care. The reason is obvious.
“Chloroquine /hydroxychloroquine has multiple modes of action which prevents the virus from penetrating the host cell using its S protein and Protease. It breaks the polymerase chain and prevents viral replication.
“It is a zinc ionophore and ensures penetration of zinc into the viral cell, altering the Ph. The Zinc also potentiates chloroquine action leading to a good safety profile in therapeutic doses,” she said.
The Chief Executive Officer of LiveWell Initiative reaffirmed that her COVID-19 team has co-hosted a webinar on 25 April 2020 with WHO Nigeria, International Pharmaceutical Federation, AFROPHARM, and EMROPHARM to further discuss on the innovations of the three phases of its study protocol.
“Our objective is to work alongside with governments of Africa and other healthcare stakeholders in the continent to join hands in reducing and eliminating the spread of the COVID-19 virus through hypothesis testing of our study protocol,” she emphasized.