Can unauthorised treatments cause harm?

Yes, there is a risk of serious harm from “unauthorised” COVID treatments that are not officially authorised by competent regulatory authorities such as MHRA in UK or FDA in USA.

If a treatment is not authorised, it should have at least have good clinical trial evidence.

India is going to a rough patch. People with COVID are desperate for treatment. There is shortage of oxygen which is a commonly used treatment.

Apart from oxygen for respiratory support, only Two treatments have been proven to be of significant help in COVID-19 pneumonia. (1) Steroids (2) An arthritis drug called Tocilizumab

Many antivirals drugs have not shown any meaningful benefit. Various other drugs are still in trials.

It is rapidly evolving area and the BMJ has a COVID guideline which is being frequently updated during this pandemic.

This is significant risk of harm from drugs which are NOT properly assessed in clinical trials.

Anecdotally there has been lot of sudden deaths in India. Lot of unproven treatments such as Azithromycin, ivermectin, antivirals agents, chloroquine, and other agents widely used in india.

Although there is no definitive proof, One cannot help wondering whether poor outcome in at least some Indian patients is related to combinations of unproven drugs that are used widely in unregulated private healthcare sector.

BMJ. Drug treatments for covid-19: living systematic review and network meta-analysis
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2980 (Published 30 July 2020)
Cite this as: BMJ 2020;370:m2980

BMJ. A living WHO guideline on drugs for covid-19 BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3379 (Published 04 September 2020).

BMJ COVID-19 Treatment algorithm.

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Anything potentially good from this COVID-19 pandemic?

It might seem foolish to ask the question “Anything good from this COVID-19 pandemic?” when so many people across the world has been so badly affected by the coronavirus pandemic.

There is some truth in the proverb that “every dark cloud has a silver lining” and no matter how bad the current pandemic is now, human spirit and endeavour would get something positive out of it.

One possible good thing that has come out of the pandemic is the “mRNA technology”.

Of the three vaccines so far, two of them the Pfizer vaccine and the Moderna vaccine are based on RNA technology.

The successful use of RNA technology for Coronavirus Vaccines would hopefully enable the versatile RNA technology to be further developed and successfully used a cancer treatment in near future.

Further clinical trials in cancer patients would be done to provide proof of their potential.

References:

Bloomberg. Technology & Ideas. mRNA Vaccines Could Vanquish Covid Today, Cancer Tomorrow.
The best news about the mRNA shots from BioNTech and Moderna is that the same technique could also defeat many other diseases.

MSKCC. In a Twist, Scientists Find Cancer Drivers Hiding in RNA, Not DNA.

Jerusalem Post Health & Science. Israeli scientists use mRNA COVID-19 vaccine technology to fight cancer. By MAAYAN JAFFE-HOFFMAN NOVEMBER 24, 2020 20:08

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

New drug treatments for COVID-19

More good news in fight against COVID-19 pandemic !

Steroids were previously proven to be effective against severe Coronavirus (COVID-19) infection. The steroids are believed to work by dampening the inflammation caused by coronavirus.

Dexamethasone and Prednisolone are the commonly used steroids.

Now two other drugs have been reported to work in COVID-19 infection. (yet to be published).

Both the anti-inflammatory drugs are not entirely new drugs as they are already routinely used for treatment of various arthritis.

The BBC reports: “The anti-inflammatory medications, given via a drip, save an extra life for every 12 treated, say researchers who have carried out a trial in NHS intensive care units”.

The two drugs “tocilizumab and sarilumab” may become available for treatment of severe COVID-19 shortly.

All these additional drug treatments are needed ONLY for severe Coronavirus (COVID-19) infection. Mild COVID-19 infections do NOT need these drug treatments.

References . BBC news. Two more life-saving Covid drugs discovered. By Michelle Roberts. Health editor, BBC News online. Published 7 Jan 2021.

BBC news. Coronavirus: Dexamethasone proves first life-saving drug. By Michelle Roberts. Health editor, BBC News online. Published 16 June 2020

BBC News. Tocilizumab: Arthritis drug may treat severe Covid. By James Gallagher. Health and science correspondent. Published 19 November 2020

BMJ. Dexamethasone in management of covid -19. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2648 (Published 03 July 2020)
Cite this as: BMJ 2020;370:m2648

BMJ. Rapid Recommendations. A living WHO guideline on drugs for covid-19. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3379 (Published 04 September 2020). Cite this as: BMJ 2020;370:m3379

BMJ. Covid-19: Arthritis drugs improve survival in intensive care patients, shows study
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n61 (Published 08 January 2021)
Cite this as: BMJ 2021;372:n61

eMC. Sarilumab is a human monoclonal antibody selective for the interleukin-6 (IL-6) receptor, produced in Chinese Hamster Ovary cells by recombinant DNA technology. (Sarilumab, administered as a subcutaneous injection is routinely used for treatment of arthritis and is not an entirely new drug).

eMC. Tocilizumab is a recombinant humanized, anti-human monoclonal antibody of the immunoglobulin G1 (IgG1) sub-class directed against soluble and membrane-bound interleukin 6 receptors. (Tocilizumab, as a intravenous or subcutaneous formulation, is routinely used for treatment of various arthritis and is also not an entirely new drug).

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Immunotherapy not superior to Chemotherapy in 1st line treatment of bladder cancer

Immunotherapy has revolutionised the treatment of many advanced cancers such Skin cancer Melanoma and Kidney cancers.

Immunotherapy is a standard treatment for 2nd line treatment of bladder cancer.

Two recent trials presented at ESMO virtual meeting explored the use of immunotherapy in 1st line setting. (Pembrolizumab and Durvalumab).

Immunotherapy alone, or in combination with Chemotherapy was not superior even in patients selected by markers thought to favour immunotherapy alone.

For most bladder cancer patients immunotherapy remains a excellent 2nd line option or as a maintenance treatment option.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

New treatment for Advanced Uterine Cancer

Women with advanced uterine / endometrial cancer are usually treated with chemotherapy.

Those who failed chemotherapy or those who are fit for chemotherapy are sometimes treated with hormone treatment.

Letrozole is one such hormone treatment for those patients with hormone sensitive cancer.

In breast cancer, Letrozole efficacy can be improved by a treatment called Palboclicib.

A trial was done to check whether the same improvement can be observed in uterine cancer when the combination of Letrozole and Palboclicib is tried.

The trial data presented at the ESMO ( European Society of Medical Oncology) is very promising.

If large trials confirm this finding, the combination would be standard treatment in future.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Chloroquine not useful for treating or preventing Coronavirus infections

Randomised Study is the considered as the gold standard for trials.

Placebos are dummy pills . Placebos are inactive drugs that look like the real drug but are essentially sugar coated dummy pills.

Trials which involve a placebo vs active drug comparison are considered one of the best trials for some clinical situations.

A “randomised trial” involving “Chloroquine ” and “placebo ” has been published in NEJM .

A randomised trial suggests Chloroquine is not better than a placebo in treatment of COVID.

Another randomised trial suggests, Hydroxycloroquine is not useful for prevention of COVID-19.

In summary, Hydroxycloroquine is not useful either as COVID-19 treatment or as a COVID-19 preventative drug as advocates in certain countries.

Please Note : Chloroquine and HydroxyChloroquine are different drugs but have broadly similar effects.

References

1. Guardian newspaper: Coronavirus outbreak. Hydroxychloroquine no better than placebo, Covid-19 study finds.

2. NEJM. https://www.nejm.org/

3. BMJ India Correspondent. Covid-19: Doctors criticise Indian research agency for recommending hydroxychloroquine prophylaxis. BMJ2020;369:m2170. doi:10.1136/bmj.m2170 pmid:32471832.

4. BMJ news: Covid-19: Hydroxychloroquine does not benefit hospitalised patients, UK trial finds. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2263 (Published 08 June 2020)

5. BMJ news. Covid-19: Hydroxychloroquine was ineffective as postexposure prophylaxis, study finds. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2242 (Published 05 June 2020)

———————————————————————–

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Is Chloroquine useful in treatment of Corona Virus?

Chloroquine and the related drug Hydroxy-Chloroquine are drugs commonly used to prevent and treat Malaria infections; and treat some Joint conditions.

During the initial stages of COVID-19 pandemic, there were some reports of Chloroquine being useful in treating Corona Virus.

A Chinese trial published in British Medical Journal BMJ now reports that ” Administration of hydroxychloroquine did not result in …. any meaningful antiviral benefits… compared to standard of care alone in patients admitted to hospital with mainly persistent mild to moderate covid-19

Chloroquine was not only useless but it had significant side effects in a minority. So Chloroquine or Hydroxy-Chloroquine should not be used routinely outside a clinical trial setting.

References

1. Hydroxychloroquine (HCQ). Wiki. https://en.m.wikipedia.org/wiki/Hydroxychloroquine

2. BMJ. Chloroquine and hydroxychloroquine in covid-19. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1432 (Published 08 April 2020)

3. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1849 (Published 14 May 2020)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.