Doctors from AIIMS Defend HCQ Use in Lancet, Say 'Use in High-risk Groups a Prudent Approach'

Nikhil Ghanekar

New Delhi: Days after the central government expanded use of anti-malarial drug hydroxychloroquine (HCQ) as preventive care against Covid-19, doctors from All India Institute of Medical Sciences (AIIMS) have defended its use through a correspondence in The Lancet journal. The correspondence was in response to a view written by doctors from Wardha and Delhi which was also published in Lancet criticizing use of HCQ’s as a prophylaxis.

In their correspondence, the AIIMS doctors argue that haemolysis or damage to red blood cells, is not clinically significant when HCQ is administered in usual therapeutic doses to individuals with WHO class II and III glucose-6-phosphate dehydrogenase deficiency (G6PD). G6PD deficiency is a condition that is inherited and involves deficiency of the glucose-6 phosphate dehydrogenase enzyme. The paucity of this enzyme can lead to hemolytic anemia. Doctors had earlier raised concerns that the prevalence of GP6D in Indians makes use of HCQ a risky proposition as anti-malarial medicines can damage red blood cells.

The AIIMS doctors also argued that the use of HCQ as prophylaxis in selected groups of high-risk contacts is a prudent approach considering the risk-benefit analysis. They added that the drug would only be used among a targeted group which is at high risk rather than the general population.

The doctors cited a French study that suggested reduction of viral shedding and symptoms and a South Korean study that showed HCQ was effective for in a post-exposure setting. However, doctors pointed out that the French study received a lot of flak from the scientific community and doctors for its small sample size of just 26 patients.

“I am glad there is a discussion and debate happening. However, all three studies they quoted, from a research perspective, have methodological flaws and their results cannot be extrapolated. You cannot apply bad science to people. More importantly, Lancet published the biggest observational study on HCQ which showed that the drug also harmed people. Admittedly, this study too has flaws but it certainly cannot be ignored,” said Dr.Shri Prakash Kalantri, Director Professor of Medicine, Mahatma Gandhi Institute of Medical Sciences and Medical Superintendent of Kasturba Hospital.

Kalantri was also one of the co-authors of the April correspondence that the AIIMS doctors were responding to. News18.com sought a comment over e-mail and also called Dr.Manish Soneja, additional professor, Department of Medicine, AIIMS, who has co-authored the defence of HCQ use. However, there was no response. The story will be updated if we receive a response.

Dr Kalantri added that Indian Council of Medical Research (ICMR) should make its stand on HCQ clear. “ICMR should have taken the stand that we don’t have the data, we are not sure. We would have appreciated this honesty. ICMR is one of the highest scientific body in the country, but it gave a generic, blanket recommendation. It should have launched a multicentre randomized controlled trial and they ought to have come out with its results. Instead, they are doing observational studies and it is a waste of time to do such studies right now,” he said.