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| CORRESPONDENCE |
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| Year : 2020 | Volume
: 152
| Issue : 1 | Page : 125-126 |
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Authors' response
Pranab Chatterjee1, Tanu Anand2, Kh Jitenkumar Singh3, Reeta Rasaily4, Ravinder Singh5, Santasabuj Das6, Harpreet Singh7, Ira Praharaj8, Raman R Gangakhedkar8, Balram Bhargava9, Samiran Panda10
1 Translational Global Health Policy Research Cell, New Delhi, India
2 Multidisciplinary Research Unit/Model Rural Health Research Unit, New Delhi, India
3 ICMR-National Institute of Medical Statistics, New Delhi, India
4 Division of Reproductive Biology, Maternal Health & Child Health, New Delhi, India
5 Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
6 Division of Clinical Medicine, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
7 Informatics, Systems & Research Management Cell, Indian Council of Medical Research, New Delhi, India
8 Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
9 Department of Health Research, Ministry of Health & Family Welfare; Indian Council of Medical Research, New Delhi, India
10 ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| Date of Web Publication | 13-Aug-2020 |
Correspondence Address:
Samiran Panda
ICMR-National AIDS Research Institute, Pune, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
Read associated with this article DOI: 10.4103/0971-5916.292028
How to cite this article:
Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Authors' response. Indian J Med Res 2020;152:125-6 |
How to cite this URL:
Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Authors' response. Indian J Med Res [serial online] 2020 [cited 2021 Jan 26];152:125-6. Available from: https://www.ijmr.org.in/text.asp?2020/152/1/125/292028 |
We thank the author for a close reading of our article and for suggesting an alternate dosing regimen of HCQ for prophylaxis against SARS-CoV-2 infection[1]. Given that the dosing proposed by the author is higher than the current recommendation, we feel that it would be prudent to establish the safety as well as efficacy of the proposed regimen through clinical studies. There is evidence from physiology-based pharmacokinetic models, which suggest that even at lower doses HCQ can attain pulmonary concentrations at which it may exhibit anti-SARS-CoV-2 properties in vitro[2]. Other models, which define the distribution of CQ in human beings, have suggested that once weekly dosing regimen could help attain effective drug concentration in the lungs[3].
Further, single-dose kinetic studies of CQ used for malaria chemoprophylaxis indicate that adequate plasma concentrations are achieved after four weeks of use, before which the individual remains susceptible to contract malaria[4]. We further agree with the author that it is likely to take some time before the dose-dependent effect of HCQ countering SARS-CoV-2 infection starts operating in vivo[5],[6] through effective concentration built-up in the lungs.
We conclude that the currently recommended regimen has some supporting evidence based on laboratory studies and clinical experience of using HCQ for malaria chemoprophylaxis. We also maintain that it would be more appropriate to adhere to stringent use of PPE and preventive measures, such as personal hygiene, social distancing and frequent hand washing along with the currently recommended regimen of HCQ prophylaxis for healthcare workers, until the safety of a higher dose regimen is demonstrated in clinical studies.
 References | |  |
| 1. | Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, et al. Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. Indian J Med Res 2020; 151 : 459-67.  |
| 2. | Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020; 71 : 732-9. |
| 3. | Aljayyoussi G, Rajoli R, Pertinez H, PenningtonS, Hong DW, O'Neill P, et al. Modelling of systemic versus pulmonary chloroquine exposure in man for COVID-19 dose selection. medRxiv 2020. doi: 10.1101/2020.04.24.20078741. |
| 4. | Frisk-Holmberg M, Bergqvist Y, Termond E, Domeij-Nyberg B. The single dose kinetics of chloroquine and its major metabolite desethylchloroquine in healthy subjects. Eur J Clin Pharmacol 1984; 26 : 521-30. |
| 5. | Adelusi SA, Salako LA. Kinetics of the distribution and elimination of chloroquine in the rat. Gen Pharmacol 1982; 13 : 433-7. |
| 6. | Smit C, Peeters MYM, van den Anker JN, Knibbe CAJ. Chloroquine for SARS-CoV-2: Implications of its unique pharmacokinetic and safety properties. Clin Pharmacokinet 2020; 59 : 659-69. |
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