Chromatography Assesses Hydroxychloroquine Dosing for COVID-19 Patients

Since December 2019, the World has been in the grip of a disease whose outbreak is like something that even Hollywood could not have thought possible. The outbreak of COVID-19, due to the virus SARS-Cov-2, has spread from China and reached all corners. The World Health Organization described the outbreak as a pandemic. There were no medicines that had demonstrated clinical efficacy against the disease by the end of March – it was a case of managing symptoms.

There were several drugs and strategies that were undergoing rapid clinical trials, both to treat the disease and to find a vaccine. One promising option that medical researchers hoped might prove effective was the drug hydroxychloroquine or HCQ. There are many trials looking at HCQ, and there have been several controversies around these trials. Let us look at one trial that looked at one aspect of using HCQ as a COVID-9 treatment – how much should we give?

What is hydroxychloroquine?

HCQ is in a family of drugs known as disease modifying anti rheumatic drugs or DMARD. It is used to treat rheumatoid arthritis and lupus. It is also used to treat and prevent malaria, although newer drugs have replaced HCQ in recent years. It works by slowing down the progression of arthritis but is not a cure.

HCQ acts as an immunomodulator and does not work as an immunosuppressant. It can alter or modulate the cytokine release storm – an inflammatory process set off in the body as a response to a disease or other medical condition. The release of the cytokines or proteins can lead to organ failure and death. The storm is not considered a medical condition, but a response or medical issue due to other underlying issues.

How much to take?

In COVID-19 cases, it is the elevation in several inflammatory cytokines that are thought to be involved in the development of acute respiratory distress syndrome, the leading cause of death in people dealing with COVID-19 illness. It is the ability of HCQ to modulate immune responses that makes it an attractive COVID-19 medicine. In a paper published in the journal Clinical Infectious Diseases, researchers in France looked to optimise the dose of HCQ for patients in Intensive Care Units.

The team based at the Saint Etienne University Hospital in France analysed the HCQ levels in serum samples routinely taken from patients in ICU. The patients had received a standard dose of 200mg of HCQ three times daily. The samples were analysed using liquid chromatography-mass spectrometry. The use of liquid chromatography to quickly analyse samples is discussed in the article, Practical Considerations for High-Throughput Chiral Screening in HPLC and SFC with 3- and Sub-2-µm Particle-Packed Columns.

The authors suggest that further pharmacokinetic studies are needed to find the optimum dose of HCQ. However, they suggest a starting point of 800mg on day 1, followed by 200mg twice daily for seven days.

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