Watching the press release last week of the FDA listing the medications currently being studied for possible use against coronavirus, I was intrigued when the official mentioned 2 drugs as possible treatment options, chloroquine and hydroxychloroquine. I am personally familiar with hydroxychloroquine because I took it for several years to successfully treat my lupus.
Ten years ago, my upper arms and lower abdominal muscles started swelling and hurting. When the pain got so bad I couldn’t turn over in bed by myself, raise my arms above my shoulders, or lift more than 5 pounds, I got scared. At the same time, my hands broke out in an itchy, painful rash, and my cuticles became so exquisitely tender that I could barely stand to wash my hands.
When I saw my family doctor, he explained that I had a type of autoimmune disease called lupus and prescribed prednisone. If I am very lucky I will NEVER, ever take that demonic medicine ever again. While I was taking the prednisone, I couldn’t eat, I could barely sleep, and had several very scary “out of body” experiences. After only one week, I quit taking it and begged my doctor for something else.
He referred me to a colleague of his, a rheumatologist at Virginia Mason Hospital in Seattle, who I found out also takes care of my younger sister. Evidently, she and I both have lupus, although she has a different type than I do. With lupus, your body attacks its own cells, creating inflammation, pain, and sometimes permanent scarring. While some types of lupus affect blood vessels or organs, I have the dermatomyositis form, which targets your skin and muscles.
My rheumatologist started me on hydroxychloroquine, the exact same drug that the FDA is now studying for use against coronavirus. Both hydroxychloroquine and its parent drug, chloroquine have been around since the mid-1940s and were originally developed and marketed as alternatives to quinine to treat malaria.
Malaria is an illness caused by a parasite called plasmodium that lives on blood. Plasmodium is transmitted from one host to another by the bite of an infected mosquito. Although malaria used to be common in parts of the United States, today nearly all cases are acquired abroad, either in travelers returning home or recent immigrants.
Half of the world’s population is at risk of developing malaria. In 2015 there were an estimated 214 million cases of malaria worldwide, 85% caused by the parasite Plasmodium falciparum, causing 438,000 deaths. Malaria from P. falciparum causes infected red blood cells to stick to the sides of blood vessels, blocking oxygen delivery to your organs, and can be fatal if not treated.
Quinine was the first drug found to be helpful against malaria. A Jesuit missionary in South America heard about the amazing healing properties of the bark of the cinchona tree in treating malaria. Native to the Andes mountains of Peru and Ecuador from the local indigenous people the padre passed on the knowledge of the cinchona bark cure to Europe.
As news spread of the cure for malaria, the cinchona tree was imported and cultivated in India and Indonesia, producing the drugs quinine and quinidine. While quinine treated malaria, quinidine was a heart suppressant used to control certain types of irregular heartbeat. Quinidine is rarely used today because safer heart medicines are available.
Quinine exists outside of malaria remedies in both tonic water and vermouth, a flavored wine used in making martinis. An extremely bitter compound, just a small amount of quinine gives tonic water and vermouth their characteristic “bite”.
When Japan captured Indonesia during World War II, it cut off the source of 90% of the world’s supply of quinine. Although German scientists found a replacement medication fairly quickly, called quinacrine, it eventually proved to be too toxic to be used for long periods of time and could not prevent malaria.
With quinine still unavailable during the 1940s, the governments of both Germany and the United States each assigned task forces of scientists to discover and develop replacement antimalarial medicines. Ironically, although each group worked independently, they both came up with the same solution: the discovery of chloroquine and a compound closely related but less toxic, hydroxychloroquine.
Chloroquine and hydroxychloroquine don’t have just the ability to combat malaria. The scientists who developed these medicines found that they also had potent anti-inflammatory properties, particularly helpful in easing the pain and stiffness of rheumatoid arthritis (RA). Hydroxychloroquine continues to be frequently used for both RA and lupus, chloroquine is reserved for treating malaria that has become resistant to other medicines.
Taking hydroxychloroquine brought my lupus under control. Let’s hope that either it or its close relative chloroquine can be found useful in today’s fight against the COVID-19 coronavirus.
If you have questions about any medication related issue, don’t be shy, go right ahead and ask me!
