LI doctor tries new hydroxychloroquine twist for elderly COVID-19 patients

A New York doctor hopes to help his elderly COVID-19 patients with a treatment plan inspired by the success tentatively being reported with hydroxychloroquine — and which he says shows promising results.
Dr. Mohammud Alam, an infectious disease specialist affiliated with Plainview Hospital, said 81 percent of infected covid patients he treated at three Long Island nursing homes recovered from the contagion.
“In this crisis, I realized I had to do something,” Alam said. ”I realized if this was my dad, what would I do? And I would do anything I could to help.”
Alam said he decided he could not apply the touted combination of the antimalarial hydroxychloroquine and antibiotic azithromycin because the side effects could be potentially fatal for his high-risk patients, many of whom had underlying heart issues.
“I knew I could not jeopardize these patients,” Alam said.
“We know from the FDA that azithromycin can cause fatal arrhythmia and abnormal heart failure that can lead to death,” Alam said.
His patients were under long-term acute care and had comorbidities such as hypertension, coronary artery disease, chronic obstructive pulmonary disease or congestive heart failure.
The FDA has warnings that azithromycin “can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm.”
So instead, Alam replaced azithromycin with another decades-old antibiotic that doesn’t pose any known risks to the heart.
“Doxycycline is an anti-inflammatory with properties similar to azithromycin but without the safety concerns and without cardiac toxicity,” he said.
“So I decided why not choose that?” added Alam, a board-certified internist, who shared the results of an observational report consisting of 47 patients he treated.
”With the [limited]resources we have at the nursing home, we took a deep breath and realized we need to do something,” Alam said.
Alam is not the only one to begin using doxycycline in the fight against COVID-19.
Henry Ford Health System has started using combinations of the three drugs because of apparently fewer side effects, published reports state.
Alam began treating his patients, 45 of whom had tested positive for the coronavirus after they developed a high fever, shortness of breath and cough.
He received permission from their families before starting them on the medications, which have not yet undergone randomized controlled trials.
“The majority had clinical improvement,” said Alam. “We had very good outcomes.”
Alam said that 38 of 47 patients treated returned to their baseline and their symptoms resolved. Seven of the patients were transferred to a hospital and two died.
There was no control group in the study so Alam acknowledged more studies are needed to evaluate his protocol’s effectiveness.
Alam noted that an 87-year-old woman with hypertension and coronary issues beat the virus. “Her daughter was so thankful that I didn’t need to transfer her to a hospital.”
“At the end of the day we feel like we sent fewer patients to the hospitals, we saved ICU beds and we saved some of the ventilators at the hospital,“ Alam said.
One health expert said using the decades-old doxycycline, which has been studied since the 1960s, is a plausible alternative to azithromycin.
“Since we’re talking about the elderly being the most vulnerable, or people with underlying conditions, there is a theoretical benefit of doxycycline over azithromycin because doxycycline is not associated with cardiovascular disease,” said Dr. Sten H. Vermund, the dean of the Yale School of Public Health.
Vermund also cautioned a clinical trial is necessary and also noted that two patients did pass away.
“I am optimistic about this combination, but a well-designed clinical study is urgently needed to identify the appropriate patient population, optimize dosing regimen and assess the side effect profile of this combination therapy,” added Dr. Ryan Saadi, a Yale-trained infectious disease epidemiologist who is currently developing a ventilator technology at Quantaira Health.
Vermund also added that other treatment alternatives that could be just as good and less toxic should also be considered.
https://nypost.com/2020/04/04/long-island-doctor-tries-new-hydroxychloroquine-for-covid-19-patients/