The anti-malaria drug that is being touted by President Donald Trump as a Covid treatment has associated risks, including a genetic-based risk for people with ethnic ties to tropical regions where malaria is most common.
Descendants from those regions can carry a genetic characteristic that is an age-old immunity adaptation that resists malaria. The occurrence is less than 10 percent, but the consequences can be fatal. Anti-malaria therapies on patients with glucose-6-dehydrogenase deficiency, or G6PD, can cause a disorder making it hard for the lungs to process oxygen.
“The use of anti-malaria drugs in patients with G6PD deficiency can lead to a reaction known as ‘hemolytic anemia,’ where the red blood cells break apart. There are a number of drugs that should be avoided in patients with this deficiency, including hydroxychloroquine, chloroquine, acetaminophen, quinine and some antibiotics known as sulfa drugs,” says Randall Moreadith, a medical doctor and CEO of Serina Therapeutics, a drug development company that is a resident associate company at the HudsonAlpha Institute for Biotechnology.
Hydroxychloroquine is the drug that Trump is taking and recommending to the general public. The FDA recently issued an emergency authorization for use of the drug for hospitalized Covid patients who cannot participate in a clinical trial.
The occurrence of G6PD deficiency among African Americans is less than 10 percent, says Moreadith. “In the U.S. the prevalence of the deficiency among African American males is less than 10 percent, and among African American females it is less than 4 percent. Among Caucasians in the U.S. it is less than 2 percent.”
Far beyond those percentages, “The higher fatality rate among African Americans infected with Covid-19 is clear — in the U.S. the case fatality rate is 2.2-2.6 fold higher,” Moreadith notes. “I don’t believe this deficiency in the U.S. is a major contributing factor to mortality among African Americans hospitalized with Covid-19. We know there are comorbid conditions that contribute to this higher mortality rate — they include hypertension, obesity, diabetes and heart disease — and all of those comorbid conditions are also higher among African Americans.
“But physicians caring from African American patients should be reminded that this deficiency exists, and it should be considered if hemolytic anemia occurs during the course of hospitalization,” says Moreadith, who also serves on the advisory board of Acclinate Genetics, a HudsonAlpha associate company dedicated to increasing the participation of ethnic minorities in clinical trials.
The use of hydroxychloroquine in combination with azithromycin, which is used to treat bacterial infections, also has been shown to increase arrhythmia and is especially risky for patients with heart conditions.