In recent days, a drug has come to the fore, which is being tested and successfully to stop and improve the symptoms of COVID-19 but which is also used in certain pregnancies and whose absence can increase the risk of miscarriage. The discovery of its use to stop the pandemic has made health authorities take control of its stock and can leave couples and / or pregnant women who need it without supply.
We wanted to ask Dr. Diana Alecsandru, from IVI’s Immunology and Reproductive Failure Unit, to tell us in this post what Dolquine is and how the situation is currently:
In these difficult times abruptly imposed by COVID-19, we want to be close to you and all the couples affected by the difficulty we are experiencing, that of being difficult to follow up with the treatment of hydroxychloroquine, Dolquine during pregnancy.
Being a treatment that has demonstrated clinical benefit in the fight against COVID-19, sales restrictions have been imposed in pharmacies and this has affected many of our patients, since the inflammatory and autoimmune clinical situations that affect the placenta, such as Lupus, antiphospholipid syndrome increasing the risk of abortion, or fetal protection in those patients with positive antiRo and antiLa Ac are not included in the list for sale in pharmacies of hydroxychloroquine.
Hydroxychloroquine and COVID-19
In COVID-19, the immune responses induced by SARS-CoV-2 (the coronavirus) have several phases: viral invasion, with mild symptoms, which initiates an immune response to stop the multiplication of the virus and subsequent initiation of a more specific one with formation of antibodies to block the entry of the virus into cells.
In some people, the virus multiplies and infects rapidly before the immune system manages to stop it, especially in those exposed to high amounts of virus called viral load (health personnel – the most exposed).
The higher the viral load, the more difficult it is for the immune system to deal with it, and this can cause you to lose control over the virus. Another reason the body loses control over the virus is the host’s own immune system. The most vulnerable population is the elderly population and people with immunosuppression secondary to other pathologies such as cancer, or secondary to medication. Under these conditions, the initial response of the immune system, which must stop the multiplication and prevent new cells from being infected by the virus, is weak and late and this allows the virus to spread in the body without control.
When the protective immune response is defective, the virus spreads and causes massive destruction of infected cells and tissues, especially in the lung, intestine or kidney with progression to pneumonia.
Some of this tissue damage is caused by the virus, but even more is due to the action of the host’s immune system in its attempt to destroy infected cells.
Infected and damaged cells induce inflammatory responses in the lungs
At this point, the disease can go in 2 directions: the response of the immune system remains stable and it regains control over the virus, eliminating it with the help of antibodies and specialized cells. Or, the immune system begins to over-respond by producing more and more inflammatory proteins called cytokines and inducing a situation called a “cytokine storm.” It is this second part that causes cell death in the lungs, leading to a severe infection with severe respiratory problems and death in some severe cases. Pulmonary inflammation is the major cause of severity and mortality at this stage.
Hydroxychloroquine helps by “calming” the immune system and preventing an exaggerated response, and at the same time, lowering the pH within cells prevents viral replication and other healthy cells from being infected. Therefore, it is a very important therapy, which prevents immune damage and prevents the disease from evolving into a critical situation.
Therefore, all of us, healthcare professionals and patients, understand and support the priority use in saving lives affected by Covid-19, but we also support its use in those gestation whose placenta faces an inflammatory immune problem that can cause damage and loss fetal and where, the use of dolquine contributes to immune control in order to create a new life.
The current situation has forced many couples to interrupt their path to motherhood and fatherhood, but many others have fulfilled their dream, achieving the desired pregnancy in the midst of the pandemic and are now facing the added stress of not being able to continue with their medication. prescribed to reduce the risk of abortion or cardiac involvement in the fetus.
Acquire it with a medical report
Health professionals understand the circumstances and from IVI, together with the Infertile Network, which provides extraordinary support to our patients and to us, the doctors, we have requested the health authorities to include pregnant patients who have a clinical indication for the use of hydroxychloroquine, in the list of its sale under the presentation of a medical report that it justifies it.
All this is aimed at helping to preserve pregnancy and reduce the risk of abortion in those pregnant women who need its use.
We are aware of the difficult situation we are going through in the context of the pandemic and we want to protect our patients and ongoing pregnancies and at the same time ensure a responsible use of hydroxychloroquine in the clinical situations mentioned.
The health authorities are open to solving this problem as soon as possible and new meetings are planned with the Infértiles Network. We all hope to have this inclusion quickly and that we can give you the good news soon.
I hope that all and your partners and family are well. Stay at home. Every day we are closer to resuming our path temporarily interrupted by the pandemic and celebrating many births very soon.
We send you a big hug and a lot of encouragement,
By Dr. Diana Alecsandru
IMMUNOLOGY AND REPRODUCTIVE FAILURE UNIT
IVI Madrid
