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Jun 4: A malaria drug President Donald Trump took to try to prevent COVID-19 proved ineffective for that in the first large, high-quality study to test it in people in close contact with someone with the disease.

Results published Wednesday by the New England Journal of Medicine show that hydroxychloroquine was no better than placebo pills at preventing illness from the coronavirus.

The drug did not seem to cause serious harm, though -- about 40% on it had side effects, mostly mild stomach problems.

 “We were disappointed. We would have liked for this to work,” said the study leader, Dr. David Boulware, an infectious disease specialist at the University of Minnesota.

“But our objective was to answer the question and to conduct a high-quality study,” because the evidence on the drug so far has been inconclusive, he said.

Hydroxychloroquine and a similar drug, chloroquine, have been the subject of much debate since Trump started promoting them in March.

Hydroxychloroquine has long been used for malaria, lupus, and rheumatoid arthritis, but no large studies have shown it or chloroquine to be safe or effective for much sicker patients with coronavirus, and some studies have suggested the drugs may do harm.

Trump took a two-week course of hydroxychloroquine, along with zinc and Vitamin D, after two staffers tested positive for COVID-19, and had no ill effects, according to results of his latest physical released by his doctor Wednesday.

Federal regulators have warned against hydroxychloroquine's use except in hospitals and formal studies because of the risk of side effects, especially heart rhythm problems.

Boulware's study involved 821 people in the United States and Canada living with someone diagnosed with COVID-19 or at high risk of getting it because of their job -- doctors, nurses, ambulance workers who had significant exposure to a sick patient while not wearing full protective gear.

They were randomly assigned to get either the nutrient folate as a placebo or hydroxychloroquine for five days, starting within four days of their exposure. Neither they nor others involved in the research knew who was getting which pills.

After 14 days in the study, 12 per cent on the drug developed COVID-19 symptoms versus 14 per cent in the placebo group, but the difference is so small it could have occurred by chance, Boulware said.

“There's basically no effect. It does not prevent infection,” he said of the drug. Even if it were to give some slim advantage, “we'd want a much larger effect” to justify its use and risk of side effects for preventing illness, he said.

Results were no different among a subgroup of participants who were taking zinc or vitamin C, which some people believe might help make hydroxychloroquine more effective or fight the coronavirus.

There are some big caveats: The study enrolled people through the Internet and social media, relying on them to report their own symptoms rather than having them tracked in a formal way by doctors.

Participants were not all tested for the coronavirus but were diagnosed as COVID-19 cases based on symptoms in many cases. And not all took their medicines as directed.

The results “are more provocative than definitive,” and the drug may yet have prevention benefits if tried sooner or in a different way, Dr. Myron Cohen of the University of North Carolina at Chapel Hill wrote in a commentary in the journal.

Others were glad to see a study that had a comparison group and good scientific methods after so many weaker reports on hydroxychloroquine.

“This fits with everything else we've seen so far which suggests that it's not beneficial," said Dr. Peter Bach, director of a health policy center at Memorial Sloan Kettering Cancer Center in New York.

This study was in younger relatively healthy people, but the results “would make me very discouraged about trying to use this in older people” who are most vulnerable to serious illness from the coronavirus, Bach said.

“If it does work, it doesn't work very well.” Dr. Dan Culver, a lung specialist at the Cleveland Clinic, said there's still a chance that giving the drug sooner than four days after someone's exposure to the virus may help prevent illness.

But the study “takes 'home run' off the table” as far as hopes for the drug, he said.

The study was mostly funded by David Baszucki, founder of Roblox, a California-based game software company, and other private donors and the Minnesota university.

Boulware also is leading a study testing hydroxychloroquine for treating COVID-19. The study is finished and results are being analyzed now.

On Tuesday, the journal Lancet posted an “expression of concern” about a study it published earlier this month of nearly 15,000 COVID-19 patients on the malaria drugs that tied their use to a higher risk of dying in the hospital or developing a heartbeat problem.

Scientists have raised serious questions about the database used for that study, and its authors have launched an independent audit.

That work had a big impact: the World Health Organization suspended use of hydroxychloroquine in a study it is leading, and French officials stopped the drug's use in hospitals. On Wednesday, the WHO said experts who reviewed safety information decided that its study could resume.

New Delhi, Jun 18: Reliance Industries Ltd on Thursday said it has sold a 2.32 per cent stake in its digital unit to Saudi Arabia's Public Investment Fund (PIF) for Rs 11,367 crore, taking the cumulative fund raising to about Rs 1.16 lakh crore in two months.

Starting with Facebook Inc on April 22, Reliance has sold almost 25 per cent of equity in Jio Platforms - the maximum reports suggest the company intends to dilute to financial investors.

The investment by Saudi sovereign wealth fund is "at an equity value of Rs 4.91 lakh crore and an enterprise value of Rs 5.16 lakh crore", the company said in a statement.

With this investment, Jio Platforms has raised Rs 115,693.95 crore from some of the leading global investment powerhouses at a time when the world is deeply impacted by the coronavirus pandemic, resulting in a recession kind of environment for the global economy.

"With the addition of PIF's investment, Jio Platforms has established partnerships with a marquee set of global financial investors, who will contribute to establishing the Digital Society vision for India," the statement said.

Jio Platforms houses India's biggest telecom firm by subscribers, Reliance Jio. With more than 388 million users, Jio has forced out several rivals and driven consolidation in the sector since entering the market in 2016 with free voice services and cut-price data.

Over the past two months, billionaire Mukesh Ambani's oil-to-telecom conglomerate has announced the sale of about $14 billion of assets, completed a Rs 53,124 crore rights issue and slowed the run rate of new investment by a quarter.

These will help Reliance meet its target of paying off Rs 1.61 lakh crore of net debt by the end of the year.
This is PIF's largest investment into the Indian economy to date.

Ambani, chairman and managing director of Reliance Industries, said, "We at Reliance have enjoyed a long and fruitful relationship with the Kingdom of Saudi Arabia for many decades. From oil economy, this relationship is now moving to strengthen India's New oil (data-driven) economy, as is evident from PIF's investment into Jio Platforms."

Yasir Al-Rumayyan, governor of PIF, commented: "We are delighted to be investing in an innovative business which is at the forefront of the transformation of the technology sector in India. We believe that the potential of the Indian digital economy is very exciting and that Jio Platforms provides us with an excellent opportunity to gain access to that growth."

"This investment will also enable us to generate significant long-term commercial returns for the benefit of Saudi Arabia's economy and our country's citizens, in line with our mandate to safeguard and grow the national wealth of the Kingdom," he said.

The transaction is subject to Indian regulatory and other customary approvals.

Morgan Stanley acted as financial advisor to Reliance Industries and AZB & Partners and Davis Polk & Wardwell acted as legal counsels.

Prior to this deal, Reliance had sold 22.38 per cent of Jio Platforms to investors including Facebook Inc, securing Rs 104,326.95 crore in eight weeks.

Facebook kicked off the party, investing Rs 43,573.62 crore for a 9.99 per cent stake on April 22. This was closely followed by a further Rs 60,753.33 crore in investment.

Silver Lake - the world's largest tech investor - bought a 1.15 per cent stake in Jio Platforms for Rs 5,665.75 crore on May 4. It invested another Rs 4,546.80 crore for additional 0.93 per cent stake on June 5, taking its total holding to 2.08 per cent
Private equity KKR and Vista Equity Partners have taken 2.32 per cent stake each for Rs 11,367 crore apiece. KKR invested in Jio Platforms on May 22 while Vista invested on May 8.

Abu Dhabi sovereign wealth fund Mubadala Investment Co picked up 1.85 per cent in Jio Platforms for Rs 9,093.60 crore on June 5. Abu Dhabi Investment Authority on June 7 invested Rs 5,683.50 crore for a 1.16 per cent stake in Jio Platforms.

On May 17, global equity firm General Atlantic picked up 1.34 per cent stake in Jio Platforms for Rs 6,598.38 crore.

Global investment firm TPG on June 13 picked up 0.93 per cent for Rs 4,546.80 crore while L Catterton bought 0.39 per cent for Rs 1,894.50 crore.