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COVID-19 Pandemic - A Narrative Review of the Potential Roles of Chloroquine and Hydroxychloroquine.
Pain Physician. 2020 08; 23(4S):S351-S366.PP

Abstract

BACKGROUND

Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used against malaria, rheumatism, inflammation in the joints, lupus, among others. These drugs showed positive results in preliminary scientific research for treatment of the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Since the studies with CQ and HCQ are initial with small patient populations, it is not yet known whether there are adverse effects from the use of CQ and HCQ for patients infected with the coronavirus.

OBJECTIVES

The aim of this study was to evaluate the evidence regarding the efficacy and safety of CQ and HCQ used against viral infection caused by SARS-CoV-2.

STUDY DESIGN

This is a narrative review of the traditional prescriptions of CQ and HCQ efficacy and adverse effects as well as their employment for coronavirus disease 2019 (COVID-19).

SETTING

In vitro and clinical studies comparing the antiviral efficacy and adverse effect profile of CQ and HCQ against COVID-19 in adult patients were evaluated.

METHODS

A systemic search of reviews, including in vitro and clinical trial studies in English focusing on CQ and HCQ effects and adverse effects against COVID-19 in the adult patient population from PubMed was performed. It included studies reporting chloroquine and hydroxychloroquine effects and adverse effects against COVID-19.

RESULTS

A total of 42 articles published between 2004 and April 2020 were reviewed for therapeutic use of CQ and HCQ. Both these drugs showed a significant in vitro potential against coronavirus. Many studies for clinical use of CQ and HCQ showed that patients presented adverse reactions on high doses.

LIMITATIONS

Clinical studies have some methodology shortcomings, such as lack of information about the treatment and small number of experimental patients, leading to a misinterpretation of the data. Besides, there are few clinical studies with a limited sample size. Moreover, most of them did not present control groups, and some patients had died during these protocols.

DISCUSSION

Despite both CQ and HCQ in vitro antiviral evidence, clinically, both drugs, either alone or combined with other medications, may increase the risk of cardiac arrhythmias, leading to cardiac arrest and sudden death. Besides, a lot of uncertainty still remains, such as starting administration period, dose prescribed, length of treatment, patients' condition, concomitant drug use, among others.

CONCLUSION

From the studies reviewed, it is not possible to state the precise efficacy and safety of CQ and HCQ use in the treatment of COVID-19 at any time in the course of the disease. Future studies are warranted.

Authors+Show Affiliations

Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, MG, Brazil; Santa Casa de Misericórdia de Alfenas, MG, Brazil; Faculty of Medicine, Federal University of Alfenas, MG, Brazil.Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, MG, Brazil.CHU Clermont-Ferrand, Clermont-Ferrand, France.Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, MG, Brazil; Department of Pharmacology, University of São Paulo, Ribeirão Preto, SP, Brazil.Faculty of Medicine, University of Itaúna, MG, Brazil.Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, MG, Brazil; Faculty of Medicine, Federal University of Alfenas, MG, Brazil.Faculty of Medicine, Federal University of Alfenas, MG, Brazil.Department of Pharmaceutical Sciences, Federal University of São Paulo, Diadema, SP, Brazil.Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, MG, Brazil.Advanced Spine on Park Avenue.Department of Clinical and Toxicological Analysis, Federal University of Alfenas, MG, Brazil.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

32942793

Citation

de Barros, Carlos M., et al. "COVID-19 Pandemic - a Narrative Review of the Potential Roles of Chloroquine and Hydroxychloroquine." Pain Physician, vol. 23, no. 4S, 2020, pp. S351-S366.
de Barros CM, Almeida CAF, Pereira B, et al. COVID-19 Pandemic - A Narrative Review of the Potential Roles of Chloroquine and Hydroxychloroquine. Pain Physician. 2020;23(4S):S351-S366.
de Barros, C. M., Almeida, C. A. F., Pereira, B., Costa, K. C. M., Pinheiro, F. A., Maia, L. D. B., Trindade, C. M., Garcia, R. C. T., Torres, L. H., Diwan, S., & Boralli, V. B. (2020). COVID-19 Pandemic - A Narrative Review of the Potential Roles of Chloroquine and Hydroxychloroquine. Pain Physician, 23(4S), S351-S366.
de Barros CM, et al. COVID-19 Pandemic - a Narrative Review of the Potential Roles of Chloroquine and Hydroxychloroquine. Pain Physician. 2020;23(4S):S351-S366. PubMed PMID: 32942793.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 Pandemic - A Narrative Review of the Potential Roles of Chloroquine and Hydroxychloroquine. AU - de Barros,Carlos M, AU - Almeida,Carolina A de Faria, AU - Pereira,Bruna, AU - Costa,Karla C Mancini, AU - Pinheiro,Flaviane A, AU - Maia,Livia Del Bianco, AU - Trindade,Cristiano M, AU - Garcia,Raphael C Tamborelli, AU - Torres,Larissa H, AU - Diwan,Sudhir, AU - Boralli,Vanessa B, PY - 2020/9/18/entrez PY - 2020/9/19/pubmed PY - 2020/9/26/medline KW - COVID 19 KW - adverse effects KW - cardiac arrhythmias KW - chloroquine KW - coronavirus KW - hydroxychloroquine KW - ocular toxicity KW - pandemic KW - pharmacokinetic KW - retinopathy KW - side effects SP - S351 EP - S366 JF - Pain physician JO - Pain Physician VL - 23 IS - 4S N2 - BACKGROUND: Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used against malaria, rheumatism, inflammation in the joints, lupus, among others. These drugs showed positive results in preliminary scientific research for treatment of the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Since the studies with CQ and HCQ are initial with small patient populations, it is not yet known whether there are adverse effects from the use of CQ and HCQ for patients infected with the coronavirus. OBJECTIVES: The aim of this study was to evaluate the evidence regarding the efficacy and safety of CQ and HCQ used against viral infection caused by SARS-CoV-2. STUDY DESIGN: This is a narrative review of the traditional prescriptions of CQ and HCQ efficacy and adverse effects as well as their employment for coronavirus disease 2019 (COVID-19). SETTING: In vitro and clinical studies comparing the antiviral efficacy and adverse effect profile of CQ and HCQ against COVID-19 in adult patients were evaluated. METHODS: A systemic search of reviews, including in vitro and clinical trial studies in English focusing on CQ and HCQ effects and adverse effects against COVID-19 in the adult patient population from PubMed was performed. It included studies reporting chloroquine and hydroxychloroquine effects and adverse effects against COVID-19. RESULTS: A total of 42 articles published between 2004 and April 2020 were reviewed for therapeutic use of CQ and HCQ. Both these drugs showed a significant in vitro potential against coronavirus. Many studies for clinical use of CQ and HCQ showed that patients presented adverse reactions on high doses. LIMITATIONS: Clinical studies have some methodology shortcomings, such as lack of information about the treatment and small number of experimental patients, leading to a misinterpretation of the data. Besides, there are few clinical studies with a limited sample size. Moreover, most of them did not present control groups, and some patients had died during these protocols. DISCUSSION: Despite both CQ and HCQ in vitro antiviral evidence, clinically, both drugs, either alone or combined with other medications, may increase the risk of cardiac arrhythmias, leading to cardiac arrest and sudden death. Besides, a lot of uncertainty still remains, such as starting administration period, dose prescribed, length of treatment, patients' condition, concomitant drug use, among others. CONCLUSION: From the studies reviewed, it is not possible to state the precise efficacy and safety of CQ and HCQ use in the treatment of COVID-19 at any time in the course of the disease. Future studies are warranted. SN - 2150-1149 UR - https://www.unboundmedicine.com/medline/citation/32942793/COVID_19_Pandemic___A_Narrative_Review_of_the_Potential_Roles_of_Chloroquine_and_Hydroxychloroquine_ L2 - http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=23&page=S351 DB - PRIME DP - Unbound Medicine ER -