CHLOROQUINE AND HYDROXYCHLOROQUINE: A MAJOR BREAKTHROUGH FOR COVID-19
DOI:
https://doi.org/10.22159/ijpps.2020v12i10.39121Keywords:
Hydroxychloroquine, Chloroquine, Coronavirus, Severe acute respiratory syndromeAbstract
Coronavirus pandemic or COVID-19 is a global public health emergency at this period. Presently, no pharmacological treatment is known to treat this condition. Hydroxychloroquine (HCQ), a derivative of chloroquine (CQ), was first synthesized in 1946 by adding a hydroxyl group to CQ, which is much less toxic than CQ in animal studies. Other than being an anti-malarial drug, it was revealed to have various pharmacological effects and one of those is its anti-viral property. CQ, as well as HCQ, has been used in SARS (Severe Acute Respiratory Syndrome) coronavirus infection due to its antiviral properties. Even though various scientists have considered HCQ as a better therapeutic approach than CQ for the treatment of coronavirus infection, there are various adverse drug reactions associated with HCQ treatment in COVID-19 patients. In this paper, we review the anti-viral mechanism, various adverse drug reactions, and side effects of HCQ for COVID-19 treatment.
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References
Ben Zvi I, Kivity S, Langevitz P, Shoenfeld Y. Hydroxy-chloroquine: from malaria to autoimmunity. Clin Rev Allergy Immunol 2012;42:145-53.
Wallace DJ, Metzger AL, Stecher VJ, Turnbull BA, Kern PA. Cholesterol-lowering effect of hydroxychloroquine in patients with rheumatic disease: reversal of deleterious effects of steroids on lipids. Am J Med 1990;89:322-6.
Chen PH, Huang YF, Tang CW, Wann SR, Chang HT. Kikuchi-fujimoto disease: an amazing response to hydroxychloroquine. Eur J Pediatr 2010;169:1557-9.
Rezai K, Kuchipudi S, Chundi V, Ariga R, Loew J, Sha BE. Kikuchi-fujimoto disease: HCQ as a treatment. Clin Infect Dis 2004;39:e124-6.
DeSimone DP, Brilliant HL, Basile J, Bell NH. Granulomatous infiltration of the talus and abnormal vitamin D and calcium metabolism in a patient with sarcoidosis: successful treatment with hydroxychloroquine. Am J Med 1989;87:694-6.
O'Leary TJ, Jones G, Yip A, Lohnes D, Cohanim M, Yendt ER. The effects of chloroquine on serum 1,25-dihydroxyvitamin D and calcium metabolism in sarcoidosis. N Engl J Med 1986;315:727-30.
Shimoni A, Hershcovici T, Mekhmandarov S, Maor Kendler Y, Beigel Y. Skeletal sarcoidosis: successful treatment with hydroxychloroquine. Isr Med Assoc J 2000;2:558-9.
Keyaerts E, Vijgen L, Maes P, Neyts J, Van Ranst M. In vitro inhibition of severe acute respiratory syndrome coronavirus by chloroquine. Biochem Biophys Res Commun 2004;323:264-8.
incent MJ, Bergeron E, Benjannet S. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J 2005;2:69.
Keyaerts E, Li S, Vijgen L. Antiviral activity of chloroquine against human coronavirus OC43 infection in newborn mice. Antimicrob Agents Chemother 2009;53:3416-21.
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, evaluation and treatment coronavirus (COVID-19). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
Kapoor KM, Kapoor A. Role of chloroquine and HCQ in the treatment of COVID-19 infection-a systematic literature review. Medrxiv; 2020.
D’Cruz M. The ICMR bulletin on targeted HCQ prophylaxis for COVID-19: need to interpret with caution. Indian J Med Ethics 2020;5:100-2.
Schrezenmeier E, Dorner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 2020;16:155-66.
Shrivastava Alankar. Analytical methods for the determination of hydroxychloroquine in various matrices. Int J Appl Pharm 2020;12:55-61.
Zhou D, Dai SM, Tong Q. COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. J Antimicrob Chemother 2020;75:1667-70.
Fantini J, Di Scala C, Chahinian H, Yahi N. Structural and molecular modeling studies reveal a new mechanism of action of chloroquine and HCQ against SARS-CoV-2 infection. Int J Antimicrob Agents 2020;55:105960.
Naksuk N, Lazar S, Peeraphatdit TB. Cardiac safety of off-label COVID-19 drug therapy: a review and proposed monitoring protocol. Eur Heart J Acute Cardiovasc Care 2020;9:215-21.
Gerard A, Romani S, Fresse A. "Off-label" use of hydroxychloroquine, azithromycin, lopinavir-ritonavir and chloroquine in COVID-19: a survey of cardiac adverse drug reactions by the french network of pharmacovigilance. Therapie 2020;75:371-9.
Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in the treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020;14:72-3.
Wang M, Cao R, Zhang L. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020;30:269-71.
Dixon DL, Van Tassell BW, Vecchie A. Cardiovascular considerations in treating patients with coronavirus disease 2019 (COVID-19). J Cardiovasc Pharmacol 2020;75:359-67.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care 2020;57:279-83.
Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discovery Ther 2020;14:58-60.
Balevic SJ, Hornik CP, Green TP. Hydroxychloroquine in patients with rheumatic disease complicated by COVID-19: clarifying target exposures and the need for clinical trials. J Rheumatol 2020;49:1424-30.
Smulyan H. The computerized ECG: friend and foe. Am J Med 2019;132:153-60.
Juurlink DN. Safety considerations with chloroquine, hydroxychloroquine and azithromycin in the management of SARS-CoV-2 infection. CMAJ 2020;192:E450-3.
Uvais NA. The risks of prescribing hyodroxychloroquine in COVID-19-infected patients with schizophrenia. Prim Care Companion CNS Disord 2020;22:20com02635. Doi:10.4088/PCC.20com02635
Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational study of HCQ in hospitalized patients with COVID-19. N Engl J Med 2020;382:2411-8.
McGhie TK, Harvey P, Su J, Anderson N, Tomlinson G, Touma Z. Electrocardiogram abnormalities related to antimalarials in systemic lupus erythematosus. Clin Exp Rheumatol 2018;36:545-51.
FDA cautions against use of HCQ or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to the risk of heart rhythm problems FDA; 2020. Available from: https://www.fda.gov/media/137250/download. [Last accessed on 20 Apr 2020].
Manufacturer's Package Insert, HCQ. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf. [Last accessed on 20 Apr 2020]
Bilbul M, Paparone P, Kim AM, Mutalik S, Ernst CL. Psychopharmacology of COVID-19. Psychosomatics 2020:1-17. https://doi.org/10.1016/j.psym.2020.05.006
Jankelson L, Karam G, Becker ML, Chinitz LA, Tsai MC. QT prolongation, torsades de pointes and sudden death with short courses of chloroquine or HCQ as used in COVID-19: a systematic review. Heart Rhythm 2020;17:1472-9.
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). CDC; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html. [Last accessed on 25 Mar 2020].
World Health Organization. Coronavirus disease (COVID-19) technical guidance: Patient management. Geneva: WHO; 2019. Available from: https://www.who.int/emergencies/diseases/ novelcoronavirus2019/technicalguidance/patientmanagement. [Last accessed on 25 Mar 2020].
World Health Organisation. Guidelines for the treatment of malaria. 3rd edition. Geneva: WHO; 2015. Available from: https://www.who.int/malaria/publications/atoz/9789241549127/en/. [Last accessed 16 Apr 2020]
Prescriber’s Digital Reference. HCQ sulfate: Drug Summary. PDR. net. date unknown. Available from: https://www.pdr.net/ drug-summary/Plaquenil-HCQsulfate-1911. [Last accessed on 16 Apr 2020]
Ferner RE, Aronson JK. Chloroquine and hydroxychloroquine in covid-19. Br Med J 2020;369:m1432.
Singh AK, Singh A, Shaikh A, Singh R, Misra A. Chloroquine and hydroxychloroquine in the treatment of COVID-19 with or without diabetes: a systematic search and a narrative review with a special reference to India and other developing countries. Diabetes Metab Syndr 2020;14:241-6.
Liu J, Cao R, Xu M. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discovery 2020;6:16.
