Should Chloroquine and Hydroxychloroquine Be Used to Treat COVID-19? A Rapid Review

Overview

Journal BJGP Open

Specialty Public Health

Date 2020 Apr 9

PMID 32265182

Citations 55

Authors

Kome Gbinigie

Kerstin Frie

Affiliations

Soon will be listed here.

Abstract

Background: On the 11 March 2020, the World Health Organization (WHO) declared that COVID-19 was a pandemic. To date, there are no medical treatments for COVID-19 with proven effectiveness. Novel treatments and/or vaccines will take time to be developed and distributed to patients. In light of this, there has been growing interest in the use of existing medications, such as chloroquine (CQ) and hydroxychloroquine (HCQ), as potential treatments of this disease.

Aim: To establish the current evidence for the effectiveness of CQ and HCQ in treating COVID-19.

Design & Setting: A rapid review of the literature was conducted.

Method: Electronic searches in PubMed and Google Scholar were conducted on 21 March 2020. A further search was conducted in Google for relevant literature on 28 March 2020.

Results: There is limited evidence of in vitro activity of CQ/HCQ against SARS-CoV-2. A number of in vivo clinical trials are underway. The empirical data available from two of these trials reveal conflicting results. Both trials are characterised by small numbers of participants ( = 30 and = 36) and suffer methodological limitations. No medium or long-term follow-up data is available.

Conclusion: At present, there is insufficient evidence to determine whether CQ/HCQ are safe and effective treatments for COVID-19. High quality, adequately powered randomised clinical trials in primary and secondary care settings are urgently required to guide policymakers and clinicians. These studies should report medium- and long-term follow-up results, and safety data.

Citing Articles

Efficacy of Ivermectin, Chloroquine/Hydroxychloroquine, and Azithromycin in Managing COVID-19: A Systematic Review of Phase III Clinical Trials.

Sansone N, Boschiero M, Marson F Biomedicines. 2024; 12(10).

PMID: 39457519 PMC: 11505156. DOI: 10.3390/biomedicines12102206.

Target in Sight: A Comprehensive Review of Hydroxychloroquine-Induced Bull's Eye Maculopathy.

Snow Z, Seely K, Barrett S, Pecha J, Goldhardt R Curr Ophthalmol Rep. 2024; 12(3):38-48.

PMID: 39371107 PMC: 11452169. DOI: 10.1007/s40135-024-00321-6.

COVID-19: Understanding the impact of anti-hypertensive drugs and hydroxychloroquine on the ACE1 and ACE2 in lung and adipose tissue in SHR and WKY rats.

Correa B, de Barros S, Vaz J, Peres M, Uchiyama M, da Silva A Physiol Rep. 2023; 11(3):e15598.

PMID: 36750199 PMC: 9904959. DOI: 10.14814/phy2.15598.

Enhanced In Vitro Antiviral Activity of Hydroxychloroquine Ionic Liquids against SARS-CoV-2.

Faisca F, Correia V, Petrovski Z, Branco L, Rebelo-de-Andrade H, Santos M Pharmaceutics. 2022; 14(4).

PMID: 35456711 PMC: 9031298. DOI: 10.3390/pharmaceutics14040877.

A Review on Measures to Rejuvenate Immune System: Natural Mode of Protection Against Coronavirus Infection.

Islam M, Haque M, Rahman M, Hossen F, Reza M, Barua A Front Immunol. 2022; 13:837290.

PMID: 35371007 PMC: 8965011. DOI: 10.3389/fimmu.2022.837290.

References

Dong L, Hu S, Gao J . Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther. 2020; 14(1):58-60. DOI: 10.5582/ddt.2020.01012. View

Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P . In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020; 71(15):732-739. PMC: 7108130. DOI: 10.1093/cid/ciaa237. View

Devaux C, Rolain J, Colson P, Raoult D . New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19?. Int J Antimicrob Agents. 2020; 55(5):105938. PMC: 7118659. DOI: 10.1016/j.ijantimicag.2020.105938. View

Rismanbaf A, Zarei S . Liver and Kidney Injuries in COVID-19 and Their Effects on Drug Therapy; a Letter to Editor. Arch Acad Emerg Med. 2020; 8(1):e17. PMC: 7075271. View

Browning D . Hydroxychloroquine and chloroquine retinopathy: screening for drug toxicity. Am J Ophthalmol. 2002; 133(5):649-56. DOI: 10.1016/s0002-9394(02)01392-2. View

Sahraei Z, Shabani M, Shokouhi S, Saffaei A . Aminoquinolines against coronavirus disease 2019 (COVID-19): chloroquine or hydroxychloroquine. Int J Antimicrob Agents. 2020; 55(4):105945. PMC: 7156117. DOI: 10.1016/j.ijantimicag.2020.105945. View

Nicastri E, Petrosillo N, Bartoli T, Lepore L, Mondi A, Palmieri F . National Institute for the Infectious Diseases "L. Spallanzani", IRCCS. Recommendations for COVID-19 clinical management. Infect Dis Rep. 2020; 12(1):8543. PMC: 7097833. DOI: 10.4081/idr.2020.8543. View

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; 57:279-283. PMC: 7270792. DOI: 10.1016/j.jcrc.2020.03.005. View

. [Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 43(0):E019. DOI: 10.3760/cma.j.issn.1001-0939.2020.0019. View

10.

Savarino A, Boelaert J, Cassone A, Majori G, Cauda R . Effects of chloroquine on viral infections: an old drug against today's diseases?. Lancet Infect Dis. 2003; 3(11):722-7. PMC: 7128816. DOI: 10.1016/s1473-3099(03)00806-5. View

11.

Costedoat-Chalumeau N, Hulot J, Amoura Z, Leroux G, Lechat P, Funck-Brentano C . Heart conduction disorders related to antimalarials toxicity: an analysis of electrocardiograms in 85 patients treated with hydroxychloroquine for connective tissue diseases. Rheumatology (Oxford). 2007; 46(5):808-10. DOI: 10.1093/rheumatology/kel402. View

12.

Zhou P, Yang X, Wang X, Hu B, Zhang L, Zhang W . A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020; 579(7798):270-273. PMC: 7095418. DOI: 10.1038/s41586-020-2012-7. View

13.

Gbinigie K, Frie K . Should chloroquine and hydroxychloroquine be used to treat COVID-19? A rapid review. BJGP Open. 2020; 4(2). PMC: 7330219. DOI: 10.3399/bjgpopen20X101069. View

14.

Chen J, Liu D, Liu L, Liu P, Xu Q, Xia L . [A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020; 49(2):215-219. PMC: 8800713. DOI: 10.3785/j.issn.1008-9292.2020.03.03. View

15.

Mavrikakis M, Papazoglou S, Sfikakis P, Vaiopoulos G, Rougas K . Retinal toxicity in long term hydroxychloroquine treatment. Ann Rheum Dis. 1996; 55(3):187-9. PMC: 1010126. DOI: 10.1136/ard.55.3.187. View

16.

Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M . Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020; 30(3):269-271. PMC: 7054408. DOI: 10.1038/s41422-020-0282-0. View

17.

Gao J, Tian Z, Yang X . Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020; 14(1):72-73. DOI: 10.5582/bst.2020.01047. View

18.

Cubero G, Reguero J, Rojo Ortega J . Restrictive cardiomyopathy caused by chloroquine. Br Heart J. 1993; 69(5):451-2. PMC: 1025112. DOI: 10.1136/hrt.69.5.451. View

19.

Ranganathan P, Pramesh C, Aggarwal R . Common pitfalls in statistical analysis: Intention-to-treat versus per-protocol analysis. Perspect Clin Res. 2016; 7(3):144-6. PMC: 4936074. DOI: 10.4103/2229-3485.184823. View

20.

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H . Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020; 6:16. PMC: 7078228. DOI: 10.1038/s41421-020-0156-0. View