Abstract
Hydroxychloroquine (HCQ), also known by its trade name Plaquenil®, has been used for over 50 years as a treatment for malaria, systemic lupus erythematosus, and rheumatoid arthritis. As the COVID-19 pandemic emerged in the United States and globally in early 2020, HCQ began to garner attention as a potential treatment and as prophylaxis against COVID-19. Preliminary data indicated that HCQ as well as chloroquine (CQ) possessed in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early clinical data from China and France reported that HCQ and CQ were associated with viral load reduction and clinical improvement in patients with COVID-19 compared to control groups; however, an overwhelming number of randomized controlled trials, meta-analyses, and systematic reviews have since concluded that HCQ used alone, or in combination with azithromycin (AZ), provides no mortality or time-to-recovery benefit in hospitalized patients with COVID-19. Additionally, these same trials reported adverse events including cardiac, neuropsychiatric, hematologic, and hepatobiliary manifestations in patients with COVID-19 whom had been treated with HCQ. This review article summarizes the available data pertaining to the adverse events associated with HCQ use, alone or in combination with azithromycin, in patients with COVID-19 in order to fully assess the risk versus benefit of treating COVID-19 patients with these agents. The results of this review lead us to conclude that the risks of adverse events associated with HCQ use (with or without AZ) outweigh the potential clinical benefits and thus recommend against its use in the treatment or prevention of COVID-19.
Highlights
Hydroxychloroquine (HCQ), known by its trade® name Plaquenil, received approval by the United StatesFood and Drug Administration (FDA) for the medical treatment of malaria in 1955 [1]
These same trials reported adverse events including cardiac, neuropsychiatric, hematologic, and hepatobiliary manifestations in patients with COVID-19 whom had been treated with HCQ. is review article summarizes the available data pertaining to the adverse events associated with HCQ use, alone or in combination with azithromycin, in patients with COVID-19 in order to fully assess the risk versus benefit of treating COVID-19 patients with these agents. e results of this review lead us to conclude that the risks of adverse events associated with HCQ use outweigh the potential clinical benefits and recommend against its use in the treatment or prevention of COVID-19
In areas where limited data are available in COVID-19 patients, we have commented on the toxicity of HCQ in other patient populations. is review which focused on articles published in 2020 and 2021 serves to answer whether the risk of using HCQ, with or without AZ, in treating patients with COVID-19 outweighs the potential benefit
Summary
Food and Drug Administration (FDA) for the medical treatment of malaria in 1955 [1]. newer medications have largely replaced HCQ in the treatment of malaria, the drug continues to be a common pharmacological option in the treatment of chronic conditions such as systemic lupus erythematosus and rheumatoid arthritis in the United States and Canada [1]. For treating patients with COVID-19, a wide range of dosing regimens has been used including daily doses ranging from 200 to 1000 mg daily with loading doses as high as 1200 mg in some cases; albeit treatment courses typically last for days in these patients as opposed to months or years [9]. HCQ which is primarily excreted in the urine (as unchanged drug or as metabolites) is reasonably well tolerated in most patients at standard doses [10,11,12] with gastrointestinal side effects including nausea, vomiting, diarrhea, anorexia, and abdominal pain being most common (Table 1) [10,11,12]. Is review which focused on articles published in 2020 and 2021 (on PubMed) serves to answer whether the risk of using HCQ, with or without AZ, in treating patients with COVID-19 outweighs the potential benefit In areas where limited data are available in COVID-19 patients, we have commented on the toxicity of HCQ in other patient populations. is review which focused on articles published in 2020 and 2021 (on PubMed) serves to answer whether the risk of using HCQ, with or without AZ, in treating patients with COVID-19 outweighs the potential benefit
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