Chloroquine For Treatment Research Articles

A survey of chloroquine use for prevention and treatment of COVID-19 in Nigeria.

Rampant chloroquine/hydroxychloroquine poisoning in Nigerian hospitals following suggestions of its possible efficacy in the treatment and prevention of the newly emerged COVID-19 disease informed this survey. The aim of this study was to assess the knowledge, attitude and perception of the Nigerian populace on the use of chloroquine in the COVID-19 pandemic. This cross-sectional study was done by administering an electronic questionnaire created using Google Docs, through social media cascade methods including the WhatsApp application software to capture data on chloroquine use between April 20 and June 20, 2020. Six hundred and twenty-eight people responded to the questionnaire (response rate 99.2%, mean age 41.05 ± 12.3) from the six geopolitical zones in Nigeria with 556 (88.5%) having tertiary level education. Only 21 (3.3%) of the respondents took chloroquine for treatment or prevention. Respondents from the North-west geopolitical zones used chloroquine 5.8 (95% CI: 1.55, 21.52, p=0.02) more times than other zones while the age group 20-29 were 8.8 times more likely to use chloroquine than any other age group (95% CI: 3.53, 21.70, p = 0.00). Female respondents were 2.3 times more likely to use chloroquine than the males (OR 2.26 95% CI: 0.90-5.68; p=0.08) and those in the income bracket of N75,000-99,000, 2.5 times more than other income groups. Young adults, North-western geopolitical zone, and female gender should be target groups for education on rational chloroquine use. The danger of chloroquine overdose should be communicated to the general population in Nigeria.

Safety and Efficacy of Hydroxychloroquine and Chloroquine in Treatment of COVID-19: A Rapid Review of Evidence

Context: The coronavirus (named COVID-19) 2019 pandemic has caused significant morbidity and mortality around the world and has created serious challenges for health systems. To date, no medical treatment is developed for COVID-19 with proven effectiveness. This study is a rapid review aimed to identify and summarize evidence on the efficacy and safety of Hydroxychloroquine (HCQ) and Chloroquine (CQ) for COVID-19 infection. Methods: This study is a rapid review that systematically searched electronic databases, including PubMed, EMBASE, ClinicalTrials.gov, and Cochrane Library, until May 22, 2020. Peer-reviewed randomized clinical trials, reviews, and observational studies on the efficacy and safety of HCQ and CQ for the prevention and treatment of COVID-19 infection were included. Results: There were seven review articles, five clinical trial studies, and eight observational studies focusing on CQ or HCQ to treat COVID-19 patients. Of five clinical trials, three reported favorable outcomes among patients who received CQ or HCQ. Of eight observational studies, four reported no difference between the use of HCQ alone or combined administration of HCQ and Azithromycin with other medications. Three studies showed that the combined administration of HCQ and Azithromycin or HCQ alone is associated with improved clinical outcomes. Conclusions: The included studies reported conflicting results on the efficacy and safety of HCQ and CQ in treating COVID-19. Therefore, it seems that there is not sufficient evidence about the effectiveness and safety of HCQ and CQ to treat patients with COVID-19 and more studies, which also report long-term follow up results, are needed.

Putative Role of Chloroquine In Amelioration of DSS Induced

Ulcerative colitis (UC) is a chronic ulceroinflammatory condition primarily confined with in colonic mucosa with variable distortion of the colonic architecture. It is associated with microbial overgrowth such as E.coli , S. typhi .However Chloroquine acts on these microbes . In our present study the anticolitic effects of Chloroquine in treatment with the DSS induced model for UC in mice were examined. Male mice of age 7 weeks are chosen .They are assigned into different groups .Negative control groups treated with normal saline solution ,positive control group treated with DSS5%, standard group treated with Balsalazide 4mg/kg & DSS 5% , Test(1) group treated with Chloroquine 6mg/kg, Test(2) group treated with Chloroquine 8mg/kg, Test(3) group treated with Chloroquine 10 mg/kg then we performed different parameters such as DAI, Oxidative damage assessment, MPO Assessment and Histopathological evaluation. The results have showed that Chloroquine has significant activity against DSS(5%) induced colitis when compared to the experimental control, with near normalization of colon architecture. Tissue oxidative stress was reduced with significant improvement in tissue levels of MDA, GSH, SOD and CAT .Furthermore,significant improvement in levels of myeloperoxidase (MPO) was observed. It is concluded that Chloroquine(10mg/kg) has got potent activity against DSS(5%) induced ulcerative colitis(UC) due to its anti inflammatory antioxidant properties.

Treatment Approaches for COVID-19: A Critical Review

Coronavirus disease 2019 (COVID-19) outbreak was declared as an emergency global public health concern on 30 January 2020. This novel coronavirus (SARS-CoV-2) outbreak was first identified in Wuhan city, China; which soon affected around 185 countries and territories all over the world through various transmission mechanisms. Having found no permanent cure to date, this pandemic threatens humanity for its very existence. In the light of rising menace, this review aims at providing collective and prominent information on the current outbreak covering its origin, structure, transmission, clinical features, potential treatment approaches, and clinical trial details. Literature published in Scopus and PubMed indexed journals were reviewed and clinical trial data was retrieved from the ClinicalTrials.gov database. Present review puts forth detailed insights on history, epidemiology, structure, genetic makeup, reservoirs, entry mechanisms, reproduction capacity, pathogenesis, routes of transmission, clinical features, diagnostics, the role of chloroquine in treatment, current promising therapies, and vaccination trials. At present, early detection, isolation of infected patients, and supportive care with a few recently USFDA approved alternative medications are being used as per the standard government guidelines. Due to insufficient proof available regarding current therapies to produce therapeutic activity against COVID-19, safety precautions, prevention methods, maintaining hygiene and management therapy with intensive care medicine is the only way to fight this current situation.

Chloroquine or hydroxychloroquine for prevention and treatment of COVID-19.

Chloroquine or hydroxychloroquine for prevention and treatment of COVID-19.

In adults exposed to COVID-19, hydroxychloroquine did not reduce confirmed or probable COVID-19; trial stopped for futility.

Boulware DR, Pullen MF, Bangdiwala AS, et al. A randomized trial of hydroxychloroquine as postexposure prophylaxis for COVID-19. N Engl J Med. 2020;383:517-25. 32492293.

Treatment Options for Coronavirus Disease 2019 in Patients With Reduced or Absent Kidney Function.

Coronavirus disease 2019, the disease caused by the severe acute respiratory syndrome coronavirus 2 virus, was first identified in the Hubei Province of China in late 2019. Currently, the only role for therapy is treatment of the disease, as opposed to postexposure prophylaxis, however multiple clinical trials are currently ongoing for both treatment and prophylaxis. Treating coronavirus disease 2019 relies on two components; the first is inhibition of the viral entrance and replication within the body and the second is inhibition of an exacerbated immune response which can be seen in patients with severe disease. Many drugs have shown in vitro antiviral activity; however, clinical trials have not been as promising. This review summarizes the current data for the most commonly used drugs for coronavirus disease 2019 and will cover the unique factors that may affect the dosing of these medications in patients with CKD. While clinical trials are ongoing, most are in patients with normal kidney function. During a pandemic, when patients with CKD are at higher risk of both infection and death, it is imperative to include patients these patients in the clinical trials.

Will Hydroxychloroquine Still Be a Game-Changer for COVID-19 by Combining Azithromycin?

Recent small-scale clinical trials have shown promising results in the use of hydroxychloroquine, an FDA approved anti-malaria drug, for the treatment of COVID-19. However, large scale, randomized and double-blind clinical trials are needed to confirm the safety and efficacy of hydroxychloroquine in COVID-19 patients. Here, we review the progress of using hydroxychloroquine or chloroquine as anti-viral agents, failed clinical trials of chloroquine in treatment of dengue virus and influenza infection, and especially the mechanism of azithromycin in inhibiting viral replication, so as to shed light on the ongoing clinical trials and further researches of hydroxychloroquine on SARS-CoV-2 infected patients.

COVID-19 Outbreak and Perspective in Morocco

Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China and rapidly spread across the world to become the first pandemic caused by a coronavirus. As of 26 March 2020, there are 275 cases affected by COVID-19 announced by the Moroccan government, and it possible to limit the spread of this serious disease, with the cooperation of all the citizens in respect of the measures of containment and individual protection. Also, with the announce yesterday by the Moroccan government of the authorization of use of chloroquine in treatment of COVID-19 pneumonia, COVID-19 will be soon eradicated from Morocco and hopefully from all over the world

Intralesional Versus Oral Chloroquine in Cutaneous Leishmaniasis: Comparison of Outcome, Duration of Treatment and Total Dose of Drug.

To compare intralesional versus oral chloroquine in cutaneous leishmaniasis and determine the cure rate, duration of treatment, and total dose of drug. Randomized controlled study. Department of Dermatology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2013 to June 2014. Consecutive 86 patients of cutaneous leishmaniasis, with single to multiple lesions of various sizes were enrolled and divided randomly into group Aand B for the purpose of intralesional and oral chloroquine administration, respectively to compare the effect of the two routes on duration of treatment and total dose of the drug. SPSS version 16 was used for data analysis after data entry into it. Quantitative variables like, duration, cost and total dose of treatment were calculated as mean and standard deviation and compared by using T-test. P-value of less than 0.05 was taken as significant. Cure rate was 100% in both groups towards the end of treatment. Mean duration of treatment was 9.17 ±3 weeks in intralesional (A) group as against 11.37 ±3 weeks in oral (B) group (p = 0.0028). Mean total dose of the drug given to each patient in group Awas 5.8 ±0.5 gm and in group B, it was 19.2 ±1.5 gm, which is significantly higher (p < 0.001). The total cost of treatment in group Awas Rs. 90 ±8 and in group B it was Rs. 91 ±1 (p=0.446). Duration of treatment is significantly shorter and total dose is lesser with intralesional compared to oral chloroquine in treatment of cutaneous leishmaniasis.

Therapy and pharmacological properties of hydroxychloroquine and chloroquine in treatment of systemic lupus erythematosus, rheumatoid arthritis and related diseases.

This review examines the pharmacokinetics, modes of action and therapeutic properties of the anti-malarial drugs, hydroxychloroquine (HCQ) and chloroquine (CQ), in the treatment of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and related conditions, as well as osteoarthritis (OA). Both HCQ and CQ have historically been employed successfully for the treatment of SLE and RA for over 70 years. HCQ has been used extensively for SLE where it has a good reputation for controlling the dermatological complications in SLE. It has also been reported to effectively control the symptoms of Sjøgren's syndrome, as well as preventing thrombosis in phospholipid antibody (aPL) syndrome. In RA and SLE, HCQ is preferred because of the lower incidence of gastrointestinal adverse reactions compared with CQ and it might have a lower risk of ocular adverse reactions. There is increasing evidence that HCQ may reduce atherosclerosis and risks of cardiovascular disease in rheumatic patients. Both HCQ and CQ have been shown to improve glycaemia and reduce the risks of type II diabetes mellitus. Although both HCQ and CQ are effective in low-moderate RA, HCQ is now preferred as part of combination therapy for more severe disease. The advantages of combination therapy are that the doses of the individual drugs may be lowered so reducing adverse reactions. Both HCQ and CQ are diastereoisomers, have basic properties and are given as the sulphate and phosphate salts. While being relatively well absorbed orally and with good bioavailability, they have long and variable plasma terminal elimination half-lives (approximately 40-60 days). This reflects their high volume of distribution, V D (HCQ 44,000L; CQ 65,000L) which extends into aqueous compartments, long mean residence time (HCQ 1300 h; CQ 900 h) and with about half the drugs (metabolites) undergoing renal clearance. The strong binding to melanin reflects the ocular injury and dermatological properties of these drugs. The consensus is that the occurrence of ocular adverse reactions can be minimised by close attention to the dose (which should be set on a body weight basis) with regular (e.g. quarterly) retinal examination. Although HCQ and CQ can pass through the placenta, the use of these drugs during pregnancy does not appear to risk harm to the baby and might be beneficial to the mother with SLE and her child by controlling the SLE disease activity, which is known to be an important factor affecting pregnancy outcome. The modes of action of HCQ and CQ in these arthritides represent somewhat of an enigma. Undoubtedly, these drugs have multiple actions related, in part, their ability to accumulate in lysosomes and autophagosomes of phagocytic cells as well as affecting MHC Class II expression and antigen presentation; actions of the production of pro-inflammatory cytokines [e.g. interleukin-1 (IL-1) tumour necrosis factor-α (TNFα)]; control of toll-like receptor-9 activation; and leucocyte generation of reactive oxygen species (ROS); i.e. antioxidant activity. The actions of these drugs on T and B cells are less clear but may depend on these leucocyte-mediated actions. Anti-malarials also protect against cytokine-mediated cartilage resorption. This and other actions may underlie the potential benefits in treating OA. The exact relationships of these various actions, mostly determined in vitro, have not been specifically defined in vivo or ex vivo in relation to clinical efficacy. HCQ and CQ have a good reputation for being effective and relatively safe treatments in SLE, mild-moderate RA and Sjøgren's syndrome. There is need for (a) more information on their mode of action in relation to the control of these diseases, (b) scope for developing formulations that have improved pharmacokinetic and therapeutic properties and safety, and (c) further exploring their use in drug combinations not only with other disease modifying agents but also with biologics.

Presbyopia: Prevalence, distribution and determinants in Owerri, Nigeria

Background: Presbyopia causes blurring and impairment of vision at near. It is the most common physiologic change in the adult eye with advancing age. Good near vision is a necessity for domestic activities, office work and near vision tasks other than reading and writing, especially among adults in a resource-limited economy. The study determined the prevalence, distribution and determinants of presbyopia; presbyopic spectacle coverage; and provided data for ready-made near vision spectacles in Imo State, Nigeria. Materials and Methods: A total of three thousand, four hundred and fifty-one adults consisting of 2606 persons as study group and 845 persons as controls were randomly selected for the study. Structured questionnaire was administered to the subjects. Their visual acuity at far and near including tonometry, ophthalmoscopy, perimetry, retinoscopy and subjective refraction were done. Subjects who could not read N6 and emmetropes, who are 40 years and above were considered as presbyopic. Results: The prevalence of presbyopia was 70.9% and 75.0% of study and control groups respectively. Females aged 40-49 were in the majority (57.1% and 51.9% of females in the study and control groups respectively). Subjects requiring additions at near of ˃+1.50DS to 2.00DS were in the majority (39.0% and 46.4% of study and control groups respectively). Amongst the presbyopes 61.3% and 78.7% of study and control groups respectively did not have presbyopic correction. The subjects were also ignorant of corneal inlay technology in treatment of presbyopia. A higher prevalence exists among rural dwellers and the contributory factors were environmental influences, poor nutrition and irrational use of chloroquine for treatment of malaria. Conclusion: Over seventy-percent of presbyopia was found in this study. The determinants were age, gender, nutrition and drug use. Majority of the presbyopes were domicile in the rural area and did not have corrective spectacles. We recommend visual health education, regular vision screening and intervention to achieve the targets of vision 2020 in low-and-medium-income countries.

Effect of Combination of Some Natural Products and Chloroquine on HCV Infection in Egyptian Patients: Pilot Study

Background: Studies using safe natural products {Blue green® tablet (Rhodiola rosea L. root dry extract; Eleutherococcus senticosus Maxim. root dry extract; Ginkgo biloba L. leaf dry extract; Klamath microalgae Aphanizomenon flos aquae (AFA) 50 mg)} showed its antiviral effect. As well as vitamin D3, linolenic acid, black seeds and honey. The aim of the study was to determine the efficacy of combination of these natural products and chloroquine in treatment of HCV patients refusing or unfit for combined Interferon and Ribavirin (INF/RBV) therapy or HCV patients who failed to achieve sustained virological response to INF/RBV. Methods: Patients with detectable HCV RNA with different stages of fibrosis and cirrhosis refusing or unfit for combined Interferon Ribavirin (INF/RBV) therapy or patients who failed to achieve sustained virological response to INF/RBV from April 2009 to March 2012 were included in this study. All the patients were treated first from coinfection as schistosomiasis and helicobacter pylori if present then received combination Blue green® tablet-original natural company, Italy; 2 tablet/30 kg once daily; Vitamin D: 1000 IU/day; tablespoon filled with paste made of linolenic acid, black seeds powder and honey; and 250 mg chloroquine once daily for 10 days and then every 3 days through the duration of therapy. Results: 195 patients with chronic HCV were included; mean age 47.8 ± 9.03 years, 67.7% males. All patients have chronic hepatitis. 24 patients had cirrhosis. 82 (42.1%) achieved negative HCV RNA after 6 months of treatment. After 12 months of treatment, 107 (54.9%) patients had negative HCV RNA. 125 (64.3%) patients achieved ETR after 18 months of treatment. Moreover, 4/6 (66.6%) patients with combined HCV and HBV showed undetectable HBV after 3 months. Two out of 8 (25%) patients who failed to achieve SVR with previous (INF/RBV) have ETR. Conclusion: Combination of safe natural products (Blue green® tablet, vitamin D3, linolenic acid, black seeds and honey) and chloroquine may have a role to achieve SVR in combination with recent direct acting antiviral drugs for HCV infection.

Low efficacy of chloroquine: Time to switchover to artemisinin-based combination therapy for falciparum malaria in India

Drug resistance in Plasmodium falciparum poses a major threat to malaria control globally; including India. Chloroquine is still the most widely used drug in the country because of its safety and cost effectiveness. Although chloroquine resistance was first reported in 1973 in North Eastern India, the extent of the problem was realized only after the more intensive 28-day drug efficacy studies were used to monitor drug resistance. In the present study, efficacy of chloroquine in treatment of uncomplicated falciparum malaria was investigated using standard World Health Organization (WHO) procedures in three distinct epidemiological settings. The prevalence of molecular markers of drug resistance, Pfcrt K76T, Pfmdr1 N86Y, was also studied. A total of 374 children and adults with uncomplicated P. falciparum malaria were enrolled at six sites in four states, treated with chloroquine and follow-up was done for 28 days. The cumulative incidence of success of chloroquine at Day 28 by the Kaplan Meier analysis in the state of Orissa (District Sundargarh, CHC Bisra and Kuarmunda) was 57 (95% CI 43–68) and 54 (95% CI 40–66); in the state of Jharkhand (District Ranchi, PHC Angara and District Simdega, PHC Jaldega) it was 72 (95% CI 59–81) and 65 (95% CI 50–76); in the state of Goa (District North-Goa, Panaji Town), it was 20 (95% CI 10–2) and in the state of Rajasthan (District Udaipur, PHC Rishabdev), it was 96 (95% CI 85–99). Treatment failure was related to Pfcrt mutations but not Pfmdr mutations. Early treatment failure was observed only in 15.8% out of total failures, probably due to the semi-immune nature of the population. This type of response may give false perception about efficacy of the failing drug to patients, clinicians and National Authorities. In a large country like India it is not feasible to conduct in vivo studies in all districts and lack of direct correlation between molecular markers, in vitro studies and treatment outcome makes it difficult to predict the areas requiring change of policy. In this scenario, it is a challenge for National Programmes to make evidence-based revisions in the drug policy. However, considering the global, especially Southeast Asian, scenario and interpretation of available in vivo data, trends of mutations, availability of effective drugs and support of international donors, India should consider changing the first line treatment, at least for all diagnosed P. falciparum cases.

Early home treatment of childhood fevers with ineffective antimalarials is deleterious in the outcome of severe malaria

BackgroundEarly diagnosis and prompt treatment including appropriate home-based treatment of malaria is a major strategy for malaria control. A major determinant of clinical outcome in case management is compliance and adherence to effective antimalarial regimen. Home-based malaria treatment with inappropriate medicines is ineffective and there is insufficient evidence on how this contributes to the outcome of severe malaria. This study evaluated the effects of pre-hospital antimalarial drugs use on the presentation and outcome of severe malaria in children in Ibadan, Nigeria.MethodsTwo hundred and sixty-eight children with a median age of 30 months comprising 114 children with cerebral malaria and 154 with severe malarial anaemia (as defined by WHO) were prospectively enrolled. Data on socio-demographic data, treatments given at home, clinical course and outcome of admission were collected and analysed.ResultsA total of 168 children had treatment with an antimalarial treatment at home before presenting at the hospital when there was no improvement. There were no significant differences in the haematocrit levels, parasite counts and nutritional status of the pre-hospital treated and untreated groups. The most commonly used antimalarial medicine was chloroquine. Treatment policy was revised to Artemesinin-based Combination Therapy (ACT) in 2005 as a response to unacceptable levels of therapeutic failures with chloroquine, however chloroquine use remains high. The risk of presenting as cerebral malaria was 1.63 times higher with pre-hospital use of chloroquine for treatment of malaria, with a four-fold increase in the risk of mortality. Controlling for other confounding factors including age and clinical severity, pre-hospital treatment with chloroquine was an independent predictor of mortality.ConclusionThis study showed that, home treatment with chloroquine significantly impacts on the outcome of severe malaria. This finding underscores the need for wide-scale monitoring to withdraw chloroquine from circulation in Nigeria and efforts intensified at promoting prompt treatment with effective medicines in the community.

Different doses of amodiaquine and chloroquine for treatment of uncomplicated malaria in children in Guinea-Bissau: implications for future treatment recommendations

The aim of the present study was to compare different doses of chloroquine (CQ) and amodiaquine (AQ) for the treatment of falciparum malaria in children. Children with Plasmodium falciparum monoinfection were allocated by block randomisation to treatment with CQ 50/kg mg or 25 mg/kg or AQ 15 mg/kg or 30 mg/kg. The main outcomes were the cumulative adequate clinical and parasitological response (ACPR) rates and the number of true recrudescences as determined by PCR. A total of 729 children were included. In an evaluability analysis, the PCR-uncorrected cumulative ACPR rates on Day 28 for the treatment groups CQ 50/kg mg or 25 mg/kg and AQ 15 mg/kg or 30 mg/kg were 90%, 76%, 92% and 94%, respectively; the PCR-adjusted ACPR rates on Day 28 were 92%, 80%, 94% and 94%, respectively. No differences in adverse effects were observed. AQ has a high cure rate given as 30 mg/kg and 15 mg/kg, although it is not superior to treatment with CQ 50 mg/kg. However, 25 mg/kg of CQ is less efficient. As an interim option, Guinea-Bissau could change the recommended first-line treatment of uncomplicated malaria to CQ 50 mg/kg, reserving AQ as a partner drug for a future combination therapy.

Safety of Chloroquine in Pregnancy

To the Editor:— I have read with considerable interest a quotation from an article I wrote in 1962, which was quoted in the March 1, 1965, issue ofThe Journal( 191 : 765), in the letter, Safety of Chloroquine in Pregnancy. I hope that the quotation, which is correct as stated, will not be taken as an endorsement for the use of chloroquine in the treatment of pregnant patients. We have used large quantities of antimalarial drugs, notably chloroquine and hydroxychloroquine in treatment of rheumatoid arthritis since approximately August of 1957. It is my personal belief that of the two drugs, chloroquine is more effective as an antiarthritic agent; but there is reason to believe that in our series of patients, one or two have sustained, perhaps, permanent damage to the retina; so that based upon our own experience, as well as that reported in the literature otherwise, we have completely

Chloroquine in Treatment of Infectious Mononucleosis

Chloroquine in Treatment of Infectious Mononucleosis