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Chloroquine for Coronavirus

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Chloroquine, a treatment for rosacea, is now being investigated as a treatment for the coronavirus. One report states, "Here we found that treating the patients diagnosed as novel coronavirus pneumonia with chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome." [1]

Another report states, "Chloroquine is effective in preventing the spread of SARS CoV in cell culture. [2]

"But it is not yet clear how well hydroxychloroquine and chloroquine work in patients with COVID-19." [3]

"Chloroquine seems to block the coronavirus in lab studies. There's some anecdotal evidence from doctors saying it has appeared to help," says James Gallagher, BBC health correspondent. [4]

"A research trial of coronavirus patients in Brazil ended after patients taking a higher dose of chloroquine, one of the drugs President Trump has promoted, developed irregular heart rates." [5]

"So until these or any drugs have been shown to be effective against SARS-CoV-2 in clinical trials and have been approved by the FDA, no one should be self-medicating." [6]

More on Coronavirus and Rosacea
End Notes

[1] Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):185-188. doi: 10.3760/cma.j.issn.1001-0939.2020.03.009.
[Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia].

[2]Virol J. 2005; 2: 69.
Chloroquine is a potent inhibitor of SARS coronavirus infection and spread
Martin J Vincent,1 Eric Bergeron, Suzanne Benjannet, Bobbie R Erickson, Pierre E Rollin, Thomas G Ksiazek, Nabil G Seidah, and Stuart T 

[3] Treating Coronavirus With Plaquenil and Aralen, Reena Mukamal, American Academy of Ophthalmology

[4] Coronavirus and chloroquine: Is there evidence it works?
By Jack Goodman and Christopher Giles, BBC Reality Check, BBC News

[5] Small Chloroquine Study Halted Over Risk of Fatal Heart Complications, By Katie Thomas and Knvul Sheikh, The New York Times

[6] Could Chloroquine Treat Coronavirus?, By Katherine Seley-Radtke, The Conversation US on March 27, 2020, Scientific American

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UPDATES

"There is currently not enough data available to support the routine use of HCQ and CQ as therapies for COVID-19. Pending further results from more extensive studies with more stringent study parameters, clinicians should defer from routine use of HCQ and CQ. There are several clinical trials currently underway with results expected soon."
Acad Emerg Med. 2020 May 2. doi: 10.1111/acem.14005. [Epub ahead of print]
A Rapid Systematic Review of Clinical Trials Utilizing Chloroquine and Hydroxychloroquine as a Treatment for COVID-19.
Chowdhury MS, Rathod J, Gernsheimer J.

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In summary, this multinational, observational, real-world study of patients with COVID-19 requiring hospitalisation found that the use of a regimen containing hydroxychloroquine or chloroquine (with or without a macrolide) was associated with no evidence of benefit, but instead was associated with an increase in the risk of ventricular arrhythmias and a greater hazard for in-hospital death with COVID-19. These findings suggest that these drug regimens should not be used outside of clinical trials and urgent confirmation from randomised clinical trials is needed.

The Lancet
Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

Prof Mandeep R Mehra, MD 
Sapan S Desai, MD
Prof Frank Ruschitzka, MD
Amit N Patel, MD

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Update

"In this study, a high-dosage of CQ (12 g) given for 10 days concurrently with azithromycin and oseltamivir was not sufficiently safe to warrant continuation of that study group. Age was an important confounder and might be associated with the unfavorable outcomes. We recommend that similar dosages no longer be used for the treatment of severe COVID-19, especially because treatment based on older patients with previous cardiac diseases who are receiving concomitant cardiotoxic drugs should be the rule. No apparent benefit of CQ was seen regarding lethality in our patients so far. To better understand the role of CQ or HCQ in the treatment of COVID-19, we recommend the following next steps: (1) randomized clinical trials evaluating its role as a prophylactic drug and (2) randomized clinical trials evaluating its efficacy against the progression of COVID-19 when administered to patients with mild or moderate disease. Even if we fail to generate good evidence in time to control the current pandemic, the information will affect how we deal with coronavirus outbreaks in the future."

JAMA Netw Open. 2020;3(4):e208857. doi:10.1001/jamanetworkopen.2020.8857
Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) InfectionA Randomized Clinical Trial
Mayla Gabriel, Silva Borba, MD; Fernando Fonseca Almeida Val, PhD, Vanderson Souza Sampaio, PhD

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