Endocrine Unit, CTO Hospital - ASL Roma 2, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Diabetes Research Institute (DRI), University of Miami Miller School of Medicine, Miami, Florida.
J Diabetes. 2020 Sep;12(9):659-667. doi: 10.1111/1753-0407.13053. Epub 2020 Jun 11.
The antimalarial drug hydroxychloroquine (HCQ) has long been used as a disease-modifying antirheumatic drug for the treatment of several inflammatory rheumatic diseases. Over the last three decades, various studies have shown that HCQ also plays a role in the regulation of glucose homeostasis. Although the mechanisms of action underlying the glucose-lowering properties of HCQ are still not entirely clear, evidence suggests that this drug may exert multifaceted effects on glucose regulation, including improvement of insulin sensitivity, increase of insulin secretion, reduction of hepatic insulin clearance, and reduction of systemic inflammation. Preliminary studies have shown the safety and efficacy of HCQ (at a dose ranging from 400 to 600 mg/day) in patients with type 2 diabetes over a short-term period. In 2014, HCQ has been approved in India as an add-on hypoglycemic agent for patients with uncontrolled type 2 diabetes. However, large randomized controlled trials are needed to establish the safety and efficacy profile of HCQ in patients with type 2 diabetes over a long-term period. With regard to the COVID-19 pandemic, several medications (including HCQ) have been used as off-label drugs because of the lack of proven effective therapies. However, emerging evidence shows limited benefit from HCQ use in COVID-19 in general. The aim of this manuscript is to comprehensively summarize the current knowledge on the antihyperglycemic properties of HCQ and to critically evaluate the potential risks and benefits related to HCQ use in patients with diabetes, even in light of the current pandemic scenario.
抗疟药羟氯喹（HCQ）长期以来一直被用作治疗几种炎症性风湿性疾病的疾病修饰抗风湿药物。在过去的三十年中，各种研究表明 HCQ 还在调节葡萄糖稳态方面发挥作用。尽管 HCQ 降低血糖特性的作用机制尚不完全清楚，但有证据表明，这种药物可能对葡萄糖调节产生多方面的影响，包括改善胰岛素敏感性、增加胰岛素分泌、减少肝胰岛素清除率和减少全身炎症。初步研究表明，HCQ（剂量范围为 400 至 600mg/天）在短期内在 2 型糖尿病患者中的安全性和有效性。2014 年，HCQ 在印度被批准为未控制的 2 型糖尿病患者的附加降糖药物。然而，需要进行大型随机对照试验来确定 HCQ 在 2 型糖尿病患者中的长期安全性和疗效。关于 COVID-19 大流行，由于缺乏经过证实的有效疗法，几种药物（包括 HCQ）已被用作标签外药物。然而，新出现的证据表明，HCQ 在 COVID-19 中的使用总体上获益有限。本文的目的是全面总结 HCQ 的抗高血糖特性的现有知识，并批判性地评估与糖尿病患者使用 HCQ 相关的潜在风险和益处，即使考虑到当前的大流行情况。
