Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, MG, Brazil; Santa Casa de Misericórdia de Alfenas, MG, Brazil; Faculty of Medicine, Federal University of Alfenas, MG, Brazil.
Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, MG, Brazil.
Pain Physician. 2020 Aug;23(4S):S351-S366.
Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used against malaria, rheumatism, inflammation in the joints, lupus, among others. These drugs showed positive results in preliminary scientific research for treatment of the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Since the studies with CQ and HCQ are initial with small patient populations, it is not yet known whether there are adverse effects from the use of CQ and HCQ for patients infected with the coronavirus.
The aim of this study was to evaluate the evidence regarding the efficacy and safety of CQ and HCQ used against viral infection caused by SARS-CoV-2.
This is a narrative review of the traditional prescriptions of CQ and HCQ efficacy and adverse effects as well as their employment for coronavirus disease 2019 (COVID-19).
In vitro and clinical studies comparing the antiviral efficacy and adverse effect profile of CQ and HCQ against COVID-19 in adult patients were evaluated.
A systemic search of reviews, including in vitro and clinical trial studies in English focusing on CQ and HCQ effects and adverse effects against COVID-19 in the adult patient population from PubMed was performed. It included studies reporting chloroquine and hydroxychloroquine effects and adverse effects against COVID-19.
A total of 42 articles published between 2004 and April 2020 were reviewed for therapeutic use of CQ and HCQ. Both these drugs showed a significant in vitro potential against coronavirus. Many studies for clinical use of CQ and HCQ showed that patients presented adverse reactions on high doses.
Clinical studies have some methodology shortcomings, such as lack of information about the treatment and small number of experimental patients, leading to a misinterpretation of the data. Besides, there are few clinical studies with a limited sample size. Moreover, most of them did not present control groups, and some patients had died during these protocols.
Despite both CQ and HCQ in vitro antiviral evidence, clinically, both drugs, either alone or combined with other medications, may increase the risk of cardiac arrhythmias, leading to cardiac arrest and sudden death. Besides, a lot of uncertainty still remains, such as starting administration period, dose prescribed, length of treatment, patients' condition, concomitant drug use, among others.
From the studies reviewed, it is not possible to state the precise efficacy and safety of CQ and HCQ use in the treatment of COVID-19 at any time in the course of the disease. Future studies are warranted.
氯喹（CQ）和羟氯喹（HCQ）是用于治疗疟疾、风湿、关节炎症、狼疮等疾病的老药。这些药物在治疗严重急性呼吸综合征冠状病毒（SARS-CoV-2）的初步科学研究中显示出积极的结果。由于 CQ 和 HCQ 的研究仍处于初始阶段，且患者人群较少，因此尚不清楚 CQ 和 HCQ 的使用是否会对感染冠状病毒的患者产生不良反应。
本研究旨在评估 CQ 和 HCQ 治疗 SARS-CoV-2 引起的病毒感染的疗效和安全性证据。
这是一篇关于 CQ 和 HCQ 疗效和不良反应的传统处方以及它们在 2019 年冠状病毒病（COVID-19）中的应用的叙述性综述。
评估了比较 CQ 和 HCQ 对成人 COVID-19 患者抗病毒疗效和不良反应的体外和临床研究。
系统检索了 2004 年至 2020 年 4 月期间在 PubMed 上发表的关于 CQ 和 HCQ 对成人患者 COVID-19 影响和不良反应的综述和临床试验研究，包括报告 CQ 和 HCQ 对 COVID-19 影响和不良反应的研究。
共审查了 42 篇发表于 2004 年至 2020 年 4 月期间的关于 CQ 和 HCQ 治疗用途的文章。这两种药物在体外均显示出对冠状病毒有显著的潜在作用。许多关于 CQ 和 HCQ 临床应用的研究表明，高剂量的患者会出现不良反应。
临床研究存在一些方法学上的缺陷，例如缺乏关于治疗的信息和实验患者数量较少，导致对数据的误解。此外，临床研究样本量有限，且大多数研究没有对照组，一些患者在这些方案中死亡。
尽管 CQ 和 HCQ 在体外具有抗病毒作用，但在临床上，这两种药物无论是单独使用还是与其他药物联合使用，都可能增加心律失常的风险，导致心脏骤停和猝死。此外，还有许多不确定性仍然存在，例如开始治疗的时间、规定的剂量、治疗时间的长短、患者的病情、同时使用的药物等。
从审查的研究来看，尚不能在疾病的任何阶段确定 CQ 和 HCQ 在 COVID-19 治疗中的确切疗效和安全性。需要进一步的研究。
