Rethinking the role of hydroxychloroquine in the treatment of COVID-19.
Identifieur interne : 001836 ( Main/Corpus ); précédent : 001835; suivant : 001837Rethinking the role of hydroxychloroquine in the treatment of COVID-19.
Auteurs : Eric A. Meyerowitz ; Augustin G L. Vannier ; Morgan G N. Friesen ; Sara Schoenfeld ; Jeffrey A. Gelfand ; Michael V. Callahan ; Arthur Y. Kim ; Patrick M. Reeves ; Mark C. PoznanskySource :
- FASEB journal : official publication of the Federation of American Societies for Experimental Biology [ 1530-6860 ] ; 2020.
English descriptors
- KwdEn :
- COVID-19 (MeSH), Coronavirus Infections (drug therapy), Datasets as Topic (standards), Heart (drug effects), Humans (MeSH), Hydroxychloroquine (adverse effects), Hydroxychloroquine (pharmacology), Hydroxychloroquine (therapeutic use), Immunity, Innate (drug effects), Pandemics (MeSH), Pneumonia, Viral (drug therapy), Randomized Controlled Trials as Topic (standards).
- MESH :
- chemical , adverse effects : Hydroxychloroquine.
- drug effects : Heart, Immunity, Innate.
- drug therapy : Coronavirus Infections, Pneumonia, Viral.
- chemical , pharmacology : Hydroxychloroquine.
- standards : Datasets as Topic, Randomized Controlled Trials as Topic.
- chemical , therapeutic use : Hydroxychloroquine.
- COVID-19, Humans, Pandemics.
Abstract
There are currently no proven or approved treatments for coronavirus disease 2019 (COVID-19). Early anecdotal reports and limited in vitro data led to the significant uptake of hydroxychloroquine (HCQ), and to lesser extent chloroquine (CQ), for many patients with this disease. As an increasing number of patients with COVID-19 are treated with these agents and more evidence accumulates, there continues to be no high-quality clinical data showing a clear benefit of these agents for this disease. Moreover, these agents have the potential to cause harm, including a broad range of adverse events including serious cardiac side effects when combined with other agents. In addition, the known and potent immunomodulatory effects of these agents which support their use in the treatment of auto-immune conditions, and provided a component in the original rationale for their use in patients with COVID-19, may, in fact, undermine their utility in the context of the treatment of this respiratory viral infection. Specifically, the impact of HCQ on cytokine production and suppression of antigen presentation may have immunologic consequences that hamper innate and adaptive antiviral immune responses for patients with COVID-19. Similarly, the reported in vitro inhibition of viral proliferation is largely derived from the blockade of viral fusion that initiates infection rather than the direct inhibition of viral replication as seen with nucleoside/tide analogs in other viral infections. Given these facts and the growing uncertainty about these agents for the treatment of COVID-19, it is clear that at the very least thoughtful planning and data collection from randomized clinical trials are needed to understand what if any role these agents may have in this disease. In this article, we review the datasets that support or detract from the use of these agents for the treatment of COVID-19 and render a data informed opinion that they should only be used with caution and in the context of carefully thought out clinical trials, or on a case-by-case basis after rigorous consideration of the risks and benefits of this therapeutic approach.
DOI: 10.1096/fj.202000919
PubMed: 32350928
PubMed Central: PMC7267640
Links to Exploration step
pubmed:32350928Le document en format XML
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<term>Hydroxychloroquine (therapeutic use)</term>
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<front><div type="abstract" xml:lang="en">There are currently no proven or approved treatments for coronavirus disease 2019 (COVID-19). Early anecdotal reports and limited in vitro data led to the significant uptake of hydroxychloroquine (HCQ), and to lesser extent chloroquine (CQ), for many patients with this disease. As an increasing number of patients with COVID-19 are treated with these agents and more evidence accumulates, there continues to be no high-quality clinical data showing a clear benefit of these agents for this disease. Moreover, these agents have the potential to cause harm, including a broad range of adverse events including serious cardiac side effects when combined with other agents. In addition, the known and potent immunomodulatory effects of these agents which support their use in the treatment of auto-immune conditions, and provided a component in the original rationale for their use in patients with COVID-19, may, in fact, undermine their utility in the context of the treatment of this respiratory viral infection. Specifically, the impact of HCQ on cytokine production and suppression of antigen presentation may have immunologic consequences that hamper innate and adaptive antiviral immune responses for patients with COVID-19. Similarly, the reported in vitro inhibition of viral proliferation is largely derived from the blockade of viral fusion that initiates infection rather than the direct inhibition of viral replication as seen with nucleoside/tide analogs in other viral infections. Given these facts and the growing uncertainty about these agents for the treatment of COVID-19, it is clear that at the very least thoughtful planning and data collection from randomized clinical trials are needed to understand what if any role these agents may have in this disease. In this article, we review the datasets that support or detract from the use of these agents for the treatment of COVID-19 and render a data informed opinion that they should only be used with caution and in the context of carefully thought out clinical trials, or on a case-by-case basis after rigorous consideration of the risks and benefits of this therapeutic approach.</div>
</front>
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<Abstract><AbstractText>There are currently no proven or approved treatments for coronavirus disease 2019 (COVID-19). Early anecdotal reports and limited in vitro data led to the significant uptake of hydroxychloroquine (HCQ), and to lesser extent chloroquine (CQ), for many patients with this disease. As an increasing number of patients with COVID-19 are treated with these agents and more evidence accumulates, there continues to be no high-quality clinical data showing a clear benefit of these agents for this disease. Moreover, these agents have the potential to cause harm, including a broad range of adverse events including serious cardiac side effects when combined with other agents. In addition, the known and potent immunomodulatory effects of these agents which support their use in the treatment of auto-immune conditions, and provided a component in the original rationale for their use in patients with COVID-19, may, in fact, undermine their utility in the context of the treatment of this respiratory viral infection. Specifically, the impact of HCQ on cytokine production and suppression of antigen presentation may have immunologic consequences that hamper innate and adaptive antiviral immune responses for patients with COVID-19. Similarly, the reported in vitro inhibition of viral proliferation is largely derived from the blockade of viral fusion that initiates infection rather than the direct inhibition of viral replication as seen with nucleoside/tide analogs in other viral infections. Given these facts and the growing uncertainty about these agents for the treatment of COVID-19, it is clear that at the very least thoughtful planning and data collection from randomized clinical trials are needed to understand what if any role these agents may have in this disease. In this article, we review the datasets that support or detract from the use of these agents for the treatment of COVID-19 and render a data informed opinion that they should only be used with caution and in the context of carefully thought out clinical trials, or on a case-by-case basis after rigorous consideration of the risks and benefits of this therapeutic approach.</AbstractText>
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<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Meyerowitz</LastName>
<ForeName>Eric A</ForeName>
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<AffiliationInfo><Affiliation>Special Advisor to the Assistant Secretary of Public Health Preparedness and Response U.S Dept of Health and Human Services, Washington, DC, USA.</Affiliation>
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