COVID-19 and hydroxychloroquine: Is the wonder drug failing?

Paliani, Ugo; Cardona, Andrea

doi:10.1016/j.ejim.2020.06.002

Cited by 11 publications

(10 citation statements)

References 14 publications

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“…Whether hydroxychloroquine administration lowered the rates of critical illness development is beyond the scope of this study. 13…”

Section: Discussionmentioning

confidence: 99%

Factors associated with progression to critical illness in 28 days among COVID-19 patients: results from a tertiary care hospital in Istanbul, Turkey

Sili

Topuzoğlu

et al. 2020

Preprint

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Background Coronavirus disease 2019 (COVID-19) quickly spread worldwide to become a pandemic. This study aimed to define the predictors of critical illness development within 28 days postadmission. Methods We conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020. The development of critical illness, e.g., invasive mechanical ventilation and/or death, was followed for a period of 28 days postadmission. Demographic characteristics, number of comorbidities, illness severity at admission defined by the WHO scale, vital signs, laboratory findings and period of admission to the hospital were independent variables. Cox proportional hazards analysis was performed, and the C-index was calculated. Results The median (IQR) age of the cohort was 55.0 (44.0-67.0) years, and 50.1% were male. The most common presenting symptoms were cough, dyspnea and fatigue. Overall, 65.2% of the patients had at least one comorbidity. Hydroxychloroquine was given to 99.2% of the patients. Critical illness developed in 45 (9.4%; 95% CI: 7.0%-12.4%) patients. In the multivariable analysis, age (HR: 1.05, p<0.001), number of comorbidities (HR: 1.33, p=0.02), procalcitonin ≥0.25 μg/L (HR: 2.12, p=0.03) and LDH ≥350 U/L (HR: 2.04, p=0.03) were independently associated with critical illness development. The WHO scale on admission was the strongest predictor of critical illness (HR: 4.15, p<0.001). Prognosis improved within the study period (p<0.05). The C-index of the model was 0.92. Conclusions Age, comorbidity number, WHO scale, LDH and procalcitonin were independently associated with critical illness development. Mortality from COVID-19 seems to be decreasing as the pandemic advances.

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“…Whether hydroxychloroquine administration lowered the rates of critical illness development is beyond the scope of this study. 13…”

Section: Discussionmentioning

confidence: 99%

Factors associated with progression to critical illness in 28 days among COVID-19 patients: results from a tertiary care hospital in Istanbul, Turkey

Sili

Topuzoğlu

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Pharmacological interaction with azithromycin can potentially prolong QT interval when these two drugs are taken together, as has been tried in the management of COVID-19. Hence, due caution and pre-treatment with follow-up ECGs to seek any developing cardiac arrhythmias might be suggested if and when HCQ is combined with azithromycin or any other drug that can cause QT prolongation [ 81 ].…”

Section: Adverse Effects Of Hydroxychloroquine Methotrexate and Colcmentioning

confidence: 99%

Benefits and adverse effects of hydroxychloroquine, methotrexate and colchicine: searching for repurposable drug candidates

2020

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Repurposing of antirheumatic drugs has garnered global attention. The aim of this article is to overview available evidence on the use of widely used antirheumatic drugs hydroxychloroquine, methotrexate and colchicine for additional indications. Hydroxychloroquine has endothelial stabilizing and anti-thrombotic effects. Its use has been explored as an adjunctive therapy in refractory thrombosis in antiphospholipid syndrome. It may also prevent recurrent pregnancy losses in the absence of antiphospholipid antibodies. Hydroxychloroquine favourably modulates atherogenic lipid and glycaemic profiles. Methotrexate has been tried for modulation of cardiovascular events in non-rheumatic clinical conditions, although a large clinical trial failed to demonstrate a benefit. Colchicine has been shown to successfully reduce the risk of recurrent cardiovascular events in a large multicentric trial. Potential antifibrotic effects of colchicine require further exploration. Hydroxychloroquine, methotrexate and colchicine are also being tried at different stages of the ongoing Coronavirus Disease 19 (COVID-19) pandemic for prophylaxis and treatment. While the use of these agents is being diversified, their adverse effects should be timely diagnosed and prevented. Hydroxychloroquine can cause retinopathy and rarely cardiac and auditory toxicity, retinopathy being dose and time dependent. Methotrexate can cause transaminitis, cytopenias and renal failure, particularly in acute overdoses. Colchicine can rarely cause myopathies, cardiomyopathy, cytopenias and transaminitis. Strong evidence is warranted to keep balance between benefits of repurposing these old antirheumatic drugs and risk of their adverse effects.

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“…We read with interest the letter entitled "COVID-19 and hydroxychloroquine: is the wonder drug failing ?" by U. Paliani and A. Cordona [1]. This work illustrates the need to be very careful in analyzing the literature at a time when scientific conflicts of this magnitude are taking place.…”

Section: Dear Editormentioning

confidence: 74%