Hydroxychloroquine is protective to the heart, not harmful: a systematic review

Abstract

Hydroxychloroquine (HCQ) has been shown to be at least somewhat effective in treating patients with coronavirus disease 2019 (COVID-19). Recently the US Food and Drug Administration and Centers for Disease Control and Prevention warnings of fatal cardiac toxicity from torsades de pointes (TDP) arrhythmia from HCQ receipt have been made, notwithstanding the long safe provision of HCQ to treat lupus and rheumatoid arthritis. This has resulted in restricted access of HCQ for COVID-19 treatment. We hypothesized that HCQ and azithromycin have not been reported to cause significant acute cardiac arrhythmic mortality. We performed a literature search for the effects of HCQ and azithromycin on the heart. No TDP or related deaths were found to have been reported as a result of HCQ and azithromycin receipt in the peer-reviewed literature. On the contrary, HCQ and azithromycin were both found to substantially reduce cardiac mortality and also decrease thrombosis, arrhythmia and cholesterol in treated patients in recent peer-reviewed studies and meeting presentations. HCQ and azithromycin do not cause TDP cardiac mortality; rather, HCQ decreases cardiac events. HCQ should not be restricted in COVID-19 patients out of fear of cardiac mortality.

Potential therapeutic agents to COVID-19: An update review on antiviral therapy, immunotherapy, and cell therapy

“…A recent controversial study by Prodromos et al, on the possible side effects of HCQ in patients with COVID-19 revealed that not only HCQ azithromycin is not cardiotoxic and does not cause cardiac arrhythmia and mortality, but also protect the heart with reducing cholesterol, thrombosis, and arrhythmia in the treated patients [79] .…”

<p>Hypothesis: What is the Best We Can Do with Hydroxychloroquine for COVID-19?</p>

“…Given the rather cost-effective and safe outcomes from recent observational experiences with HCQ, 8,9,11,14,16,31 pending the outcomes of the ongoing clinical trials, we would propose, prepare now and implement promptly the following outline protocol for this and possibly subsequent outbreaks of COVID-19 (Figure 1).…”

“…However, the SARS-CoV-2 load is low during early onset before massive viral replications in the body, hence only a low dose of HCQ is needed, thus better safety, without additional need for azithromycin that is known to be synergistic with HCQ or CQ for cardiac toxicity. 5 , 30 , 31 Therefore, both timing and dose appear crucial for the optimal use of HCQ in COVID-19 treatment. More recently, sequela such as fatigue, shortness of breath and headache are reported among patients three months after their recovery, even those with “mild” symptoms can suffer from COVID-19 for a long time.…”

“…Given the rather cost-effective and safe outcomes from recent observational experiences with HCQ, 8 , 9 , 11 , 14 , 16 , 31 pending the outcomes of the ongoing clinical trials, we would propose, prepare now and implement promptly the following outline protocol for this and possibly subsequent outbreaks of COVID-19 ( Figure 1 ). By way of preparation, ensure the availability of sufficient quantities of the (easily prepared, small molecule) drug in oral doses, together with guidelines for prescription and use consistent with the regime outlined in this protocol.…”

Regarding: “Hydroxychloroquine: a comprehensive review and its controversial role in coronavirus disease 2019”

“…The review article by Bansal and co-workers discusses hydroxychloroquine (HCQ), which at the moment is the most widely used prophylactic and therapeutic agent for SARS-CoV-2 infection (COVID-19) in the world [ 1 ]. The safety profile of this long-utilized antimalarial/anti-inflammatory is well understood and its benefit to risk relationship is encountered everyday as physicians prescribe this agent [ 2 , 3 ]. In Figure 4, the authors depict a large white scar in the short axis image of the left ventricle similar to that of a myocardial infarction.…”