Repositioning Chloroquine as Ideal Antiviral Prophylactic against COVID-19 - Time is Now

Abstract

The novel coronavirus 2019 pandemic is rapidly advancing despite public health measures. Pharmaceutical prophylaxis is an established approach to potentially control infectious diseases and is one solution to the urgent public health challenge posed by COVID-19. Screening and development of new vaccines and antivirals is expensive and time consuming while the repositioning of available drugs should receive priority attention as well as international government and agency support. Here we propose an old drug chloroquine (CQ) to be urgently repositioned as an ideal antiviral prophylactic against COVID-19. CQ has ability to block viral attachment and entry to host cells. Its proven clinical efficacy against a variety of viruses including COVID-19 and its current deployment in COVID-19 therapeutic trials strengthens its potential candidacy as a prophylactic. Furthermore, CQ has a long safety record, is inexpensive and widely vailable. Here we reviewed CQ's antiviral mechanisms, its laboratory efficacy activity against COVID-19, as well as CQ's pharmacokinetics in its established use against malaria and autoimmune diseases to recommend safe and potentially efficacious dose regimens for protection against COVID-19: a pre-exposure prophylaxis of 250-500mg daily and post-exposure prophylaxis at 8mg/kg/day for 3 days. We recommend further urgent research on CQ for COVID-19 prevention and urge that the above regimens be investigated in parallel with mass deployment by relevant agencies in attempts to contain the pandemic without unnecessary regulatory delays as benefits far outweigh risks or costs.

Role of Chloroquine and Hydroxychloroquine in the Treatment of COVID-19 Infection- A Systematic Literature Review

“…This protocol has pre-exposure prophylaxis of 250-500mg CQ daily and post-exposure prophylaxis at 8mg/kg/day CQ for three days. 24 All rights reserved. No reuse allowed without permission.…”

“…Arya R et al23 NA NA CQ inhibitor of the crucial viral protein, PLpro.16aChang R et al24 CQ 8mg/kg/day for three days in post-exposure but asymptomatic cases, ideally to be taken within hours after known viral exposure bas…”

Prevention and management of COVID-19 among patients with diabetes: an appraisal of the literature

“…Evidence from randomised clinical trials is urgently needed. Chloroquine has demonstrated antiviral activity against five out of seven known human coronaviruses, including COVID-19 [80] and is a leading candidate for prophylactic use [81]. Ongoing trials in China have yielded encouraging preliminary findings [70], but the data are generally contentious.…”

Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study

“…Moreover, the clinical features of severe COVID-19 patients were similar to the Middle East respiratory syndrome-related coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) that might occur acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver and kidney injury and even death [6,7]. There are no vaccines and no FDA-approved therapeutics or drugs to treat, cure or prevent COVID-19 and this issue is more important in the case of Iran, because Iran is under severe sanctions [8][9][10]. Despite the growing body of studies in the recent four months, there are few reports on the clinical and laboratory features of COVID-19 cases outside China, and especially in Iran.…”