Review: Hydroxychloroquine and Chloroquine for Treatment of SARS-CoV-2 (COVID-19)

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly emerging viral infection causing coronavirus disease 2019 (COVID-19). Hydroxychloroquine and chloroquine have garnered unprecedented attention as potential therapeutic agents against COVID-19 following several small clinical trials, uncontrolled case series, and public figure endorsements. While there is a growing body of scientific data, there is also concern for harm, particularly QTc prolongation and cardiac arrhythmias. Here, we perform a rapid narrative review and discuss the strengths and limitations of existing in vitro and clinical studies. We call for additional randomized controlled trial evidence prior to the widespread incorporation of hydroxychloroquine and chloroquine into national and international treatment guidelines.

Post-exposure prophylaxis or pre-emptive therapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): study protocol for a pragmatic randomized-controlled trial

“…39 Several in vitro and in vivo studies have shown data that may support its possible efficacy, but clinical data are limited to small clinical trials and uncontrolled case series and cohorts. 20 There is an urgent need for the rigorous evaluation of hydroxychloroquine as a therapeutic option against COVID-19. 40 This innovative trial is adequately powered to rapidly answer urgent questions regarding the effectiveness of hydroxychloroquine and its ability to prevent or reduce the severity of COVID-19.…”

“…While few pharmacologic agents have shown in vitro suppression of viral replication against coronaviruses, 20 one agent, chloroquine, has been shown to be effective at reducing laboratory established infection and spread to adjacent cells from SARS-CoV. 21 More recently, the related drug hydroxychloroquine was found to prevent SARS-CoV-2 viral replication before and after infection of Vero cell lines.…”

“…28,32 Nevertheless, the current evidence base is limited because of small, underpowered sample sizes and large observational studies without proper controls. 20 Global political forces continue to emphasize a not-yetproven role for hydroxychloroquine in the paradigm of COVID-19 treatment. Urgent clinical trials are therefore needed to establish whether hydroxychloroquine may be an effective therapy for COVID-19.…”

Post-exposure Prophylaxis or Preemptive Therapy for SARS-Coronavirus-2: Study Protocol for a Pragmatic Randomized Controlled Trial

“…39 Several in vitro and in vivo studies have shown data that may support its possible efficacy, but clinical data is limited to small clinical trials and uncontrolled case series and cohorts. 20 There is an urgent need for the rigorous evaluation of hydroxychloroquine as a therapeutic option against This innovative trial is adequately powered to rapidly answer urgent questions regarding the effectiveness of hydroxychloroquine and its ability to prevent or reduce the severity of COVID-19. The novel web-based design of this trial, in the setting of a highly contagious global pandemic, has ensured that all interactions with participants, including enrollment and informed consent, are done remotely using courier services for medicine delivery and internet-based follow-up.…”

“…28,32 However, the current evidence base is limited due to small, underpowered sample sizes and large observational studies without proper controls. 20 Global political forces continue to emphasize a not-yet-proven role for hydroxychloroquine in the paradigm of COVID-19 treatment. Urgent clinical trials are therefore needed to establish whether hydroxychloroquine may be an effective therapy for COVID-19.…”