Should chloroquine and hydroxychloroquine be used to treat COVID-19? A rapid review

Abstract

Background: On the 11 March 2020, the World Health Organization (WHO) declared that COVID-19 was a pandemic. To date, there are no medical treatments for COVID-19 with proven effectiveness. Novel treatments and/or vaccines will take time to be developed and distributed to patients. In light of this, there has been growing interest in the use of existing medications, such as chloroquine (CQ) and hydroxychloroquine (HCQ), as potential treatments of this disease.Aim: To establish the current evidence for the effectiveness of CQ and HCQ in treating COVID-19. Design & setting:A rapid review of the literature was conducted.Method: Electronic searches in PubMed and Google Scholar were conducted on 21 March 2020. A further search was conducted in Google for relevant literature on 28 March 2020.Results: There is limited evidence of in vitro activity of CQ/HCQ against SARS-CoV-2. A number of in vivo clinical trials are underway. The empirical data available from two of these trials reveal conflicting results. Both trials are characterised by small numbers of participants (n = 30 and n = 36) and suffer methodological limitations. No medium or long-term follow-up data is available.Conclusion: At present, there is insufficient evidence to determine whether CQ/HCQ are safe and effective treatments for COVID-19. High quality, adequately powered randomised clinical trials in primary and secondary care settings are urgently required to guide policymakers and clinicians. These studies should report medium-and long-term follow-up results, and safety data. How this fits inChloroquine (CQ) and hydroxychloroquine (HCQ) have been used in the treatment and prophylaxis of a number of conditions, such as malaria, for several years. As novel treatments for COVID-19 are likely to take time to develop, a number of clinical trials have been registered to investigate the effectiveness of existing medications such as CQ or HCQ. At present, there is insufficient evidence to recommend their use for the current pandemic outside of clinical trials. Further, high quality studies are urgently needed to provide timely guidance for clinicians and policymakers alike.

Review of Current Evidence of Hydroxychloroquine in Pharmacotherapy of COVID-19

“…This is in agreement with the other authors with similar findings of lack of literature in this regard. 28,29,30,46 The earliest nonempirical evidence came from China in form of report letter in which more than 100 patients with COVID pneumonia showed clinical improvement and changes in image findings on chloroquine administration. 43 It is pertinent to note that this letter was the brief report of ongoing many trials in various locations in China, neither it mentioned any specific data regarding interventions, study design, study population and outcome measures, nor any adverse events were discussed.…”

Respiratory conditions in coronavirus disease 2019 (COVID-19): Important considerations regarding novel treatment strategies to reduce mortality

“…It was recently suggested that chloroquine (CQ) and hydroxychloroquine (HCQ) may be useful in the treatment of COVID-19, but presently there is inadequate evidence to support their safe and effective treatment of COVID-19 [33]. There is emerging evidence suggesting that CQ and HCQ may directly impact cornavirus attachment to respiratory cells [34], but there is also interesting potential modes of action for these drugs with respect to respiratory conditions associated with COVID-19.…”

Statins and the COVID-19 main protease: in silico evidence on direct interaction

“…In fact, only preventive and supportive therapies directed to prevent complications of the disease and organ damage are available. Although antimalarial drugs chloroquine and hydroxychloroquine are used in some countries for the treatment of this disease, at present there is not sufficient evidence to determine whether they are effective treatments for COVID-19 [5].…”