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Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified?

The outbreak of COVID-19 in Wuhan, China and its declaration as a global pandemic by WHO has left the medical community under significant pressure to rapidly identify effective therapeutic and preventative strategies. Chloroquine (CQ) and its analogue hydroxychloroquine (HCQ) were found to be effica...

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Autores principales: Stevenson, Alex, Kirresh, Ali, Conway, Samuel, White, Laura, Ahmad, Mahmood, Little, Callum
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440188/
https://www.ncbi.nlm.nih.gov/pubmed/32817375
http://dx.doi.org/10.1136/openhrt-2020-001362
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author Stevenson, Alex
Kirresh, Ali
Conway, Samuel
White, Laura
Ahmad, Mahmood
Little, Callum
author_facet Stevenson, Alex
Kirresh, Ali
Conway, Samuel
White, Laura
Ahmad, Mahmood
Little, Callum
author_sort Stevenson, Alex
collection PubMed
description The outbreak of COVID-19 in Wuhan, China and its declaration as a global pandemic by WHO has left the medical community under significant pressure to rapidly identify effective therapeutic and preventative strategies. Chloroquine (CQ) and its analogue hydroxychloroquine (HCQ) were found to be efficacious against SARS-CoV-2 when investigated in preliminary in vitro experiments. Reports of success in early clinical studies were widely publicised by news outlets, politicians and on social media. These results led several countries to approve the use of these drugs for the treatment of patients with COVID-19. Despite having reasonable safety profiles in the treatment of malaria and certain autoimmune conditions, both drugs are known to have potential cardiotoxic side effects. There is a high incidence of myocardial injury and arrhythmia reported with COVID-19 infection, and as such this population may be more susceptible to this side-effect profile. Studies to date have now demonstrated that in patients with COVID-19, these drugs are associated with significant QTc prolongation, as well as reports of ventricular arrhythmias. Furthermore, subsequent studies have failed to demonstrate clinical benefit from either drug. Indeed, clinical trials have also been stopped early due to safety concerns over HCQ. There is an urgent need for credible solutions to the global pandemic, but we argue that in the absence of high-quality evidence, there needs to be greater caution over the routine use or authorisation of drugs for which efficacy and safety is unproven.
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spelling pubmed-74401882020-08-20 Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified? Stevenson, Alex Kirresh, Ali Conway, Samuel White, Laura Ahmad, Mahmood Little, Callum Open Heart Special Populations The outbreak of COVID-19 in Wuhan, China and its declaration as a global pandemic by WHO has left the medical community under significant pressure to rapidly identify effective therapeutic and preventative strategies. Chloroquine (CQ) and its analogue hydroxychloroquine (HCQ) were found to be efficacious against SARS-CoV-2 when investigated in preliminary in vitro experiments. Reports of success in early clinical studies were widely publicised by news outlets, politicians and on social media. These results led several countries to approve the use of these drugs for the treatment of patients with COVID-19. Despite having reasonable safety profiles in the treatment of malaria and certain autoimmune conditions, both drugs are known to have potential cardiotoxic side effects. There is a high incidence of myocardial injury and arrhythmia reported with COVID-19 infection, and as such this population may be more susceptible to this side-effect profile. Studies to date have now demonstrated that in patients with COVID-19, these drugs are associated with significant QTc prolongation, as well as reports of ventricular arrhythmias. Furthermore, subsequent studies have failed to demonstrate clinical benefit from either drug. Indeed, clinical trials have also been stopped early due to safety concerns over HCQ. There is an urgent need for credible solutions to the global pandemic, but we argue that in the absence of high-quality evidence, there needs to be greater caution over the routine use or authorisation of drugs for which efficacy and safety is unproven. BMJ Publishing Group 2020-08-19 /pmc/articles/PMC7440188/ /pubmed/32817375 http://dx.doi.org/10.1136/openhrt-2020-001362 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Special Populations
Stevenson, Alex
Kirresh, Ali
Conway, Samuel
White, Laura
Ahmad, Mahmood
Little, Callum
Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified?
title Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified?
title_full Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified?
title_fullStr Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified?
title_full_unstemmed Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified?
title_short Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified?
title_sort hydroxychloroquine use in covid-19: is the risk of cardiovascular toxicity justified?
topic Special Populations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440188/
https://www.ncbi.nlm.nih.gov/pubmed/32817375
http://dx.doi.org/10.1136/openhrt-2020-001362
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