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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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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. |
format | Online Article Text |
id | pubmed-7440188 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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