Medical Journal of Dr. D.Y. Patil Vidyapeeth

COMMENTARY
Year
: 2020  |  Volume : 13  |  Issue : 3  |  Page : 208--209

Hydroxychloroquine, COVID-19, and prophylaxis


Viroj Wiwanitkit 
 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India; partment of Community Medicine, Hainan Medical University, Haikou, China; Department of Community Medicine, Faculty of Medicine, University of Nis, Nis, Serbia; Department of Community Medicine, Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria

Correspondence Address:
Viroj Wiwanitkit
Professor, Dr. DY Patil University, Pune, Maharashtra




How to cite this article:
Wiwanitkit V. Hydroxychloroquine, COVID-19, and prophylaxis.Med J DY Patil Vidyapeeth 2020;13:208-209


How to cite this URL:
Wiwanitkit V. Hydroxychloroquine, COVID-19, and prophylaxis. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Aug 11 ];13:208-209
Available from: http://www.mjdrdypv.org/text.asp?2020/13/3/208/285764


Full Text



As a new emerging infection, the effective treatment for COVID-19 is still unavailable. There are several attempts to find new drugs to manage this infection. At the same time, there are attempts to use classical available drug for trial treatment of the patients. Many drugs including antiretroviral drugs, antibiotics, antimalarial drug, and hydroxychloroquine are presently being tested for efficacy in treatment of COVID-19. Hydroxychloroquine is one of the drugs mentioned for its effectiveness in COVID-19 patients. Presently, this drug is used in rheumatology for treating systemic lupus erythematosus (SLE) and patients with other autoimmune conditions. The extremely low incidence of COVID-19 among patients with underlying SLE is an important clue triggering the study of efficacy of hydroxychloroquine against COVID-19.[1]

If hydroxychloroquine is used for treatment of patients with COVID-19, effectiveness of the drug is the main parameter to be evaluated. In addition, the safety of the drug has to be verified. Meyerowitz et al. noted that the drug “should only be used with caution and in the context of carefully thought out clinical trials, or on a case-by-case basis after rigorous consideration of the risks and benefits of this therapeutic approach.[2]” In the above study,[3] the safety of the drug is reported. According to this study on “Adverse drug reaction profile of prophylactic hydroxychloroquine for COVID-19 amongst doctors,” there is no serious adverse reaction of the drug in the sample of doctors observed.

In fact, the risk of using hydroxychloroquine for treatment of COVID-19 is an important issue to be addressed. The single use or combination with antibiotics such as azithromycin might cause clinical problem.[4] An important basic risk of using hydroxychloroquine is the triggering of hemolytic episode in patients with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency.[5] This is a common genetic disorder in many areas of the world; the risk in these regions should be kept in mind. Another important risk of using hydroxychloroquine for COVID-19 treatment is cardiac complication. Acquired long QT syndrome is a possible adverse effect due to proarrhythmic effects of hydroxychloroquine.[6],[7] A rarer unwanted adverse effect on hepatic function is also reported on using hydroxychloroquine in patients with COVID-19. Using hydroxychloroquine is reported for possible induction of “10-fold increase in serum levels of transaminases” in COVID-19 patients.[8] When used for prophylaxis in people with cardiac and hepatic conditions, monitoring of electrocardiogram and liver function tests is recommended.

However, since hydroxychloroquine is a classical drug that is not expensive and is already adapted in management of many clinical problems such as diabetes, Singh et al. noted that it is “worthy of fast-track clinical trial for treatment, and may be carefully considered for clinical use as experimental drug.[9]” At least, if hydroxychloroquine is selected for treatment of patients with COVID-19, a simple test for G6PD deficiency is required before starting of hydroxychloroquine. Finally, if the drug is finally confirmed for effectiveness and safety, the further issue to be studied is the proper dosage for use in management of COVID-19.

References

1Joob B, Wiwanitkit V. SLE, hydroxychloroquine and no SLE patients with covid-19: A comment. Ann Rheum Dis 2020;79:e61.
2Meyerowitz EA, Vannier AGL, Friesen MGN, Schoenfeld S, Gelfand JA, Callahan MV, et al. Rethinking the role of hydroxychloroquine in the treatment of COVID-19. FASEB J 2020;34:6027-37.
3Kulkarni RK, Kinikar AA, Jadhav T. Adverse drug reaction profile of prophylactic Hydroxychloroquine for COVID-19 amongst doctors. Med J Dr DY Patil Vidyapeeth 2020;13:3.
4Javelot H, El-Hage W, Meyer G, Becker G, Michel B, Hingray C. COVID-19 and (hydroxy) chloroquine-azithromycin combination: Should we take the risk for our patients? Br J Clin Pharmacol 2020. [Doi: 10.1111/bcp.14335].
5Beauverd Y, Adam Y, Assouline B, Samii K. COVID-19 infection and treatment with hydroxychloroquine cause severe haemolysis crisis in a patient with glucose-6-phosphate dehydrogenase deficiency. Eur J Haematol 2020;10. doi:10.1111/ejh.13432.
6Tomcsányi J, Tomcsányi K. Hazard of acquired long QT syndrome during coronavirus pandemic. Focus on hydroxychloroquine. Orv Hetil 2020;161:689-91.
7Lentini G, Cavalluzzi MM, Habtemariam S. COVID-19, Chloroquine repurposing, and cardiac safety concern: Chirality might help. Molecules 2020;25:1834.
8Falcão MB, Pamplona de Góes Cavalcanti L, Filgueiras Filho NM, Antunes de Brito CA. Case report: Hepatotoxicity associated with the use of hydroxychloroquine in a patient with novel coronavirus disease (COVID-19). Am J Trop Med Hyg 2020. doi:10.4269/ajtmh.20-0276.
9Singh AK, Singh A, Shaikh A, Singh R, Misra A. Chloroquine and hydroxychloroquine in the treatment of COVID-19 with or without diabetes: A systematic search and a narrative review with a special reference to India and other developing countries. Diabetes Metab Syndr 2020;14:241-6.