Chloroquine and hydroxychloroquine in coronavirus disease 2019 (COVID-19). Facts, fiction and the hype: a critical appraisal

Int J Antimicrob Agents. 2020 Sep;56(3):106101. doi: 10.1016/j.ijantimicag.2020.106101. Epub 2020 Jul 17.

Abstract

The coronavirus infection (COVID-19) has turned into a global catastrophe and there is an intense search for effective drug therapy. Of all the potential therapies, chloroquine and hydroxychloroquine have been the focus of tremendous public attention. Both drugs have been used in the treatment and prophylaxis of malaria. Long-term use of hydroxychloroquine is the cornerstone in the treatment of several auto-immune disorders. There is convincing evidence that hydroxychloroquine has strong in vitro antiviral activity against SARS-CoV-2. A few small uncontrolled trials and several anecdotal reports have shown conflicting results of such drug therapy in COVID-19. However, the results of preliminary large-scale randomized controlled trials have failed to show any survival benefit of such drug therapy in COVID-19. Despite the lack of such evidence, hydroxychloroquine has been used as a desperate attempt for prophylaxis and treatment of COVID-19. The drug has wide-ranging drug interactions and potential cardiotoxicity. Indiscriminate unsupervised use can expose the public to serious adverse drug effects.

Keywords: COVID-19; Chloroquine; Coronavirus; Hydroxychloroquine; Pandemic; SARS-CoV-2.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents / administration & dosage*
  • Anti-Inflammatory Agents / adverse effects
  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / adverse effects
  • Betacoronavirus / drug effects
  • Betacoronavirus / growth & development
  • Betacoronavirus / immunology
  • COVID-19
  • Chloroquine / administration & dosage*
  • Chloroquine / adverse effects
  • Clinical Trials as Topic
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / prevention & control
  • Coronavirus Infections / virology
  • Cytokine Release Syndrome / drug therapy
  • Cytokine Release Syndrome / mortality
  • Cytokine Release Syndrome / prevention & control*
  • Cytokine Release Syndrome / virology
  • Cytokines / antagonists & inhibitors
  • Cytokines / genetics
  • Cytokines / immunology
  • Drug Administration Schedule
  • Host-Pathogen Interactions / drug effects
  • Host-Pathogen Interactions / genetics
  • Host-Pathogen Interactions / immunology
  • Humans
  • Hydroxychloroquine / administration & dosage*
  • Hydroxychloroquine / adverse effects
  • Immunologic Factors / administration & dosage*
  • Immunologic Factors / adverse effects
  • Pandemics / prevention & control
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / prevention & control
  • Pneumonia, Viral / virology
  • SARS-CoV-2
  • Survival Analysis
  • Virus Internalization / drug effects
  • Virus Replication / drug effects

Substances

  • Anti-Inflammatory Agents
  • Antiviral Agents
  • Cytokines
  • Immunologic Factors
  • Hydroxychloroquine
  • Chloroquine