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Papageorgiou JM, Almroth H, Törnudd M, van der Wal H, Varelogianni G, Lawesson SS. Fulminant myocarditis in a COVID-19 positive patient treated with mechanical circulatory support - a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 5:ytaa523. [PMID: 33594347 PMCID: PMC7799209 DOI: 10.1093/ehjcr/ytaa523] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/07/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) spreading from Wuhan, Hubei province in China, is an expanding global pandemic with significant morbidity and mortality. Even though respiratory failure is the cardinal form of severe COVID-19, concomitant cardiac involvement is common. Myocarditis is a challenging diagnosis due to heterogeneity of clinical presentation, ranging from mild symptoms to fatal arrhythmia and cardiogenic shock (CS). The aetiology is often viral and endomyocardial biopsy (EMB) is the gold standard for definite myocarditis. However, the diagnosis is often made on medical history, clinical presentation, magnetic resonance imaging, and blood tests. Case summary We present a 43-year-old man with mixed connective tissue disease treated with hydroxychloroquine who rapidly developed CS 4 days from symptom onset with fever and cough, showing positive polymerase chain reaction nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. While computed tomography of the thorax was normal, high-sensitivity troponin T was elevated and electrocardiogram showed diffuse ST elevation and low voltage as signs of myocardial oedema. Echocardiography showed severe depression of left ventricular function. The myocardium recovered completely after a week with mechanical circulatory support (MCS). EMB was performed but could neither identify the virus in the cardiomyocytes, nor signs of inflammation. Still the most probable aetiology of CS in this case is myocarditis as a sole symptom of COVID-19. Discussion COVID-19 patients in need of hospitalization present commonly with respiratory manifestations. We present the first case of fulminant myocarditis rapidly progressing to CS in a COVID-19 patient without respiratory failure, successfully treated with inotropes and MCS.
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Affiliation(s)
| | - Henrik Almroth
- Department of Cardiology, Linköping University Hospital, SE-58185 Linköping, Sweden
| | - Mattias Törnudd
- Department of Cardiothoracic and Vascular Surgery in Linköping and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Hospital, SE-58185 Linköping, Sweden
| | | | - Georgia Varelogianni
- Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Hospital, SE-58185 Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology in Linköping and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Hospital, SE-58185 Linköping, Sweden
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Lei ZN, Wu ZX, Dong S, Yang DH, Zhang L, Ke Z, Zou C, Chen ZS. Chloroquine and hydroxychloroquine in the treatment of malaria and repurposing in treating COVID-19. Pharmacol Ther 2020; 216:107672. [PMID: 32910933 PMCID: PMC7476892 DOI: 10.1016/j.pharmthera.2020.107672] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Chloroquine (CQ) and Hydroxychloroquine (HCQ) have been commonly used for the treatment and prevention of malaria, and the treatment of autoimmune diseases for several decades. As their new mechanisms of actions are identified in recent years, CQ and HCQ have wider therapeutic applications, one of which is to treat viral infectious diseases. Since the pandemic of the coronavirus disease 2019 (COVID-19), CQ and HCQ have been subjected to a number of in vitro and in vivo tests, and their therapeutic prospects for COVID-19 have been proposed. In this article, the applications and mechanisms of action of CQ and HCQ in their conventional fields of anti-malaria and anti-rheumatism, as well as their repurposing prospects in anti-virus are reviewed. The current trials and future potential of CQ and HCQ in combating COVID-19 are discussed.
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Affiliation(s)
- Zi-Ning Lei
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA.
| | - Zhuo-Xun Wu
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA.
| | - Shaowei Dong
- Key Laboratory of medical electrophysiology of education ministry, School of Pharmacy, Southwest Medical University, China,Shenzhen Public Service Platform on Tumor Precision Medicine and Molecular Diagnosis, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Dong-Hua Yang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA.
| | - Litu Zhang
- Department of Research, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zunfu Ke
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China.
| | - Chang Zou
- Key Laboratory of medical electrophysiology of education ministry, School of Pharmacy, Southwest Medical University, China; Shenzhen Public Service Platform on Tumor Precision Medicine and Molecular Diagnosis, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China.
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA.
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Heinrich MA, Martina B, Prakash J. Nanomedicine strategies to target coronavirus. NANO TODAY 2020; 35:100961. [PMID: 32904707 PMCID: PMC7457919 DOI: 10.1016/j.nantod.2020.100961] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/07/2020] [Accepted: 08/26/2020] [Indexed: 05/05/2023]
Abstract
With the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002, the middle east respiratory syndrome CoV (MERS-CoV) in 2012 and the recently discovered SARS-CoV-2 in December 2019, the 21st first century has so far faced the outbreak of three major coronaviruses (CoVs). In particular, SARS-CoV-2 spread rapidly over the globe affecting nearly 25.000.000 people up to date. Recent evidences pointing towards mutations within the viral spike proteins of SARS-CoV-2 that are considered the cause for this rapid spread and currently around 300 clinical trials are running to find a treatment for SARS-CoV-2 infections. Nanomedicine, the application of nanocarriers to deliver drugs specifically to a target sites, has been applied for different diseases, such as cancer but also in viral infections. Nanocarriers can be designed to encapsulate vaccines and deliver them towards antigen presenting cells or function as antigen-presenting carriers themselves. Furthermore, drugs can be encapsulated into such carriers to directly target them to infected cells. In particular, virus-mimicking nanoparticles (NPs) such as self-assembled viral proteins, virus-like particles or liposomes, are able to replicate the infection mechanism and can not only be used as delivery system but also to study viral infections and related mechanisms. This review will provide a detailed description of the composition and replication strategy of CoVs, an overview of the therapeutics currently evaluated in clinical trials against SARS-CoV-2 and will discuss the potential of NP-based vaccines, targeted delivery of therapeutics using nanocarriers as well as using NPs to further investigate underlying biological processes in greater detail.
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Affiliation(s)
- Marcel Alexander Heinrich
- Department of Biomaterials Science and Technology, Section Targeted Therapeutics, Technical Medical Centre, University of Twente, 7500AE, Enschede, the Netherlands
| | - Byron Martina
- Artemis One Health Research Institute, 2629JD, Delft, the Netherlands
| | - Jai Prakash
- Department of Biomaterials Science and Technology, Section Targeted Therapeutics, Technical Medical Centre, University of Twente, 7500AE, Enschede, the Netherlands
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Morris G, Athan E, Walder K, Bortolasci CC, O'Neil A, Marx W, Berk M, Carvalho AF, Maes M, Puri BK. Can endolysosomal deacidification and inhibition of autophagy prevent severe COVID-19? Life Sci 2020; 262:118541. [PMID: 33035581 PMCID: PMC7537668 DOI: 10.1016/j.lfs.2020.118541] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
Abstract
The possibility is examined that immunomodulatory pharmacotherapy may be clinically useful in managing the pandemic coronavirus disease 2019 (COVID-19), known to result from infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a positive-sense single-stranded RNA virus. The dominant route of cell entry of the coronavirus is via phagocytosis, with ensconcement in endosomes thereafter proceeding via the endosomal pathway, involving transfer from early (EEs) to late endosomes (LEs) and ultimately into lysosomes via endolysosomal fusion. EE to LE transportation is a rate-limiting step for coronaviruses. Hence inhibition or dysregulation of endosomal trafficking could potentially inhibit SARS-CoV-2 replication. Furthermore, the acidic luminal pH of the endolysosomal system is critical for the activity of numerous pH-sensitive hydrolytic enzymes. Golgi sub-compartments and Golgi-derived secretory vesicles also depend on being mildly acidic for optimal function and structure. Activation of endosomal toll-like receptors by viral RNA can upregulate inflammatory mediators and contribute to a systemic inflammatory cytokine storm, associated with a worsened clinical outcome in COVID-19. Such endosomal toll-like receptors could be inhibited by the use of pharmacological agents which increase endosomal pH, thereby reducing the activity of acid-dependent endosomal proteases required for their activity and/or assembly, leading to suppression of antigen-presenting cell activity, decreased autoantibody secretion, decreased nuclear factor-kappa B activity and decreased pro-inflammatory cytokine production. It is also noteworthy that SARS-CoV-2 inhibits autophagy, predisposing infected cells to apoptosis. It is therefore also suggested that further pharmacological inhibition of autophagy might encourage the apoptotic clearance of SARS-CoV-2-infected cells.
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Affiliation(s)
- Gerwyn Morris
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Eugene Athan
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, School of Medicine, Geelong, Victoria, Australia,Department of Infectious Disease, Barwon Health, Geelong, Australia
| | - Ken Walder
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Chiara C. Bortolasci
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, School of Medicine, Geelong, Victoria, Australia,Deakin University, Centre for Molecular and Medical Research, School of Medicine, Geelong, Victoria, Australia
| | - Adrienne O'Neil
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Wolf Marx
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, School of Medicine, Geelong, Victoria, Australia,Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - André F. Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Michael Maes
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, School of Medicine, Geelong, Victoria, Australia,Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Basant K. Puri
- C.A.R., Cambridge, UK,Corresponding author at: Level 1, Block A, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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55
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Younis NK, Zareef RO, Al Hassan SN, Bitar F, Eid AH, Arabi M. Hydroxychloroquine in COVID-19 Patients: Pros and Cons. Front Pharmacol 2020; 11:597985. [PMID: 33364965 PMCID: PMC7751757 DOI: 10.3389/fphar.2020.597985] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023] Open
Abstract
The pandemic of COVID-19, caused by SARS-CoV-2, has recently overwhelmed medical centers and paralyzed economies. The unparalleled public distress caused by this pandemic mandated an urgent quest for an effective approach to manage or treat this disease. Due to their well-established anti-infectious and anti-inflammatory properties, quinine derivatives have been sought as potential therapies for COVID-19. Indeed, these molecules were originally employed in the treatment and prophylaxis of malaria, and later in the management of various autoimmune rheumatic and dermatologic diseases. Initially, some promising results for the use of hydroxychloroquine (HCQ) in treating COVID-19 patients were reported by a few in vitro and in vivo studies. However, current evidence is not yet sufficiently solid to warrant its use as a therapy for this disease. Additionally, the therapeutic effects of HCQ are not without many side effects, which range from mild gastrointestinal effects to life-threatening cardiovascular and neurological effects. In this review, we explore the controversy associated with the repurposing of HCQ to manage or treat COVID-19, and we discuss the cellular and molecular mechanisms of action of HCQ.
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Affiliation(s)
- Nour K Younis
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana O Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally N Al Hassan
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali H Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar.,Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Molecular effects and retinopathy induced by hydroxychloroquine during SARS-CoV-2 therapy: Role of CYP450 isoforms and epigenetic modulations. Eur J Pharmacol 2020; 886:173454. [PMID: 32763298 PMCID: PMC7402235 DOI: 10.1016/j.ejphar.2020.173454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 01/07/2023]
Abstract
Antimalaria drugs such as chloroquine (CQ) and hydroxychloroquine (HCQ) have been administered to several inflammatory diseases including rheumatoid arthritis and systemic lupus erythematosus, and infectious diseases such as acquired immune deficiency syndrome and influenza. Recently, several patients infected with novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were given HCQ, and showed a discrepant response. HCQ inhibits SARS-CoV-2 cell entry, and inflammatory cascade by interfering with lysosomal and endosomal activities, and autophagy, impeding virus-membrane fusion, and inhibiting cytokine production resulted from inflammatory pathways activation. Despite ongoing administration of HCQ in a wide spectrum of disorders, there are some reports about several side effects, especially retinopathy in some patients treated with HCQ. Cytochrome P450 (CYP450) and its isoforms are the main metabolizers of HCQ and CQ. Pharmacokinetic properties of CYP enzymes are influenced by CYP polymorphism, non-coding RNAs, and epigenetic mechanisms such as DNA methylation, and histone acetylation. Accumulating evidence about side effects of HCQ in some patients raise the possibility that different response of patients to HCQ might be due to difference in their genome. Therefore, CYP450 genotyping especially for CYP2D6 might be helpful to refine HCQ dosage. Also, regular control of retina should be considered for patients under HCQ treatment. The major focus of the present review is to discuss about the pharmacokinetic and pharmacodynamic properties of CQ and HCQ that may be influenced by epigenetic mechanisms, and consequently cause several side effects especially retinopathy during SARS-CoV-2 therapy.
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Goldman A, Bomze D, Dankner R, Hod H, Meirson T, Boursi B, Maor E. Cardiovascular adverse events associated with hydroxychloroquine and chloroquine: A comprehensive pharmacovigilance analysis of pre-COVID-19 reports. Br J Clin Pharmacol 2020; 87:1432-1442. [PMID: 32964535 DOI: 10.1111/bcp.14546] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 12/27/2022] Open
Abstract
AIM There is a clinical need for safety data regarding hydroxychloroquine (HCQ) and chloroquine (CQ) during the coronavirus (COVID-19) pandemic. We analysed real-world data using the U.S. Food and Drug Administration Adverse Events Reporting System (FAERS) database to assess HCQ/CQ-associated cardiovascular adverse events (CVAEs) in pre-COVID-19 reports. METHODS We conducted disproportionality analysis of HCQ/CQ in the FAERS database (07/2014-9/2019), using reporting odds ratio (ROR) and the lower bound of the information component 95% credibility interval (IC025 ). RESULTS The full database contained 6 677 225 reports with a mean (±SD) age of 53 (±17) years and 74% females. We identified 4895 reports of HCQ/CQ related adverse events, of which 696 (14.2%) were CVAEs. Compared with the full database, HCQ/CQ use was associated with a higher reporting rate of major CVAEs, including cardiomyopathy (n = 86 [1.8%], ROR = 29.0 [23.3-35.9]), QT prolongation (n = 43 [0.9%], ROR = 4.5 [3.3-6.1]), cardiac arrhythmias (n = 117 [2.4%], ROR = 2.2 [1.8-2.7]) and heart failure (n = 136 [2.8%], ROR = 2.2 [1.9-2.7], all IC₀₂₅ > 0). No statistically significant differences were observed between sex and age groups. CVAEs were reported more often in patients with systemic lupus erythematosus and Sjogren's syndrome. HCQ/CQ-associated CVAEs demonstrated subsequent hospitalization and mortality rates of 39% and 8%, respectively. Overdose reports demonstrated an increased frequency of QT prolongation and ventricular arrhythmias (35% and 25%, respectively). CONCLUSION In a real-world setting, HCQ/CQ treatment is associated with higher reporting rates of various CVAEs, particularly cardiomyopathy, QT prolongation, cardiac arrhythmias and heart failure. HCQ/CQ-associated CVAEs result in high rates of severe outcomes and should be carefully considered as an off-label indication, especially for patients with cardiac disorders.
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Affiliation(s)
- Adam Goldman
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Israel.,School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - David Bomze
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Israel.,School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Rachel Dankner
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Israel.,Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| | - Hanoch Hod
- School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Tomer Meirson
- Azrieli Faculty of Medicine, Bar-Ilan University, Israel
| | - Ben Boursi
- School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Elad Maor
- School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
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Giri A, Das A, Sarkar AK, Giri AK. Mutagenic, Genotoxic and Immunomodulatory effects of Hydroxychloroquine and Chloroquine: a review to evaluate its potential to use as a prophylactic drug against COVID-19. Genes Environ 2020; 42:25. [PMID: 32884603 PMCID: PMC7462746 DOI: 10.1186/s41021-020-00164-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022] Open
Abstract
Hydroxychloroquine (HCQ) and Chloroquine (CQ) are two anti-malarial drugs that are now being extensively used by front-line healthcare workers and other common people as a prophylactic drug against the Corona Virus Disease − 19 (COVID-19) in India and as well as in many parts of the world. While only a few in vitro studies have pointed to some efficacy of these drugs as a prophylactic against COVID-19, to date, there are no clinical studies that have established any clinical efficacy of these drugs as a prophylactic. These drugs are commonly used for the treatment of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) because of its immunomodulatory effects. Previously, we have evaluated the genetic toxicology of different drugs and chemicals including antimalarial drug CQ both in vitro and in vivo. Thus, we recognize the need to critically review the mutagenic, genotoxic, and immunomodulatory effects of these drugs, to find out whether it is safe to use as a prophylactic drug against COVID-19. Existing literature suggests that CQ can induce mutagenic and genotoxic effects in multiple test systems and both the drugs have immunomodulatory effects. There was no data available to evaluate the mutagenicity and genotoxicity for HCQ. However, during metabolism about 60% of both the drugs remain unchanged and about 40% of the drugs are metabolized into two metabolites, desethylchloroquine and bisdesethylchloroquine by the action of the cytochrome P450 (CYP) enzymes in the liver. Both HCQ and CQ are immunomodulatory drugs and have the potential to suppress normal immune system activation. In this review, we have elucidated the mechanism of immunomodulation by both HCQ and CQ and highlighted the mutagenic and genotoxic effects from the available literature. This article is written with the sole objective that the reader will be able to recognize the adverse effects of these drugs when consumed by healthy individuals as a prophylactic. Current literature indicates that healthy individuals should refrain from the use of these drugs until further investigation.
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Affiliation(s)
- Allan Giri
- Department of Biomedical Science, Kansas City University of Medicine and Biosciences, Kansas City, MO 64106 USA
| | - Ankita Das
- Department of Environmental Sciences, University of Calcutta, Kolkata, 700019 India
| | - Ajoy K Sarkar
- Intensive Care Unit, Peerless Hospital, B.K. Roy Research Centre, Kolkata, 700094 India
| | - Ashok K Giri
- Molecular Genetics Division, CSIR-Indian Institute of Chemical Biology, 4 Raja S. C. Mullick Road, Kolkata, 700032 India
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Oscanoa TJ, Romero-Ortuno R, Carvajal A, Savarino A. A pharmacological perspective of chloroquine in SARS-CoV-2 infection: An old drug for the fight against a new coronavirus? Int J Antimicrob Agents 2020; 56:106078. [PMID: 32629115 PMCID: PMC7334645 DOI: 10.1016/j.ijantimicag.2020.106078] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is having serious consequences on health and the economy worldwide. All evidence-based treatment strategies need to be considered to combat this new virus. Drugs need to be considered on scientific grounds of efficacy, safety and cost. Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used in the treatment of malaria. Moreover, their antiviral properties have been previously studied, including against coronaviruses, where evidence of efficacy has been found. In the current race against time triggered by the COVID-19 pandemic, the search for new antivirals is very important. However, consideration should be given to old drugs with known anti-coronavirus activity, such as CQ and HCQ. These could be integrated into current treatment strategies while novel treatments are awaited, also in light of the fact that they display an anticoagulant effect that facilitates the activity of low-molecular-weight heparin, aimed at preventing acute respiratory distress syndrome (ARDS)-associated thrombotic events. The safety of CQ and HCQ has been studied for over 50 years, however recently published data raise concerns for cardiac toxicity of CQ/HCQ in patients with COVID-19. This review also re-examines the real information provided by some of the published alarming reports, although concluding that cardiac toxicity should in any case be stringently monitored in patients receiving CQ/HCQ.
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Affiliation(s)
- Teodoro J Oscanoa
- Department of Pharmacology, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru, and Drug Safety Research Center, Facultad de Medicina Humana, Universidad de San Martín de Porres, Hospital Almenara, ESSALUD, Lima, Peru.
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland, and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Alfonso Carvajal
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), Universidad de Valladolid, Valladolid, Spain
| | - Andrea Savarino
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Fernandez-Ruiz R, Bornkamp N, Kim MY, Askanase A, Zezon A, Tseng CE, Belmont HM, Saxena A, Salmon JE, Lockshin M, Buyon JP, Izmirly PM. Discontinuation of hydroxychloroquine in older patients with systemic lupus erythematosus: a multicenter retrospective study. Arthritis Res Ther 2020; 22:191. [PMID: 32807233 PMCID: PMC7430013 DOI: 10.1186/s13075-020-02282-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background Although hydroxychloroquine (HCQ) is a mainstay of treatment for patients with systemic lupus erythematosus (SLE), ocular toxicity can result from accumulated exposure. As the longevity of patients with SLE improves, data are needed to balance the risk of ocular toxicity and the risk of disease flare, especially in older patients with quiescent disease. Accordingly, this study was initiated to examine the safety of HCQ withdrawal in older SLE patients. Methods Data were obtained by retrospective chart review at three major lupus centers in New York City. Twenty-six patients who discontinued HCQ and thirty-two patients on HCQ matched for gender, race/ethnicity, and age were included in this study. The primary outcome was the occurrence of a lupus flare classified by the revised version of the Safety of Estrogens in Lupus Erythematosus: National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) Flare composite index, within 1 year of HCQ withdrawal or matched time of continuation. Results Five patients (19.2%) in the HCQ withdrawal group compared to five (15.6%) in the HCQ continuation group experienced a flare of any severity (odds ratio [OR] = 1.28; 95% CI 0.31, 5.30; p = 0.73). There were no severe flares in either group. The results were similar after adjusting for length of SLE, number of American College of Rheumatology criteria, low complement levels, and SELENA-SLEDAI score, and in a propensity score analysis (OR = 1.18; 95% CI 0.23, 6.16; p = 0.84). The analysis of time to any flare revealed a non-significant earlier time to flare in the HCQ withdrawal group (log-rank p = 0.67). Most flares were in the cutaneous and musculoskeletal systems, but one patient in the continuation group developed pericarditis. The most common reason for HCQ withdrawal was retinal toxicity (42.3%), followed by patient’s preference (34.6%), other confirmed or suspected adverse effects (15.4%), ophthalmologist recommendation for macular degeneration (3.8%), and rheumatologist recommendation for quiescent SLE (3.8%). Conclusions In this retrospective study of older stable patients with SLE on long-term HCQ, withdrawal did not significantly increase the risk of flares.
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Affiliation(s)
- Ruth Fernandez-Ruiz
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
| | - Nicole Bornkamp
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Mimi Y Kim
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Anna Zezon
- Division of Rheumatology, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Chung-E Tseng
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Amit Saxena
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Jane E Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Michael Lockshin
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
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Li G, Saguner AM, An J, Ning Y, Day JD, Ding L, Waintraub X, Wang J. Cardiovascular disease during the COVID-19 pandemic: Think ahead, protect hearts, reduce mortality. Cardiol J 2020; 27:616-624. [PMID: 32789839 PMCID: PMC8078991 DOI: 10.5603/cj.a2020.0101] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is rapidly spreading globally. As of October 3, 2020, the number of confirmed cases has been nearly 34 million with more than 1 million fatalities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is accountable for COVID-19. Newly diagnosed and worsening cardiovascular disease are common complications in COVID-19 patients, including acute cardiac injury, hypertension, arrhythmia, myocardial infarction, heart failure and sudden cardiac arrest. The mechanisms contributing to cardiac disease burden include hypoxemia, inflammatory factor storm, dysfunctional angiotensin converting enzyme 2 (ACE2), and drug-induced cardiac toxicity. Notably, the macrophages expressing ACE2 as direct host cells of SARS-CoV-2 secrete chemokine and inflammatory cytokines, as well as a decrease in cellular immune responses to SARS-CoV-2 infection due to elevated exhaustion levels and dysfunctional diversity of T cells, that may be accountable for the "hyperinflammation and cytokine storm syndrome" and subsequently acute cardiac injury and deteriorating cardiovascular disease in COVID-19 patients. However, no targeted medication or vaccines for COVID-19 are yet available. The management of cardiovascular disease in patients with COVID-19 include general supportive treatment, circulatory support, other symptomatic treatment, psychological assistance as well as online consultation. Further work should be concentrated on better understanding the pathogenesis of COVID-19 and accelerating the development of drugs and vaccines to reduce the cardiac disease burden and promote the management of COVID-19 patients, especially those with a severe disease course and cardiovascular complications.
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Affiliation(s)
- Guoliang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Atrial Fibrillation Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Cardiology Institute, Rhythmology Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Jiaqi An
- Atrial Fibrillation Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Stroke Center and Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Yuye Ning
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Atrial Fibrillation Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Stroke Center and Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - John D. Day
- Intermountain Medical Center Heart Institute, Murray, UT, United States
| | - Ligang Ding
- Department of Cardiovascular Medicine, Clinical EP Lab and Arrhythmia Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xavier Waintraub
- Cardiology Institute, Rhythmology Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Jie Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Hematology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Li C, Cheng G. Will Hydroxychloroquine Still Be a Game-Changer for COVID-19 by Combining Azithromycin? Front Immunol 2020; 11:1969. [PMID: 32849658 PMCID: PMC7426511 DOI: 10.3389/fimmu.2020.01969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/21/2020] [Indexed: 12/23/2022] Open
Abstract
Recent small-scale clinical trials have shown promising results in the use of hydroxychloroquine, an FDA approved anti-malaria drug, for the treatment of COVID-19. However, large scale, randomized and double-blind clinical trials are needed to confirm the safety and efficacy of hydroxychloroquine in COVID-19 patients. Here, we review the progress of using hydroxychloroquine or chloroquine as anti-viral agents, failed clinical trials of chloroquine in treatment of dengue virus and influenza infection, and especially the mechanism of azithromycin in inhibiting viral replication, so as to shed light on the ongoing clinical trials and further researches of hydroxychloroquine on SARS-CoV-2 infected patients.
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Affiliation(s)
- Chunfeng Li
- Institute for Immunity, Transplantation, and Infection, School of Medicine, Stanford University, Stanford, CA, United States
| | - Genhong Cheng
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, CA, United States
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Eiras S, Álvarez E, Brión M, González-Juanatey JR. [COVID-19 and treatment guided by biochemical and molecular diagnostic tests to reduce myocardial damage and cardiotoxicity]. Rev Esp Cardiol 2020; 73:691-693. [PMID: 32372844 PMCID: PMC7198176 DOI: 10.1016/j.recesp.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Sonia Eiras
- Grupo de Cardiología Traslacional, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, España
| | - Ezequiel Álvarez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, España
- Grupo de Cardiología, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - María Brión
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, España
- Grupo de Genética Cardiovascular, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - José Ramón González-Juanatey
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, España
- Grupo de Cardiología, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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Eiras S, Álvarez E, Brión M, González-Juanatey JR. COVID-19 and treatment guided by biochemical and molecular diagnostic tests to reduce myocardial damage and cardiotoxicity. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:691-693. [PMID: 32493574 PMCID: PMC7245328 DOI: 10.1016/j.rec.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sonia Eiras
- Grupo de Cardiología Traslacional, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, Spain
| | - Ezequiel Álvarez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, Spain; Grupo de Cardiología, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, Spain
| | - María Brión
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, Spain; Grupo de Genética Cardiovascular, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, Spain
| | - José Ramón González-Juanatey
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, Spain; Grupo de Cardiología, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, Spain; Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
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Della Porta A, Bornstein K, Coye A, Montrief T, Long B, Parris MA. Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians. Am J Emerg Med 2020; 38:2209-2217. [PMID: 33071096 PMCID: PMC7369162 DOI: 10.1016/j.ajem.2020.07.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality. Objective This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population. Discussion Chloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10–30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention. Conclusions An understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease.
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Affiliation(s)
- Alessandra Della Porta
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA
| | - Kasha Bornstein
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA
| | - Austin Coye
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA
| | - Tim Montrief
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA
| | - Brit Long
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA.
| | - Mehruba Anwar Parris
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA.
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Zhang Y, Coats AJ, Zheng Z, Adamo M, Ambrosio G, Anker SD, Butler J, Xu D, Mao J, Khan MS, Bai L, Mebazaa A, Ponikowski P, Tang Q, Ruschitzka F, Seferovic P, Tschöpe C, Zhang S, Gao C, Zhou S, Senni M, Zhang J, Metra M. Management of heart failure patients withCOVID‐19: a joint position paper of the Chinese Heart Failure Association & National Heart Failure Committee and the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22:941-956. [PMID: 32463543 DOI: 10.1002/ejhf.1915] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | | | - Zhe Zheng
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
| | - Giuseppe Ambrosio
- Division of CardiologyUniversity of Perugia School of Medicine Perugia Italy
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin Berlin Berlin Germany
| | - Javed Butler
- Department of MedicineUniversity of Mississippi Medical Center Jackson MS USA
| | - Dingli Xu
- Key Laboratory for Organ Failure Research, Department of CardiologyNanfang Hospital, Southern Medical University, Guangzhou Regenerative Medicine and Health Guangdong Laboratory Guangzhou China
| | - Jingyuan Mao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine Tianjin China
| | | | - Ling Bai
- Department of Cardiovascular MedicineThe First Affiliated Hospital of Xi'an Jiaotong University Xi'an China
| | - Alexandre Mebazaa
- Université de Paris, Paris, France; U942 Inserm – MASCOT and Department of Anaesthesia and Critical CareUniversity Hospitals Saint Louis‐Lariboisière, APHP Paris France
| | - Piotr Ponikowski
- Center for Heart DiseasesUniversity Hospital, Medical University Wroclaw Poland
| | - Qizhu Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research InstituteWuhan University, Hubei Key Laboratory of Cardiology Wuhan China
| | - Frank Ruschitzka
- University Heart CentreUniversity Hospital Zurich Zurich Switzerland
| | - Petar Seferovic
- Clinic of Endocrinology, Diabetes and Metabolic DiseasesBelgrade University Medical Center Belgrade Serbia
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow KlinikumCharite ‐ Universitaetsmedizin Berlin Berlin Germany
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College & Chinese Academy of Medical SciencePeking Union Medical College Hospital Beijing China
| | - Chuanyu Gao
- Department of Cardiology, Henan Provincial People's HospitalFuwai Central China Cardiovascular Hospital Zhengzhou China
| | - Shenghua Zhou
- Department of CardiologyThe Second Xiangya Hospital of Central South University Changsha China
| | - Michele Senni
- Cardiology Division, Cardiovascular DepartmentPapa Giovanni XXIII Hospital Bergamo Italy
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
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Eljaaly K, Alireza KH, Alshehri S, Al-Tawfiq JA. Hydroxychloroquine safety: A meta-analysis of randomized controlled trials. Travel Med Infect Dis 2020; 36:101812. [PMID: 32645478 PMCID: PMC7342171 DOI: 10.1016/j.tmaid.2020.101812] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/25/2020] [Indexed: 12/23/2022]
Abstract
Background Hydroxychloroquine (HCQ) is currently being examined for COVID-19. No previous meta-analysis has evaluated its side effects versus placebo. We conducted this meta-analysis to compare the safety of HCQ versus placebo. Methods Two authors independently searched PubMed and EMBASE databases for randomized controlled trials (RCTs) of adults comparing the adverse events (AEs) of HCQ versus placebo for any indication. Peto odds ratios (Peto ORs) and 95% confidence intervals (CIs) were calculated based on random-effects models. The heterogeneity (I2) was assessed using Cochran's Q test. Results Nine RCTs (eight were double-blind) with a total of 916 patients were included. HCQ caused significantly more skin pigmentation than placebo (Peto OR, 4.64; 95% CI, 1.13 to 19.00; P-value = 0.033; I2 = 0%). The increase in other AEs did not reach statistical significance: rash (Peto OR, 1.11; 95% CI, 0.3 to 3.77; P-value = 0.03; I2 = 0%); gastrointestinal AEs (Peto OR, 1.43; 95% CI, 0.55 to 3.72; P-value = 0.46; I2 = 15.17%); headache (Peto OR, 1.94; 95% CI, 0.65 to 5.78; P-value = 0.23; I2 = 9.99%); dizziness (Peto OR, 1.32; 95% CI, 0.49 to 3.52; P-value = 0.58; I2 = 0%); fatigue (Peto OR, 2.13; 95% CI, 0.76 to 5.98; P-value = 0.15; I2 = 0%); and visual AEs (Peto OR, 1.61; 95% CI, 0.76 to 3.41; P-value = 0.22; I2 = 0%). Cardiac toxicity was not reported. Conclusions This meta-analysis of RCTs found a significantly higher risk of skin pigmentation in HCQ users versus placebo. More data are needed to evaluate HCQ in the context of COVID-19 treatment.
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Affiliation(s)
- Khalid Eljaaly
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | | | - Samah Alshehri
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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68
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Biguetti C, Marrelli MT, Brotto M. Primum non nocere - Are chloroquine and hydroxychloroquine safe prophylactic/treatment options for SARS-CoV-2 (covid-19)? Rev Saude Publica 2020; 54:68. [PMID: 32638884 PMCID: PMC7319500 DOI: 10.11606/s1518-8787.2020054002631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022] Open
Abstract
Chloroquine (CQ) and its analog hydroxychloroquine (HCQ) were recently included in several clinical trials as potential prophylactic and therapeutic options for SARS-COV-2 infection/covid-19. However, drug effectiveness in preventing, treating, or slowing the progression of the disease is still unknown. Despite some initial promising in vitro results, rigorous pre-clinical animal studies and randomized clinical trials have not been performed yet. On the other hand, while the potential effectiveness of CQ/HCQ is, at best, hypothetical, their side effects are factual and most worrisome, particularly when considering vulnerable groups of patients being treated with these drugs. in this comment, we briefly explain the possible mechanisms of action of CQ/HCQ for treating other diseases, possible actions against covid-19, and their potent side effects, in order to reinforce the necessity of evaluating the benefit-risk balance when widely prescribing these drugs for SARS-COV-2 infection/covid-19. We conclude by strongly recommending against their indiscriminate use.
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Affiliation(s)
- Claudia Biguetti
- University of Texas-ArlingtonCollege of Nursing & Health InnovationBone-Muscle Research CenterArlingtonTXUSAUniversity of Texas-Arlington. College of Nursing & Health Innovation. Bone-Muscle Research Center. Arlington, TX 76010, USA
| | - Mauro Toledo Marrelli
- University of Texas-ArlingtonCollege of Nursing & Health InnovationBone-Muscle Research CenterArlingtonTXUSAUniversity of Texas-Arlington. College of Nursing & Health Innovation. Bone-Muscle Research Center. Arlington, TX 76010, USA
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de EpidemiologiaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil
| | - Marco Brotto
- University of Texas-ArlingtonCollege of Nursing & Health InnovationBone-Muscle Research CenterArlingtonTXUSAUniversity of Texas-Arlington. College of Nursing & Health Innovation. Bone-Muscle Research Center. Arlington, TX 76010, USA
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Chary MA, Barbuto AF, Izadmehr S, Hayes BD, Burns MM. COVID-19: Therapeutics and Their Toxicities. J Med Toxicol 2020; 16:284-294. [PMID: 32356252 PMCID: PMC7192319 DOI: 10.1007/s13181-020-00777-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 is a novel coronavirus that emerged in 2019 and is causing the COVID-19 pandemic. There is no current standard of care. Clinicians need to be mindful of the toxicity of a wide variety of possibly unfamiliar substances being tested or repurposed to treat COVID-19. The United States Food and Drug Administration (FDA) has provided emergency authorization for the use of chloroquine and hydroxychloroquine. These two medications may precipitate ventricular dysrhythmias, necessitating cardiac and electrolyte monitoring, and in severe cases, treatment with epinephrine and high-doses of diazepam. Recombinant protein therapeutics may cause serum sickness or immune complex deposition. Nucleic acid vaccines may introduce mutations into the human genome. ACE inhibitors and ibuprofen have been suggested to exacerbate the pathogenesis of COVID-19. Here, we review the use, mechanism of action, and toxicity of proposed COVID-19 therapeutics.
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Affiliation(s)
- Michael A Chary
- Division of Emergency Medicine, Harvard Medical Toxicology Fellowship, Boston Children's Hospital, Boston, MA, USA.
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA.
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Alexander F Barbuto
- Division of Emergency Medicine, Harvard Medical Toxicology Fellowship, Boston Children's Hospital, Boston, MA, USA
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sudeh Izadmehr
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bryan D Hayes
- Department of Pharmacy, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michele M Burns
- Division of Emergency Medicine, Harvard Medical Toxicology Fellowship, Boston Children's Hospital, Boston, MA, USA
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA
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Dhanushkodi M, Kulkarni P. COVID-19 Management: What We Need to Know? Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_192_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Padmaj Kulkarni
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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Belkin MN, Dela Cruz M, Nadeem U, Patel AR, Kim G, Grinstein J. Massive Myocardial Calcium Deposition: Hardened Heart. JACC Case Rep 2020; 2:996-1003. [PMID: 34317401 PMCID: PMC8302108 DOI: 10.1016/j.jaccas.2020.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023]
Abstract
A 25-year-old African-American woman with end-stage renal disease presented with new-onset heart failure. Transthoracic echocardiography indicated a significantly hyperechoic myocardium, and computed tomography noted a circumferential hyperattenuated myocardium. Endomyocardial biopsy revealed focal interstitial and intramyocyte calcium deposition in the heart, confirming a rare diagnosis of massive myocardial calcium deposition. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Mark N. Belkin
- Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Mark Dela Cruz
- Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Urooba Nadeem
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Amit R. Patel
- Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Gene Kim
- Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Jonathan Grinstein
- Section of Cardiology, University of Chicago, Chicago, Illinois
- Address for correspondence: Dr. Jonathan Grinstein, University of Chicago, 5841 South Maryland Avenue, A621, Chicago, Illinois 60637.
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Abstract
Coronavirus disease 2019 (COVID-19) is a pandemic infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 significantly affects multiple systems including the cardiovascular system. Most importantly, in addition to the direct injury from the virus per se, the subsequent cytokine storm, an overproduction of immune cells and their activating compounds, causes devastating damage. To date, emerging anti-SARS-CoV-2 treatments are warranted to control epidemics. Several candidate drugs have been screened and are currently under investigation. These primarily include antiviral regimens and immunomodulatory regimens. However, beyond the anti-SARS-CoV-2 effects, these drugs may also have risks to the cardiovascular system, especially altering cardiac conduction. Herein, we review the cardiovascular risks of potential anti-COVID-19 drugs.
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Roschewski M, Lionakis MS, Sharman JP, Roswarski J, Goy A, Monticelli MA, Roshon M, Wrzesinski SH, Desai JV, Zarakas MA, Collen J, Rose K, Hamdy A, Izumi R, Wright GW, Chung KK, Baselga J, Staudt LM, Wilson WH. Inhibition of Bruton tyrosine kinase in patients with severe COVID-19. Sci Immunol 2020; 5:eabd0110. [PMID: 32503877 PMCID: PMC7274761 DOI: 10.1126/sciimmunol.abd0110] [Citation(s) in RCA: 254] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022]
Abstract
Patients with severe COVID-19 have a hyperinflammatory immune response suggestive of macrophage activation. Bruton tyrosine kinase (BTK) regulates macrophage signaling and activation. Acalabrutinib, a selective BTK inhibitor, was administered off-label to 19 patients hospitalized with severe COVID-19 (11 on supplemental oxygen; 8 on mechanical ventilation), 18 of whom had increasing oxygen requirements at baseline. Over a 10-14 day treatment course, acalabrutinib improved oxygenation in a majority of patients, often within 1-3 days, and had no discernable toxicity. Measures of inflammation - C-reactive protein and IL-6 - normalized quickly in most patients, as did lymphopenia, in correlation with improved oxygenation. At the end of acalabrutinib treatment, 8/11 (72.7%) patients in the supplemental oxygen cohort had been discharged on room air, and 4/8 (50%) patients in the mechanical ventilation cohort had been successfully extubated, with 2/8 (25%) discharged on room air. Ex vivo analysis revealed significantly elevated BTK activity, as evidenced by autophosphorylation, and increased IL-6 production in blood monocytes from patients with severe COVID-19 compared with blood monocytes from healthy volunteers. These results suggest that targeting excessive host inflammation with a BTK inhibitor is a therapeutic strategy in severe COVID-19 and has led to a confirmatory international prospective randomized controlled clinical trial.
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Affiliation(s)
- Mark Roschewski
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Michail S Lionakis
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Jeff P Sharman
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Joseph Roswarski
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Andre Goy
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - M Andrew Monticelli
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Michael Roshon
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Stephen H Wrzesinski
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Jigar V Desai
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Marissa A Zarakas
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Jacob Collen
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Keith Rose
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Ahmed Hamdy
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Raquel Izumi
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - George W Wright
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Kevin K Chung
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Jose Baselga
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Louis M Staudt
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD; Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Willamette Valley Cancer Institute and Research Center, US Oncology, Eugene, OR; Hematology-Oncology Department, Walter Reed National Military Medical Center, Bethesda, MD; John Theurer Cancer Center, Hackensack Meridian and School of Medicine at Seton Hall, NJ; Rocky Mountain Cancer Center, US Oncology, Colorado Springs, CO; Department of Emergency Medicine, Penrose-St. Francis Health Services, Colorado Springs, CO; US Acute Care Solutions, Canton, OH; Department of Medicine, St. Peter's Hospital and US Oncology, Albany, NY; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Acerta Pharma, South San Francisco, CA; Biometric Research Branch, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA AstraZeneca, One MedImmune Way, Gaithersburg, MD
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Yoshimoto FK. The Proteins of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2 or n-COV19), the Cause of COVID-19. Protein J 2020; 39:198-216. [PMID: 32447571 PMCID: PMC7245191 DOI: 10.1007/s10930-020-09901-4] [Citation(s) in RCA: 336] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The devastating effects of the recent global pandemic (termed COVID-19 for "coronavirus disease 2019") caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) are paramount with new cases and deaths growing at an exponential rate. In order to provide a better understanding of SARS CoV-2, this article will review the proteins found in the SARS CoV-2 that caused this global pandemic.
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Affiliation(s)
- Francis K Yoshimoto
- Department of Chemistry, The University of Texas at San Antonio (UTSA), San Antonio, TX, 78249-0698, USA.
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75
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Khan Z, Karataş Y, Rahman H. Anti COVID-19 Drugs: Need for More Clinical Evidence and Global Action. Adv Ther 2020; 37:2575-2579. [PMID: 32350686 PMCID: PMC7189176 DOI: 10.1007/s12325-020-01351-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Indexed: 02/08/2023]
Abstract
The World Health Organization (WHO) called the outbreak of coronavirus infectious disease-2019 (COVID-19) a "Public Health Emergency of International Concern" (PHEIC). According to the WHO, Centers for Disease Control and Prevention (CDC), and the US Food and Drug Administration (FDA), currently there are no medicines or vaccines that have been claimed to be useful in the prevention or treatment of COVID-19. Several existing antiviral drugs, previously developed or used as treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), human immunodeficiency virus (HIV), and malaria, are being investigated as COVID-19 treatments and some of them are being used in clinical trials. According to the CDC and Chinese treatment guidelines for COVID-19, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and one of the investigational agents (remdesivir) are recommended in critically ill older patients. The use of other potential drugs reported in different studies may be considered if treatment with first-line drugs is ineffective. There are currently no complete data available from large randomized clinical trials (RCTs) to provide clinical guidance on the use, dosing, or duration to validate the effective role, safety profile, and adverse effects of all of the trial drugs for prophylaxis or treatment of COVID-19. Until now, it is still unclear which drug can successfully fight against the disease. Therefore, for the better safety of patients with COVID-19, further clinical trials and large randomized controlled studies are needed to validate the effective role, safety profile, and adverse effects of all the potential drugs. Such a measure requires action at the global level.
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Affiliation(s)
- Zakir Khan
- Tıbbi Farmakoloji Anabilim Dalı, Tıp Fakültesi, Çukurova Üniversitesi, Sarıçam, Adana, Turkey.
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Yusuf Karataş
- Tıbbi Farmakoloji Anabilim Dalı, Tıp Fakültesi, Çukurova Üniversitesi, Sarıçam, Adana, Turkey
- Pharmacovigilance specialist, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Hazir Rahman
- Department of Microbiology, Faculty of Chemical and Life Sciences, Abdul Wali Khan University Mardan (AWKUM), Mardan, KPK, Pakistan
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Fatal arrhythmias: Another reason why doctors remain cautious about chloroquine/hydroxychloroquine for treating COVID-19. Heart Rhythm 2020; 17:1445-1451. [PMID: 32479900 PMCID: PMC7256542 DOI: 10.1016/j.hrthm.2020.05.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 12/27/2022]
Abstract
Background Early during the current coronavirus disease 19 (COVID-19) pandemic, hydroxychloroquine (HCQ) received a significant amount of attention as a potential antiviral treatment, such that it became one of the most commonly prescribed medications for COVID-19 patients. However, not only has the effectiveness of HCQ remained questionable, but mainly based on preclinical and a few small clinical studies, HCQ is known to be potentially arrhythmogenic, especially as a result of QT prolongation. Objective The purpose of this study was to investigate the arrhythmic effects of HCQ, as the heightened risk is especially relevant to COVID-19 patients, who are at higher risk for cardiac complications and arrhythmias at baseline. Methods An optical mapping technique utilizing voltage-sensitive fluorescent dyes was used to determine the arrhythmic effects of HCQ in ex vivo guinea pig and rabbit hearts perfused with the upper therapeutic serum dose of HCQ (1000 ng/mL). Results HCQ markedly increased action potential dispersion, resulted in development of repolarization alternans, and initiated polymorphic ventricular tachycardia. Conclusion The study results further highlight the proarrhythmic effects of HCQ.
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77
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Guidon AC, Amato AA. COVID-19 and neuromuscular disorders. Neurology 2020; 94:959-969. [PMID: 32284362 DOI: 10.1212/wnl.0000000000009566] [Citation(s) in RCA: 201] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 01/13/2023] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. This article reviews (1) potential neuromuscular complications of COVID-19, (2) assessment and mitigation of COVID-19-related risk for patients with preexisting neuromuscular disease, (3) guidance for management of immunosuppressive and immunomodulatory therapies, (4) practical guidance regarding neuromuscular care delivery, telemedicine, and education, and (5) effect on neuromuscular research. We outline key unanswered clinical questions and highlight the need for team-based and interspecialty collaboration. Primary goals of clinical research during this time are to develop evidence-based best practices and to minimize morbidity and mortality related to COVID-19 for patients with neuromuscular disorders.
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Affiliation(s)
- Amanda C Guidon
- From the Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital (A.C.G.), and Division of Neuromuscular Medicine, Department of Neurology, Brigham and Woman's Hospital (A.A.A.), Harvard Medical School, Boston, MA.
| | - Anthony A Amato
- From the Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital (A.C.G.), and Division of Neuromuscular Medicine, Department of Neurology, Brigham and Woman's Hospital (A.A.A.), Harvard Medical School, Boston, MA.
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Deoraj S, Mandal AKJ, Zairis M, Missouris CG. Multifactorial aggressive and reversible cardiomyopathy in systemic lupus erythematosus. Br J Hosp Med (Lond) 2020; 81:1-4. [DOI: 10.12968/hmed.2020.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stuart Deoraj
- Department of Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Amit KJ Mandal
- Department of Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Michail Zairis
- Department of Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Constantinos G Missouris
- Department of Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
- University of Cyprus Medical School, Nicosia, Cyprus
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79
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Matos Santana H, Heindl B, Suri S, Khatoon S, Aryal S, Chatterjee A, Litovsky S, Ahmed H, Schnell A, Rajapreyar I. A Case of Heart Failure in a Patient With Systemic Lupus Erythematosus. JACC Case Rep 2020; 2:414-419. [PMID: 34317253 PMCID: PMC8311708 DOI: 10.1016/j.jaccas.2019.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/26/2019] [Indexed: 11/02/2022]
Abstract
Patients with systemic lupus erythematosus (SLE) can present with multiple cardiovascular pathologies, including pulmonary hypertension, valvular disease, pericarditis, myocarditis, and premature atherosclerosis. SLE medications can also cause cardiovascular side effects. We present a patient who developed a severe cardiomyopathy secondary to the hydroxychloroquine prescribed to treat her SLE. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Heriberto Matos Santana
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brittain Heindl
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarabjeet Suri
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Salma Khatoon
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sudeep Aryal
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Arka Chatterjee
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Silvio Litovsky
- Division of Anatomic, Clinical and Laboratory Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hamdy Ahmed
- Division of Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amanda Schnell
- Division of Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Indranee Rajapreyar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
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Halacoglu J, Shea LA. Cardiovascular Risk Assessment and Therapeutic Implications in Rheumatoid Arthritis. J Cardiovasc Transl Res 2020; 13:878-890. [PMID: 32080804 DOI: 10.1007/s12265-020-09964-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
Patients with rheumatoid arthritis (RA) suffer from a magnitude of excess cardiovascular risk. A paradoxical lipid pattern has been observed in rheumatoid arthritis patients where low levels of total cholesterol and low-density lipoprotein are associated with a higher risk of cardiovascular disease. This paper aims to break down the evidence explaining why patients with low to normal LDL, and total cholesterol have such excess cardiovascular risk. A component of the enhanced cardiovascular risk is systemic inflammation and the subsequent pro-atherogenic dyslipidemia patterns. Due to this "lipid paradox," current risk algorithms and guidelines designed for the general population may underestimate cardiovascular risk in patients with rheumatoid arthritis. The purpose of this paper is to critically evaluate some of the discrepancies and layers of cardiovascular risk in RA patients, the role RA medication may have in mitigating or increasing cardiovascular risk, and the possible role of statin therapy.
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Affiliation(s)
- Juli Halacoglu
- Rueckert-Hartman College for Health Professions, School of Pharmacy, Regis University, 3333 Regis Blvd H-28, Denver, CO, 80221, USA
| | - Leticia A Shea
- Rueckert-Hartman College for Health Professions, School of Pharmacy, Regis University, 3333 Regis Blvd H-28, Denver, CO, 80221, USA.
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Nandkeolyar S, Kim HB, Doctorian T, Stoletniy LN, Sandhu VK, Yu M, Zuppan CW, Razzouk A, Hilliard A, Parwani P. A case report of heart transplant for ischaemic cardiomyopathy from lupus coronary vasculitis. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-7. [PMID: 32123802 PMCID: PMC7042145 DOI: 10.1093/ehjcr/ytz183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/29/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022]
Abstract
Background Coronary vasculitis is a rare, life-threatening complication of systemic lupus erythematosus (SLE). Case summary A 23-year-old woman with SLE presented with typical angina and worsening dyspnoea on exertion. Coronary angiography revealed severe triple vessel disease with a ‘string of beads’ appearance classic for coronary vasculitis. Transthoracic echocardiogram revealed ejection fraction of 25–30% with a severely hypokinetic distal septum and distal anterior wall and an akinetic apical wall. Despite vasculitis treatment with cyclophosphamide and pulse-dose steroids, her coronary vasculitis did not improve. She was refractory to anti-anginal and guideline-directed medical therapy for heart failure and successfully underwent orthotopic heart transplant (OHT). Discussion This is the first reported case of OHT in the case of SLE coronary vasculitis. Chronic SLE coronary vasculitis is caused by lymphocyic infiltration leading to inflammation and fibrosis of the major epicardial coronary arteries but can be successfully managed with OHT when refractory to medical SLE and heart failure therapies. It can affect patients of all ages with SLE, emphasizing the importance of thorough history taking and clinical evaluation in young patients presenting with cardiac symptoms to establish an appropriate diagnosis and treatment plan.
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Affiliation(s)
- Shuktika Nandkeolyar
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Hyungjin B Kim
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Tanya Doctorian
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Liset N Stoletniy
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Vaneet K Sandhu
- Division of Rheumatology, Loma Linda University Medical Center, 11234 Anderson St. Room 3650, Loma Linda, CA 92354, USA
| | - Micah Yu
- Division of Rheumatology, Loma Linda University Medical Center, 11234 Anderson St. Room 3650, Loma Linda, CA 92354, USA
| | - Craig W Zuppan
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, 11234 Anderson St. Ste 2950, Loma Linda, CA 92354, USA
| | - Anees Razzouk
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, 11234 Anderson St. Ste 1617, Loma Linda, CA 92354, USA
| | - Anthony Hilliard
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St. Room 4404, Loma Linda, CA 92354, USA
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Chang A, Stolin G, Fan J, Larreta BR, Fishbein GA, Wallace WD, Baas AS, Cruz D, Wang J. Hypertrophic cardiomyopathy in a lupus patient: a case of hydroxychloroquine cardiotoxicity. ESC Heart Fail 2019; 6:1326-1330. [PMID: 31493341 PMCID: PMC6989295 DOI: 10.1002/ehf2.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/10/2019] [Accepted: 07/22/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
| | | | - Judith Fan
- Institute for Precision Health, UCLA, Los Angeles, CA, USA
| | | | - Gregory A Fishbein
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA, USA
| | | | | | - Daniel Cruz
- Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Jessica Wang
- Department of Medicine, UCLA, Los Angeles, CA, USA
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Cardiac Complications Attributed to Chloroquine and Hydroxychloroquine: A Systematic Review of the Literature. Drug Saf 2019; 41:919-931. [PMID: 29858838 DOI: 10.1007/s40264-018-0689-4] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Chloroquine and hydroxychloroquine are widely used in the long-term treatment of connective tissue disease and usually considered safe. However, chloroquine- or hydroxychloroquine-related cardiac disorder is a rare but severe adverse event, which can lead to death. This systematic review investigates cardiac complications attributed to chloroquine and hydroxychloroquine. METHODS PubMED, EMBASE, and Cochrane database searches were conducted using keywords derived from MeSH terms. Reports published prior to 31 July, 2017 were eligible for inclusion, without restriction to study design. Searches were also conducted on reference lists of included studies. RESULTS Eighty-six articles were identified, reporting individual cases or short series, providing information on 127 patients (65.4% female). A majority of patients were treated with chloroquine (58.3%), with the remaining treated with hydroxychloroquine (39.4%), or both in succession. Most patients had been treated for a long time (median 7 years, minimum 3 days; maximum 35 years) and with a high cumulative dose (median 1235 g for hydroxychloroquine and 803 g for chloroquine). Conduction disorders were the main side effect reported, affecting 85% of patients. Other non-specific adverse cardiac events included ventricular hypertrophy (22%), hypokinesia (9.4%), heart failure (26.8%), pulmonary arterial hypertension (3.9%), and valvular dysfunction (7.1%). For 78 patients reported to have been withdrawn from treatment, some recovered normal heart function (44.9%), while for others progression was unfavorable, resulting in irreversible damage (12.9%) or death (30.8%). LIMITATIONS The risk of cardiac complications attributed to chloroquine/hydroxychloroquine was not quantified because of the lack of randomized controlled trials and observational studies investigating the association. CONCLUSIONS Clinicians should be warned that chloroquine- or hydroxychloroquine-related cardiac manifestations, even conduction disorders without repercussion, may be initial manifestations of toxicity, and are potentially irreversible. Therefore, treatment withdrawal is required when cardiac manifestations are present.
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Tselios K, Deeb M, Gladman DD, Harvey P, Akhtari S, Mak S, Butany J, Urowitz MB. Antimalarial-induced Cardiomyopathy in Systemic Lupus Erythematosus: As Rare as Considered? J Rheumatol 2018; 46:391-396. [PMID: 30323009 DOI: 10.3899/jrheum.180124] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Antimalarials (AM) are recommended for all systemic lupus erythematosus (SLE) patients without specific contraindications. Their main adverse effect is retinal damage; however, heart disease has been described in isolated cases. The aim of our study is to describe 8 patients with AM-induced cardiomyopathy (AMIC) in a defined SLE cohort. METHODS Patients attending the Toronto Lupus Clinic and diagnosed with definite (based on endomyocardial biopsy; EMB) and possible AMIC were included [based on cardiac magnetic resonance imaging (cMRI) and other investigations]. RESULTS Eight female patients (median age 62.5 yrs, disease duration 35 yrs, AM use duration 22 yrs) were diagnosed with AMIC in the past 2 years. Diagnosis was based on EMB in 3 (extensive cardiomyocyte vacuolation, intracytoplasmic myelinoid, and curvilinear bodies). In 4 patients, cMRI was highly suggestive of AMIC (ventricular hypertrophy and/or atrial enlargement and late gadolinium enhancement in a nonvascular pattern). Another patient was diagnosed with complete atrioventricular block, left ventricular and septal hypertrophy, along with concomitant ocular toxicity. All patients had abnormal cardiac troponin I (cTnI) and brain natriuretic peptide (BNP), whereas 7/8 also had chronically elevated creatine phosphokinase. During followup, 1 patient died from refractory heart failure. In the remaining patients, hypertrophy regression and a steady decrease of heart biomarkers were observed after AM cessation. CONCLUSION Once considered extremely rare, AMIC seems to be underrecognized, probably because of the false attribution of heart failure or hypertrophy to other causes. Certain biomarkers (cTnI, BNP) and imaging findings may lead to early diagnosis and enhance survival.
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Affiliation(s)
- Konstantinos Tselios
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Mery Deeb
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Dafna D Gladman
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Paula Harvey
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Shadi Akhtari
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Susanna Mak
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Jagdish Butany
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Murray B Urowitz
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada. .,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases.
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85
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Dogar MU, Shah NN, Ishtiaq S, Shah PN, Shah P, Mathew S, Vittorio TJ. Hydroxychloroquine-induced restrictive cardiomyopathy: a case report. Postgrad Med J 2018; 94:185-186. [PMID: 29353247 DOI: 10.1136/postgradmedj-2017-135236] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/22/2017] [Accepted: 12/23/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Muhammad U Dogar
- Department of Medicine, Crozer-Chester Medical Center, Chester, Pennsylvania, USA
| | - Niel N Shah
- Intern, Smt N. H. L. Municipal Medical College, Ahmedabad, Gujarat, India
| | - Sameera Ishtiaq
- Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, New York, USA
| | - Parin N Shah
- Department of Biochemistry, B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Pratik Shah
- Medical Student, Hofstra University, Hempstead, New York, USA
| | - Shawn Mathew
- Medical Student, New York Institute of Technology, Old Westbury, New York, USA
| | - Timothy J Vittorio
- Department of Medicine, Division of Cardiology, Bronx-Lebanon Hospital Center, Bronx, New York, USA
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86
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Zhao H, Wald J, Palmer M, Han Y. Hydroxychloroquine-induced cardiomyopathy and heart failure in twins. J Thorac Dis 2018; 10:E70-E73. [PMID: 29600108 DOI: 10.21037/jtd.2017.12.66] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hydroxychloroquine (HCQ)-induced cardiomyopathy is one of the rare but severe complications following prolonged HCQ use. However, the exact mechanism of HCQ cardiotoxicity remains unclear and it is difficult to identify risk factors. We present a case of twin sisters who both suffered from systemic lupus erythematosus (SLE) and HCQ-induced cardiomyopathy presenting with decompensated heart failure (HF), suggesting that genetic predisposition might be a factor in HCQ-induced cardiomyopathy.
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Affiliation(s)
- Hang Zhao
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Joyce Wald
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Palmer
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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87
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Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections. Clin Microbiol Rev 2017; 30:529-555. [PMID: 28298472 DOI: 10.1128/cmr.00033-16] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Whipple's disease is a rare infectious disease that can be fatal if left untreated. The disease is caused by infection with Tropheryma whipplei, a bacterium that may be more common than was initially assumed. Most patients present with nonspecific symptoms, and as routine cultivation of the bacterium is not feasible, it is difficult to diagnose this infection. On the other hand, due to the generic symptoms, infection with this bacterium is actually quite often in the differential diagnosis. The gold standard for diagnosis used to be periodic acid-Schiff (PAS) staining of duodenal biopsy specimens, but PAS staining has a poor specificity and sensitivity. The development of molecular techniques has resulted in more convenient methods for detecting T. whipplei infections, and this has greatly improved the diagnosis of this often missed infection. In addition, the molecular detection of T. whipplei has resulted in an increase in knowledge about its pathogenicity, and this review gives an overview of the new insights in epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of Tropheryma whipplei infections.
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88
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Tselios K, Deeb M, Gladman DD, Harvey P, Urowitz MB. Antimalarial-induced cardiomyopathy: a systematic review of the literature. Lupus 2017; 27:591-599. [DOI: 10.1177/0961203317734922] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K Tselios
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, ON, Canada
| | - M Deeb
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, ON, Canada
| | - D D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, ON, Canada
| | - P Harvey
- Department of Medicine, University of Toronto, Physician-in-Chief, Women's College Hospital, Toronto, ON, Canada
| | - M B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, ON, Canada
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89
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Friedman D, Lovig L, Halushka M, Clancy RM, Izmirly PM, Buyon JP. No histologic evidence of foetal cardiotoxicity following exposure to maternal hydroxychloroquine. Clin Exp Rheumatol 2017; 35:857-859. [PMID: 28598777 PMCID: PMC5657477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
It is currently recommended that hydroxychloroquine (HCQ) be maintained during pregnancy in patients with systemic lupus erythematosus. Recent data suggest that this Toll-like receptor inhibitor may also reduce the recurrence rate of anti-SSA/Ro associated congenital heart block (CHB). This case report describes a unique situation in which a CHB-afflicted, HCQ-exposed pregnancy was electively terminated. The heart did not reveal any characteristic features of cardiotoxicity, providing further evidence supporting the safety of foetal exposure to HCQ.
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Affiliation(s)
| | - Leif Lovig
- Paediatric Cardiology, Children's and Women's Physicians of Westchester LLP, Norwalk, CT, USA
| | - Marc Halushka
- Pathology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Robert M Clancy
- Medicine, Division of Rheumatology, New York University School of Medicine, New York, USA
| | - Peter M Izmirly
- Medicine, Division of Rheumatology, New York University School of Medicine, New York, USA
| | - Jill P Buyon
- Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY, USA.
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90
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Narang N, Lang RM, Liarski VM, Jeevanandam V, Hofmann Bowman MA. Aortic Valve Replacement for Moderate Aortic Stenosis with Severe Calcification and Left Ventricualr Dysfunction-A Case Report and Review of the Literature. Front Cardiovasc Med 2017; 4:14. [PMID: 28396860 PMCID: PMC5366320 DOI: 10.3389/fcvm.2017.00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/06/2017] [Indexed: 12/13/2022] Open
Abstract
A 55-year-old man with a history of erosive, seropositive rheumatoid arthritis (RA), and interstitial lung disease presented with shortness of breath. Echocardiography showed new-onset severe left ventricular (LV) dysfunction with an ejection fraction (EF) of 15% and moderately increased mean aortic valve gradient of 20 mmHg in a trileaflet aortic valve with severe sclero-calcific degeneration. Coronary angiography revealed no significant obstructive coronary disease. Invasive hemodynamic studies and dobutamine stress echocardiography were consistent with moderate aortic stenosis. Guideline directed medical therapy for heart failure with reduced EF was initiated; however, diuretics and neurohormonal blockade (beta-blocker and angiotensin receptor blocker) provided minimal improvement, and the patient remained functionally limited. Of interest, echocardiography performed 1 year prior to his presentation showed normal LV EF and mild aortic leaflet calcification with moderate stenosis, suggesting a rapid progressing of calcific aortic valve disease. Subsequently, the patient underwent surgical aortic valve replacement and demonstrated excellent postsurgical recovery of LV EF (55%). Calcific aortic valve disease is commonly associated with aging, bicuspid aortic valve, and chronic kidney disease. Pathophysiological mechanism for valvular calcification is incompletely understood but include osteogenic transformation of valvular interstitial cells mediated by local and systemic inflammatory processes. Several rheumatologic diseases including RA are associated with premature atherosclerosis and arterial calcification, and we speculated a similar role of RA accelerating calcific aortic valve disease. We present a case of accelerated aortic valve calcification with (only) moderate stenosis, complicated by a rapid decline in LV systolic performance. Guidelines for AVR in moderate stenosis without concomitant cardiac surgery are not well established, although it should be considered in selected patients.
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Affiliation(s)
- Nikhil Narang
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center , Chicago, IL , USA
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center , Chicago, IL , USA
| | - Vladimir M Liarski
- Department of Medicine, Section of Rheumatology, University of Chicago Medical Center , Chicago, IL , USA
| | | | - Marion A Hofmann Bowman
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center , Chicago, IL , USA
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91
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Hydroxychloroquine-induced cardiomyopathy in a patient with limited cutaneous systemic sclerosis. Clin Res Cardiol 2016; 106:234-236. [PMID: 28004183 DOI: 10.1007/s00392-016-1064-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/15/2016] [Indexed: 01/15/2023]
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92
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Ponticelli C, Moroni G. Hydroxychloroquine in systemic lupus erythematosus (SLE). Expert Opin Drug Saf 2016; 16:411-419. [DOI: 10.1080/14740338.2017.1269168] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- C. Ponticelli
- Nephrological Unit, Humanitas Clinical and Research Center, Rozzano (Milano), Italy
| | - G. Moroni
- Nephrological Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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93
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Page RL, O'Bryant CL, Cheng D, Dow TJ, Ky B, Stein CM, Spencer AP, Trupp RJ, Lindenfeld J. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e32-69. [PMID: 27400984 DOI: 10.1161/cir.0000000000000426] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients.
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94
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Sabato LA, Mendes LA, Cox ZL. Restrictive Cardiomyopathy Associated With Long-Term Use of Hydroxychloroquine for Systemic Lupus Erythematosus. J Pharm Pract 2016; 30:571-575. [PMID: 27353145 DOI: 10.1177/0897190016655726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Hydroxychloroquine (HQ) is commonly prescribed for autoimmune diseases such as systemic lupus erythematosus. We report a case of a 75-year-old female presenting with de novo decompensated heart failure and restrictive cardiomyopathy (left ventricular ejection fraction: 40%-45%) after treatment with HQ for more than 11 years. Hydroxychloroquine was discontinued, and follow-up echocardiogram 57 days after discontinuation showed normalization of her left ventricular ejection fraction. A score of 7 on the Naranjo Adverse Drug Reaction Probability Scale indicates that HQ is a probable cause of this patient's cardiomyopathy. An adverse drug effect due to HQ should be considered in treated patients who present with restrictive cardiomyopathy. Discontinuation may allow for partial or complete reversal of the cardiomyopathy.
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Affiliation(s)
- Leah A Sabato
- 1 Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa A Mendes
- 2 Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary L Cox
- 3 Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN, USA
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95
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Gruber JR, Sarro R, Delaloye J, Surmely JF, Siniscalchi G, Tozzi P, Jaques C, Jaton K, Delabays A, Greub G, Rutz T. Tropheryma whipplei bivalvular endocarditis and polyarthralgia: a case report. J Med Case Rep 2015; 9:259. [PMID: 26577283 PMCID: PMC4650277 DOI: 10.1186/s13256-015-0746-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/23/2015] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Tropheryma whipplei infection should be considered in patients with suspected infective endocarditis with negative blood cultures. The case (i) shows how previous symptoms can contribute to the diagnosis of this illness, and (ii) elucidates current recommended diagnostic and therapeutic approaches to Whipple's disease. CASE PRESENTATION A 71-year-old Swiss man with a past history of 2 years of diffuse arthralgia was admitted for a possible endocarditis with severe aortic and mitral regurgitation. Serial blood cultures were negative. Our patient underwent replacement of his aortic and mitral valve by biological prostheses. T. whipplei was documented by polymerase chain reactions on both removed valves and on stools, as well as by valve histology. A combination of hydroxychloroquine and doxycycline was initiated as lifetime treatment followed by the complete disappearance of his arthralgia. CONCLUSIONS This case report underlines the importance of considering T. whipplei as a possible causal etiology of blood culture-negative endocarditis. Lifelong antibiotic treatment should be considered for this pathogen (i) due to the significant rate of relapses, and (ii) to the risk of reinfection with another strain since these patients likely have some genetic predisposition.
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Affiliation(s)
- Janina Rivas Gruber
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 11, 1011, Lausanne, Switzerland.
| | - Rossella Sarro
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 25, 1011, Lausanne, Switzerland.
| | - Julie Delaloye
- Infectious Disease Service, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 48, 1011, Lausanne, Switzerland.
| | | | - Giuseppe Siniscalchi
- Service of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 46, 1011, Lausanne, Switzerland.
| | - Piergiorgio Tozzi
- Service of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 46, 1011, Lausanne, Switzerland. .,Service of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Cyril Jaques
- Cabinet Medical, Avenue de Florimont 8, 1006, Morges, Switzerland.
| | - Katia Jaton
- Institute of Microbiology, University of Lausanne, Rue de Bugnon 48, 1011, Lausanne, Switzerland.
| | - Alain Delabays
- Service of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Gilbert Greub
- Infectious Disease Service, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 48, 1011, Lausanne, Switzerland.
| | - Tobias Rutz
- Service of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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96
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Zerbib Y, Guillaumont MP, Touati G, Duhaut P, Schmidt J. [Early cardiotoxicity of Hydroxychloroquine]. Rev Med Interne 2015; 37:209-11. [PMID: 26320366 DOI: 10.1016/j.revmed.2015.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/09/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hydroxychloroquine (HCQ) is most frequently used in the treatment of systemic inflammatory diseases. Cardiac complications of anti-malarial drugs are uncommon, and most of the time are the result of a long-term exposition. In this case, cardiotoxicity is the consequence of the lysosomal dysfunction and the result of intracytoplasmic granular material inclusions. CASE REPORT We report a 77-year-old woman who presented a very early and reversible cardiotoxicity, probably related to the quinidine like effect of the HCQ, 10 days after initiation of therapy for Whipple endocarditis. CONCLUSION We discuss the different mechanisms of cardiotoxicity of anti-malarial drugs and their clinical manifestations.
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Affiliation(s)
- Y Zerbib
- Service de médecine interne et RECIF, CHU Amiens-Picardie, Amiens, France.
| | | | - G Touati
- Service de chirurgie cardiaque, CHU Amiens-Picardie, Amiens, France
| | - P Duhaut
- Service de médecine interne et RECIF, CHU Amiens-Picardie, Amiens, France; Inserm 1088, université de Picardie-Jules-Verne, Amiens, France
| | - J Schmidt
- Service de médecine interne et RECIF, CHU Amiens-Picardie, Amiens, France; Inserm 1088, université de Picardie-Jules-Verne, Amiens, France
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97
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Mucke HA. Drug Repurposing Patent Applications January–March 2015. Assay Drug Dev Technol 2015. [DOI: 10.1089/adt.2015.29017.patdrrr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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98
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Cairoli E, Danese N, Teliz M, Bruzzone MJ, Ferreira J, Rebella M, Cayota A. Cumulative dose of hydroxychloroquine is associated with a decrease of resting heart rate in patients with systemic lupus erythematosus: a pilot study. Lupus 2015; 24:1204-9. [DOI: 10.1177/0961203315580870] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 03/17/2015] [Indexed: 11/17/2022]
Abstract
Introduction The use of hydroxychloroquine (HCQ) in patients with systemic lupus erythematosus (SLE) offers a wide range of benefits. However, there are evidence in favour of cardiotoxicity, including heart conduction disturbances and congestive heart failure. Objective To determine the effects of HCQ in the resting heart rate (RHR) of SLE patients. Patients and methods Included were patients with non active SLE, with a sedentary lifestyle and treated with HCQ. Excluded were patients on beta blocker treatment, trained patients, pacemaker´s users and patients with clinical or analytical evidence of anemia, renal disease, obstructive pulmonary disease, obesity, uncontrolled thyroid disease, fever or current infection. Standard 12-lead electrocardiogram was performed in the resting condition (supine decubitus and orthostatic position). Comparison between groups was performed using Mann–Whitney U test. A multiple linear regression was performed. A p value <0.05 was considered statistically significant. Results 42 patients were included. Patients were divided in two groups based on the cumulative dose of HCQ (CD-HCQ), considering 365 g as cut-off. There were 24 patients with low-HCQ (<365 g) and 18 patients with high-HCQ (>365 g). Non significant differences were found in age, sex, prednisone dose or SLEDAI. The mean RHR was 73 ± 6 beats/min in the low-HCQ and 65 ± 7 beats/min in the high-HCQ, with a significant decrease of 11% ( p = 0.003). In multiple linear regressions, there were non significant association between the decrease of RHR and prednisone dose, age, SLEDAI or TSH, but there was significant association between RHR and CD-HCQ ( p = 0.024) and RHR and time of exposure to HCQ ( p = 0.029). Conclusion CD-HCQ higher than 365 g was associated with a significant decrease (11%) in RHR in non-active SLE patients, although a larger prospective study is required to allow more definitive conclusions.
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Affiliation(s)
- E Cairoli
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - N Danese
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - M Teliz
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - M J Bruzzone
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - J Ferreira
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - M Rebella
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - A Cayota
- Departamento Básico de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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99
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Al-Bari MAA. Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases. J Antimicrob Chemother 2015; 70:1608-21. [PMID: 25693996 PMCID: PMC7537707 DOI: 10.1093/jac/dkv018] [Citation(s) in RCA: 287] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antimalarial drugs (e.g. chloroquine and its close structural analogues) were developed primarily to treat malaria; however, they are beneficial for many dermatological, immunological, rheumatological and severe infectious diseases, for which they are used mostly today. Chloroquine and hydroxychloroquine, two of the most fascinating drugs developed in the last 50 years, are increasingly recognized for their effectiveness in myriad non-malarial diseases. In advanced research, chloroquine and hydroxychloroquine have been shown to have various immunomodulatory and immunosuppressive effects, and currently have established roles in the management of rheumatic diseases, lupus erythematosus (different forms) and skin diseases, and in the treatment of different forms of cancer. Recently, chloroquine analogues have also been found to have metabolic, cardiovascular, antithrombotic and antineoplastic effects. This review is concerned with the lysosomotropic, anti-inflammatory and immunomodulatory mechanisms of chloroquine, hydroxychloroquine, quinacrine and related analogues, and the current evidence for both their beneficial effects and potential adverse manifestations in various diseases.
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100
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Sen D, González-Mayda M, Brasington RD. Cardiovascular disease in rheumatoid arthritis. Rheum Dis Clin North Am 2013; 40:27-49. [PMID: 24268008 DOI: 10.1016/j.rdc.2013.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
RA can manifest in a variety of cardiac complications, including pericarditis, valvular disease, cardiomyopathy, and amyloidosis. Subclinical involvement is higher than anticipated. CVD is also prevalent in patients with RA, with onset in early disease. Several disease-specific risk factors, like seropositivity, disease activity, and medications, are implicated in the pathogenesis of CVD in RA. Cardiovascular risk assessment in RA varies from the general population. Some traditional risk factors like BMI and lipid levels apply differently to the RA population. Statins are useful in managing dyslipidemia in RA. There is good evidence to support cardiovascular risk reduction with methotrexate and TNF-I use if good disease control is achieved.
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Affiliation(s)
- Deepali Sen
- Division of Rheumatology, Department of Medicine, Campus Box 8045, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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