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Song E. Effects of hydroxychloroquine on atrial electrophysiology in in silico wild-type and PITX2 +/- atrial cardiomyocytes. Herz 2023; 48:384-392. [PMID: 36732468 PMCID: PMC9894744 DOI: 10.1007/s00059-023-05162-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/07/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hydroxychloroquine (HCQ) is commonly used in the treatment of autoimmune diseases and increases the risk of QT interval prolongation. However, it is unclear how HCQ affects atrial electrophysiology and the risk of atrial fibrillation (AF). METHODS We quantitatively examined the potential atrial arrhythmogenic effects of HCQ on AF using a computational model of human atrial cardiomyocytes. We measured atrial electrophysiological markers after systematically varying HCQ concentrations. RESULTS The HCQ concentrations were positively correlated with the action potential duration (APD), resting membrane potential, refractory period, APD alternans threshold, and calcium transient alternans threshold (p < 0.05). By contrast, HCQ concentrations were inversely correlated with the maximum upstroke velocity and calcium transient amplitude (p < 0.05). When the therapeutic concentration (Cmax) of HCQ was applied, HCQ increased APD90 by 1.4% in normal sinus rhythm, 1.8% in wild-type AF, and 2.6% in paired-like homeodomain transcription factor 2 (PITX2)+/- AF, but did not affect the alternans thresholds. The overall in silico results suggest no significant atrial arrhythmogenic effects of HCQ at Cmax, instead implying a potential antiarrhythmic role of low-dose HCQ in AF. However, at an HCQ concentration of fourfold Cmax, a rapid pacing rate of 4 Hz induced prominent APD alternans, particularly in the PITX2+/- AF model. CONCLUSION Our in silico analysis suggests a potential antiarrhythmic role of low-dose HCQ in AF. Concomitant PITX2 mutations and high-dose HCQ treatments may increase the risk of AF, and this potential genotype/dose-dependent arrhythmogenic effect of HCQ should be investigated further.
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Affiliation(s)
- Euijun Song
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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2
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Ezemma O, Devjani S, Jothishankar B, Kelley KJ, Senna MM. Adverse effects of hydroxychloroquine use in patients with cicatricial alopecia: A systematic review. Int J Dermatol 2023; 62:e473-e474. [PMID: 37036025 DOI: 10.1111/ijd.16660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/20/2023] [Accepted: 03/11/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Ogechi Ezemma
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Shivali Devjani
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | | | - Kristen J Kelley
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Maryanne M Senna
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, MA, USA
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
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3
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da Silva NS, de Araújo NK, Dos Santos KA, de Souza KSC, de Araújo JNG, Cruz MS, Parra EJ, Silbiger VN, Luchessi AD. Post-Covid condition and clinic characteristics associated with SARS-CoV-2 infection: a 2-year follow-up to Brazilian cases. Sci Rep 2023; 13:13973. [PMID: 37633999 PMCID: PMC10460396 DOI: 10.1038/s41598-023-40586-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023] Open
Abstract
Until January 2023, Brazil recorded 37 million COVID-19 cases despite the decrease in mortality due to mass vaccination efforts against COVID-19. The infection continues to challenge researchers and health professionals with the persistent symptoms and onset manifestations after the acute phase of the disease, namely Post-Covid Condition (PCC). Being one of the countries with the highest infection rate, Brazil must prepare for a growing number of patients with chronic health consequences of COVID-19. Longitudinal studies that follow patients over extended periods are crucial in understanding the long-term impacts of COVID-19, including potential health consequences and the effects on quality of life. We describe the clinical profile of a cohort of COVID-19 patients infected during the first year of the pandemic in Brazil and a follow-up after two years to investigate the health impacts of SARS-CoV-2 infection. The first wave of SARS-CoV-2 infection in Brazil featured extensive drug misuse, notably the ineffective COVID kit comprised of ivermectin, antimalarials and azithromycin, and elevated in-hospital mortality. In the second phase of the study, Post-Covid Condition was reported by symptomatic COVID-19 subjects across different severity levels two years after infection. Long haulers are more likely to be women, previously hospitalized, and reported a range of symptoms from muscle pain to cognitive deficit. Our longitudinal study is essential to inform public health authorities to develop strategies and policies to control the spread of the virus and mitigate its impacts on society.
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Affiliation(s)
- Nayara Sousa da Silva
- Northeast Biotechnology Network (RENORBIO), Graduate Program in Biotechnology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Nathália Kelly de Araújo
- Graduate Program of Health and Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Biological Sciences, Federal Institute of Rondônia, Guajará-Mirim, Brazil
| | - Katiusse Alves Dos Santos
- Graduate Program of Pharmaceutical Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Jéssica Nayara Góes de Araújo
- Northeast Biotechnology Network (RENORBIO), Graduate Program in Biotechnology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Marina Sampaio Cruz
- Graduate Program of Health and Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA, USA
| | - Esteban J Parra
- Department of Anthropology, University of Toronto at Mississauga, Mississauga, ON, Canada
| | - Vivian Nogueira Silbiger
- Northeast Biotechnology Network (RENORBIO), Graduate Program in Biotechnology, Federal University of Rio Grande do Norte, Natal, Brazil.
- Graduate Program of Pharmaceutical Sciences, Federal University of Rio Grande do Norte, Natal, Brazil.
- Department of Clinical and Toxicology Analysis, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, 384, Natal, RN, 59012-570, Brazil.
| | - André Ducati Luchessi
- Northeast Biotechnology Network (RENORBIO), Graduate Program in Biotechnology, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Program of Health and Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Program of Pharmaceutical Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Clinical and Toxicology Analysis, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, 384, Natal, RN, 59012-570, Brazil
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4
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Yoon SH, Lee HL, Jeong DU, Lim KM, Park SJ, Kim KS. Assessment of the proarrhythmic effects of repurposed antimalarials for COVID-19 treatment using a comprehensive in vitro proarrhythmia assay (CiPA). Front Pharmacol 2023; 14:1220796. [PMID: 37649890 PMCID: PMC10464612 DOI: 10.3389/fphar.2023.1220796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
Due to the outbreak of the SARS-CoV-2 virus, drug repurposing and Emergency Use Authorization have been proposed to treat the coronavirus disease 2019 (COVID-19) during the pandemic. While the efficiency of the drugs has been discussed, it was identified that certain compounds, such as chloroquine and hydroxychloroquine, cause QT interval prolongation and potential cardiotoxic effects. Drug-induced cardiotoxicity and QT prolongation may lead to life-threatening arrhythmias such as torsades de pointes (TdP), a potentially fatal arrhythmic symptom. Here, we evaluated the risk of repurposed pyronaridine or artesunate-mediated cardiac arrhythmias alone and in combination for COVID-19 treatment through in vitro and in silico investigations using the Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative. The potential effects of each drug or in combinations on cardiac action potential (AP) and ion channels were explored using human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and Chinese hamster ovary (CHO) cells transiently expressing cardiac ion channels (Nav1.5, Cav1.2, and hERG). We also performed in silico computer simulation using the optimized O'Hara-Rudy human ventricular myocyte model (ORd model) to classify TdP risk. Artesunate and dihydroartemisinin (DHA), the active metabolite of artesunate, are classified as a low risk of inducing TdP based on the torsade metric score (TMS). Moreover, artesunate does not significantly affect the cardiac APs of hiPSC-CMs even at concentrations up to 100 times the maximum serum concentration (Cmax). DHA modestly prolonged at APD90 (10.16%) at 100 times the Cmax. When considering Cmax, pyronaridine, and the combination of both drugs (pyronaridine and artesunate) are classified as having an intermediate risk of inducing TdP. However, when considering the unbound concentration (the free fraction not bound to carrier proteins or other tissues inducing pharmacological activity), both drugs are classified as having a low risk of inducing TdP. In summary, pyronaridine, artesunate, and a combination of both drugs have been confirmed to pose a low proarrhythmogenic risk at therapeutic and supratherapeutic (up to 4 times) free Cmax. Additionally, the CiPA initiative may be suitable for regulatory use and provide novel insights for evaluating drug-induced cardiotoxicity.
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Affiliation(s)
- Seung-Hyun Yoon
- R&D Center for Advanced Pharmaceuticals and Evaluation, Korea Institute of Toxicology, Daejeon, Republic of Korea
- College of Veterinary Medicine, Research Institute of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hyun-Lee Lee
- R&D Center for Advanced Pharmaceuticals and Evaluation, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Da Un Jeong
- Intelligent Human Twin Research Center, Electronics and Telecommunications Research Institute, Daejeon, Republic of Korea
| | - Ki Moo Lim
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, Republic of Korea
| | - Seong-Jun Park
- College of Veterinary Medicine, Research Institute of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Ki-Suk Kim
- R&D Center for Advanced Pharmaceuticals and Evaluation, Korea Institute of Toxicology, Daejeon, Republic of Korea
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5
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Naveen R, Nikiphorou E, Joshi M, Sen P, Lindblom J, Agarwal V, Lilleker JB, Tan AL, Salim B, Ziade N, Velikova T, Gracia-Ramos AE, Kuwana M, Day J, Makol A, Distler O, Chinoy H, Traboco LS, Wibowo SAK, Tehozol EAZ, Serrano JR, García-De La Torre I, Aggarwal R, Gupta L, Agarwal V, Parodis I. Safety and tolerance of vaccines against SARS-CoV-2 infection in systemic lupus erythematosus: results from the COVAD study. Rheumatology (Oxford) 2023; 62:2453-2463. [PMID: 36413073 PMCID: PMC10321116 DOI: 10.1093/rheumatology/keac661] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/10/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To determine COVID-19 vaccine-related adverse events (AEs) in the seven-day post-vaccination period in patients with SLE vs autoimmune rheumatic diseases (AIRDs), non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HC). METHODS Data were captured through the COVID-19 Vaccination in Autoimmune Diseases (COVAD) questionnaire (March-December 2021). Multivariable regression models accounted for age, gender, ethnicity, vaccine type and background treatment. RESULTS Among 9462 complete respondents, 583 (6.2%) were SLE patients (mean age: 40.1 years; 94.5% females; 40.5% Asian; 42.9% Pfizer-recipients). Minor AEs were reported by 83.0% of SLE patients, major by 2.6%, hospitalization by 0.2%. AE and hospitalization frequencies were similar between patients with active and inactive SLE. Rashes were more frequent in SLE patients vs HC (OR; 95% CI: 1.2; 1.0, 1.5), chills less frequent in SLE vs AIRDs (0.6; 0.4, 0.8) and nrAIDs (0.5; 0.3, 0.8), and fatigue less frequent in SLE vs nrAIDs (0.6; 0.4, 0.9). Pfizer-recipients reported higher overall AE (2.2; 1.1, 4.2) and injection site pain (2.9; 1.6, 5.0) frequencies than recipients of other vaccines, Oxford/AstraZeneca-recipients more body ache, fever, chills (OR: 2.5, 3.0), Moderna-recipients more body ache, fever, chills, rashes (OR: 2.6, 4.3). Hospitalization frequencies were similar across vaccine types. AE frequencies were similar across treatment groups, although chills were less frequent in antimalarial users vs non-users (0.5; 0.3, 0.9). CONCLUSION While COVID-19 vaccination-related AEs were reported by four-fifths of SLE patients, those were mostly minor and comparable to AEs reported by healthy individuals, providing reassurance regarding COVID-19 vaccination safety in SLE.
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Affiliation(s)
- R Naveen
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Parikshit Sen
- Maulana Azad Medical College, New Delhi, Delhi, India
| | - Julius Lindblom
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Vishwesh Agarwal
- Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
| | - James B Lilleker
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Babur Salim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
- Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Tsvetelina Velikova
- Department of Clinical Immunology, Medical Faculty, University Hospital 'Lozenetz', Sofia University St. Kliment Ohridski, Sofia, Bulgaria
| | - Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center, 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Hector Chinoy
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Lisa S Traboco
- Department of Medicine, Section of Rheumatology, St. Luke's Medical Center-Global City, Taguig, Philippines
| | - Suryo Anggoro Kusumo Wibowo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Jorge Rojas Serrano
- Rheumatologist and Clinical Investigator, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Ignacio García-De La Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente and University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Alsaidan AA, Al‐Kuraishy HM, Al‐Gareeb AI, Alexiou A, Papadakis M, Alsayed KA, Saad HM, Batiha GE. The potential role of SARS‐CoV‐2 infection in acute coronary syndrome and type 2 myocardial infarction (T2MI): Intertwining spread. Immun Inflamm Dis 2023; 11:e798. [PMID: 36988260 PMCID: PMC10022425 DOI: 10.1002/iid3.798] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID‐19) is a novel pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). It has been shown that SARS‐CoV‐2 infection‐induced inflammatory and oxidative stress and associated endothelial dysfunction may lead to the development of acute coronary syndrome (ACS). Therefore, this review aimed to ascertain the link between severe SARS‐CoV‐2 infection and ACS. ACS is a spectrum of acute myocardial ischemia due to a sudden decrease in coronary blood flow, ranging from unstable angina to myocardial infarction (MI). Primary or type 1 MI (T1MI) is mainly caused by coronary plaque rupture and/or erosion with subsequent occlusive thrombosis. Secondary or type 2 MI (T2MI) is due to cardiac and systemic disorders without acute coronary atherothrombotic disruption. Acute SARS‐CoV‐2 infection is linked with the development of nonobstructive coronary disorders such as coronary vasospasm, dilated cardiomyopathy, myocardial fibrosis, and myocarditis. Furthermore, SARS‐CoV‐2 infection is associated with systemic inflammation that might affect coronary atherosclerotic plaque stability through augmentation of cardiac preload and afterload. Nevertheless, major coronary vessels with atherosclerotic plaques develop minor inflammation during COVID‐19 since coronary arteries are not initially and primarily targeted by SARS‐CoV‐2 due to low expression of angiotensin‐converting enzyme 2 in coronary vessels. In conclusion, SARS‐CoV‐2 infection through hypercytokinemia, direct cardiomyocyte injury, and dysregulation of the renin‐angiotensin system may aggravate underlying ACS or cause new‐onset T2MI. As well, arrhythmias induced by anti‐COVID‐19 medications could worsen underlying ACS.
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Affiliation(s)
- Aseel Awad Alsaidan
- Department of Family and Community Medicine, College of MedicineJouf UniversitySakakaSaudi Arabia
| | - Hayder M. Al‐Kuraishy
- Department of Clinical Pharmacology and Medicine, College of MedicineALmustansiriyia UniversityBaghdadIraq
| | - Ali I. Al‐Gareeb
- Department of Clinical Pharmacology and Medicine, College of MedicineALmustansiriyia UniversityBaghdadIraq
| | - Athanasios Alexiou
- Department of Science and EngineeringNovel Global Community Educational FoundationHebershamNew South WalesAustralia,Department of Research and DevelopmentAFNP MedWienAustria
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten‐Herdecke, Heusnerstrasse 40University of Witten‐HerdeckeWuppertalGermany
| | - Khalid Adel Alsayed
- Department of Family and Community MedicineSecurity Forces Hospital ProgramRiyadhSaudi Arabia
| | - Hebatallah M. Saad
- Department of Pathology, Faculty of Veterinary MedicineMatrouh UniversityMatrouhEgypt
| | - Gaber El‐Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary MedicineDamanhour UniversityAlBeheiraEgypt
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7
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Thaper A, Ross SJ, Agarwal Z, Langston M, Miles WM, Austin A. Progression of ECG in hydroxychloroquine overdose. J Electrocardiol 2023; 77:68-71. [PMID: 36652870 DOI: 10.1016/j.jelectrocard.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
Hydroxychloroquine overdose is associated with myocardial toxicity and conduction disorders. We report a case of hydroxychloroquine overdose that demonstrated a rapid progressive intraventricular conduction delay and QT prolongation resulting in significant bradycardia and shock despite aggressive treatment. We describe the rare capture of abrupt abnormalities of this overdose in sequential electrocardiograms in the immediate hours post-ingestion.
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Affiliation(s)
- Arushi Thaper
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Steven J Ross
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - Zubin Agarwal
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - Michael Langston
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, United States of America
| | - William M Miles
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - Adam Austin
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, United States of America.
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8
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Wang J, Jing X, Hua L, Zheng Y, Hu S, Xiao J, Guo D, Wu W, Ji H, Peng L, Jiang S, Gao X. Hypertension related toxicity of chloroquine explains its failure against COVID-19: Based on rat model. Front Pharmacol 2022; 13:1051694. [DOI: 10.3389/fphar.2022.1051694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
Chloroquine was once thought to be a promising treatment for COVID-19 but it quickly failed due to its inefficiency and association with increased mortality. Further, comorbidities such as hypertension may have contributed this failure. The safety and toxicity of chloroquine at doses required for treating SARS-CoV-2 infection in hypertensive patients remain unknown. Herein, to investigate these effects, we performed a safety evaluation of chloroquine at the approved dose (63 mg/kg) and at a high dose (126 mg/kg) in hypertensive rats. We found that chloroquine increased the mortality of hypertensive rats to 18.2% and 100%, respectively, after 7 days. During the chloroquine exposure period, the bodyweight, feed, and water consumption of hypertensive rats were decreased significantly. In addition, we show that chloroquine induces prolongation of QTc interval, elevation of LDH and CK, and histopathological damage of the myocardium in hypertensive rats. Ocular toxicity was observed in hypertensive rats in the form of hemorrhage in the eyes and retinal damage. Furthermore, we also observed intestinal toxicity in hypertensive rats, which presented as thinning intestinal walls with hemorrhagic contents, and histopathological changes of the jejunum. Hepatotoxicity was also evidenced by elevated ALT, and vacuolization of hepatocytes was also observed. Nephrotoxicity was observed only in high dose chloroquine-treated hypertensive rats, presenting as alterations of urinalysis and renal function. Immune alterations were also found in high-dose chloroquine-treated hypertensive rats with elevation of serum IL-10, IL-1β and GRO, and moderate damage to the spleen. In summary, this study partially explains the reason for the failure of chloroquine as a COVID-19 therapy, and underlines the importance of safety evaluation and medical supervision of chloroquine to avoid patient harm, especially to those with hypertension.
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9
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Liao Y, Liu PY, Huang MS, Mau YL, Su PF, Huang TC. Risk Factors for QT Prolongation in Patients with Chronic Hydroxychloroquine Use. ACTA CARDIOLOGICA SINICA 2022; 38:723-735. [PMID: 36440249 PMCID: PMC9692211 DOI: 10.6515/acs.202211_38(6).20220415a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hydroxychloroquine is used as an antimalarial and immunomodulator, however it can induce QT prolongation that could potentially lead to fatal arrhythmia. We investigated changes in QT interval in long-term hydroxychloroquine users, and identified possible risk factors associated with significant QTc prolongation. METHODS We retrospectively enrolled 3603 patients who received long-term hydroxychloroquine treatment from 2009 to 2019, of whom 167 had electrocardiography (ECG) results before and during hydroxychloroquine therapy. Baseline characteristics, laboratory data, comorbidities, concurrent medications, and related clinical outcomes were reviewed. RESULTS Overall, 225 patients (6.2%) died within the study period, with 50 patients (1.4%) continuously receiving hydroxychloroquine treatment until death. Three patients had fatal ventricular arrhythmia. No significant change in corrected QT interval (QTc) was noted before and during hydroxychloroquine treatment (451.1 ± 39.9 ms vs. 456.0 ± 37.3 ms, P = 0.140) in the ECG cohort. Multivariable logistic regression showed that diabetes mellitus [odds ratio (OR): 9.55, 95% confidence interval (CI): 2.02-45.22; P = 0.005] and use of additional QT-prolonging drugs (OR: 2.89, 95% CI: 1.40-5.94; P = 0.004) were independent risk factors for significant QTc prolongation. Multiple linear regression, with the number of QT-prolonging drugs and comorbidities including diabetes mellitus, hypertension, and atrial fibrillation as explanatory variables, predicted QTc response (adjusted R2 = 0.385) in the long-term hydroxychloroquine users. CONCLUSIONS In the long-term users of hydroxychloroquine, those with diabetes mellitus and concurrent use of additional QT-prolonging drugs were at a higher risk of significant QTc prolongation. Baseline QTc interval, concurrent medications, and comorbidities predicted QTc response.
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Affiliation(s)
- Yu Liao
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Ping-Yen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University;
,
Institute of Clinical Medicine, College of Medicine
| | - Mu-Shiang Huang
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Yu-Lin Mau
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fang Su
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Chun Huang
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University;
,
Institute of Clinical Medicine, College of Medicine
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10
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Mohammad KO, Rodriguez JBC, Urey MA. Coronavirus disease 2019 and the cardiologist. Curr Opin Cardiol 2022; 37:335-342. [PMID: 35731679 DOI: 10.1097/hco.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW There continues to be extensive clinical and epidemiological data to suggest that coronavirus disease 2019 (COVID-19) infection is associated with numerous different types of cardiac involvement. RECENT FINDINGS Myocardial injury has been reported in over 25% of patients hospitalized due to COVID-19 infection and is not only associated with a worse prognosis but with higher mortality, approaching 40%. Currently proposed mechanisms of myocardial injury include direct viral infection, cytokine storm, endothelial inflammation, demand ischemia, interferon-mediated response and stress cardiomyopathy. COVID-19 infection is associated with new-onset arrhythmias and heart failure regardless of history of previous cardiovascular disease. Echocardiographic findings can be useful to predict mortality in COVID-19 patients and cardiac MRI is an effective tool to both assess COVID-19 induced myocarditis and to follow-up on cardiac complications of COVID-19 long-term. Although there is an association between COVID-19 vaccination and myocarditis, pericarditis or arrhythmias, the risk appears lower when compared to risk attributable to the natural infection. SUMMARY Patients with cardiovascular disease are not only more likely to suffer from severe COVID-19 infection but are at increased risk for further complications and higher mortality. Further data compilation on current and emerging treatments of COVID-19 will have additional impact on cardiovascular morbidity and mortality of COVID-19 infection.
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Affiliation(s)
- Khan O Mohammad
- Department of Internal Medicine, Dell Medical School at the University of Texas, Austin, Texas
| | - Jose B Cruz Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Marcus A Urey
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
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11
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Villa Zapata L, Boyce RD, Chou E, Hansten PD, Horn JR, Gephart SM, Subbian V, Romero A, Malone DC. QTc Prolongation with the Use of Hydroxychloroquine and Concomitant Arrhythmogenic Medications: A Retrospective Study Using Electronic Health Records Data. Drugs Real World Outcomes 2022; 9:415-423. [PMID: 35665910 PMCID: PMC9167427 DOI: 10.1007/s40801-022-00307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Hydroxychloroquine can induce QT/QTc interval prolongation for some patients; however, little is known about its interactions with other QT-prolonging drugs. Objective The purpose of this retrospective electronic health records study was to evaluate changes in the QTc interval in patients taking hydroxychloroquine with or without concomitant QT-prolonging medications. Methods De-identified health records were obtained from the Cerner Health Facts® database. Variables of interest included demographics, diagnoses, clinical procedures, laboratory tests, and medications. Patients were categorized into six cohorts based on exposure to hydroxychloroquine, methotrexate, or sulfasalazine alone, or the combination of any those drugs with any concomitant drug known to prolong the QT interval. Tisdale QTc risk score was calculated for each patient cohort. Two-sample paired t-tests were used to test differences between the mean before and after QTc measurements within each group and ANOVA was used to test for significant differences across the cohort means. Results A statistically significant increase in QTc interval from the last measurement prior to concomitant exposure of 18.0 ms (95% CI 3.5–32.5; p < 0.05) was found in the hydroxychloroquine monotherapy cohort. QTc changes varied considerably across cohorts, with standard deviations ranging from 40.9 (hydroxychloroquine monotherapy) to 57.8 (hydroxychloroquine + sulfasalazine). There was no difference in QTc measurements among cohorts. The hydroxychloroquine + QTc-prolonging agent cohort had the highest average Tisdale Risk Score compared with those without concomitant exposure (p < 0.05). Conclusion Our analysis of retrospective electronic health records found hydroxychloroquine to be associated with a moderate increase in the QTc interval compared with sulfasalazine or methotrexate. However, the QTc was not significantly increased with concomitant exposure to other drugs known to increase QTc interval.
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Affiliation(s)
- Lorenzo Villa Zapata
- Department of Pharmacy Practice, College of Pharmacy, Mercer University, Atlanta, GA, USA
| | - Richard D Boyce
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, The Offices@Baum, 5607 Baum Blvd, Pittsburgh, PA, 15202, USA.
| | - Eric Chou
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, The Offices@Baum, 5607 Baum Blvd, Pittsburgh, PA, 15202, USA
| | | | - John R Horn
- Department of Pharmacy Practice, School of Pharmacy and Pharmacy Services UW Medicine, University of Washington, Seattle, WA, USA
| | - Sheila M Gephart
- Community and Health Systems Science, College of Nursing, The University of Arizona, Tucson, AZ, USA
| | - Vignesh Subbian
- Department of Biomedical Engineering and Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, USA
| | - Andrew Romero
- Department of Pharmacy, Banner University Medical Center, Tucson, AZ, USA
| | - Daniel C Malone
- College of Pharmacy, L.S. Skaggs Research Institute, University of Utah, Salt Lake City, UT, USA
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12
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Senderovich H, Vinoraj D, Stever M, Waicus S. Efficacy of COVID-19 treatments among geriatric patients: a systematic review. Ther Adv Infect Dis 2022; 9:20499361221095666. [PMID: 35677110 PMCID: PMC9168946 DOI: 10.1177/20499361221095666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/29/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: A majority of the fatalities due to COVID-19 have been observed in those over
the age of 60. There is no approved and universally accepted treatment for
geriatric patients. The aim of this review is to assess the current
literature on efficacy of COVID-19 treatments in geriatric populations. Methods: A systematic review search was conducted in PubMed, MedRxiv, and JAMA
databases with the keywords COVID-19, geriatric, hydroxychloroquine,
dexamethasone, budesonide, remdesivir, favipiravir, ritonavir, molnupiravir,
tocilizumab, bamlanivimab, baricitinib, sotrovimab, fluvoxamine,
convalescent plasma, prone position, or anticoagulation. Articles published
from January 2019 to January 2022 with a population greater than or equal to
60 years of age were included. Interventions examined included
hydroxychloroquine, remdesivir, favipiravir, dexamethasone, budesonide,
tocilizumab, bamlanivimab, baricitinib, sotrovimab, convalescent plasma,
prone position, and anticoagulation therapy. Outcome measures included viral
load, viral markers, ventilator-free days, or clinical improvement. Results: The search revealed 302 articles, 52 met inclusion criteria.
Hydroxychloroquine, dexamethasone, and remdesivir revealed greater side
effects or inefficiency in geriatric patients with COVID-19. Favipiravir,
bamlanivimab, baricitinib, and supportive therapy showed a decrease in viral
load and improvement of clinical symptoms. There is conflicting evidence
with tocilizumab, convalescent plasma, and anticoagulant therapy in reducing
mortality, ventilator-free days, and clinical improvements. In addition,
there was limited evidence and lack of data due to ongoing trials for
treatments with sotrovimab and budesonide. Conclusion: No agent is known to be effective for preventing COVID-19 after exposure to
the virus. Further research is needed to ensure safety and efficacy of each
of the reviewed interventions for older adults.
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Affiliation(s)
- Helen Senderovich
- Baycrest, 3560 Bathurst Street, Toronto, ON M6A 2E1, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, University of Toronto, Toronto, ON, Canada
| | - Danusha Vinoraj
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Sarah Waicus
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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13
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Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review. Pharmaceuticals (Basel) 2022; 15:ph15050634. [PMID: 35631460 PMCID: PMC9144263 DOI: 10.3390/ph15050634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 01/09/2023] Open
Abstract
Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.
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14
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Amuzie CI, Kalu KU, Izuka M, Nwamoh UN, Emma-Ukaegbu U, Odini F, Metu K, Ozurumba C, Okedo-Alex IN. Prevalence, pattern and predictors of self-medication for COVID-19 among residents in Umuahia, Abia State, Southeast Nigeria: policy and public health implications. J Pharm Policy Pract 2022; 15:34. [PMID: 35501929 PMCID: PMC9058746 DOI: 10.1186/s40545-022-00429-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 has led to restrictions on movements and lockdown measures, which have resulted to higher utilization of over-the-counter drugs compared to prescription-only drugs. This study determined the prevalence, pattern and predictors of self-medication for COVID-19 prevention and treatment. METHODS A cross-sectional survey was conducted between October and November 2021 among the residents of Umuahia, Abia State. The respondents were selected using a snowball sampling technique, and a self-administered semi-structured questionnaire was used to collect data on the variables via Google forms. Descriptive, bivariate and multivariate analyses were done using IBM SPSS version 26. The level of significance was set at 5%. RESULTS A total of 469 respondents participated in the survey. The overall prevalence of self-medication for COVID-19 prevention and treatment was 30.3% (95%CI: 26.7-34.1). The most commonly used medication was herbal products (43.7%). This was mainly self-prepared (41.5%). The major source of information for self-medication was from family members (39.4%). The majority of the respondents reported fear of isolation (76.3%), followed by fear of stigmatization (75.7%) as the triggers of self-medication. Older age (aOR = 1.87, 95% CI: 1.11-3.13), lower educational status [No formal education (aOR = 3.78, 95% CI: 1.28-11.19)], [Primary education (aOR = 2.15, 95% CI: 1.17-3.097)] and perception to cost (aOR = 2.29; 95CI: I.24-4.24) were the predictors of self-medication. CONCLUSION Every one in three residents of Umuahia, Abia State, practiced self-medication for COVID-19 prevention and treatment. Some economic and socio-demographic factors were significantly associated with self-medication. We recommend intensifying public awareness campaigns on the risk of self-medication.
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Affiliation(s)
- Chidinma Ihuoma Amuzie
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria.
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
| | - Kalu Ulu Kalu
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria
| | - Michael Izuka
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria
| | - Uche Ngozi Nwamoh
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria
| | - Uloaku Emma-Ukaegbu
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Franklin Odini
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria
| | - Kingsley Metu
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria
| | - Chigozie Ozurumba
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
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15
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Alkodaymi MS, Omrani OA, Fawzy NA, Shaar BA, Almamlouk R, Riaz M, Obeidat M, Obeidat Y, Gerberi D, Taha RM, Kashour Z, Kashour T, Berbari EF, Alkattan K, Tleyjeh IM. Prevalence of post-acute COVID-19 syndrome symptoms at different follow-up periods: a systematic review and meta-analysis. Clin Microbiol Infect 2022; 28:657-666. [PMID: 35124265 PMCID: PMC8812092 DOI: 10.1016/j.cmi.2022.01.014] [Citation(s) in RCA: 224] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Post-acute coronavirus 2019 (COVID-19) syndrome is now recognized as a complex systemic disease that is associated with substantial morbidity. OBJECTIVES To estimate the prevalence of persistent symptoms and signs at least 12 weeks after acute COVID-19 at different follow-up periods. DATA SOURCES Searches were conducted up to October 2021 in Ovid Embase, Ovid Medline, and PubMed. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Articles in English that reported the prevalence of persistent symptoms among individuals with confirmed severe acute respiratory syndrome coronavirus 2 infection and included at least 50 patients with a follow-up of at least 12 weeks after acute illness. METHODS Random-effect meta-analysis was performed to produce a pooled prevalence for each symptom at four different follow-up time intervals. Between-study heterogeneity was evaluated using the I2 statistic and was explored via meta-regression, considering several a priori study-level variables. Risk of bias was assessed using the Joanna Briggs Institute tool and the Newcastle-Ottawa Scale for prevalence studies and comparative studies, respectively. RESULTS After screening 3209 studies, a total of 63 studies were eligible, with a total COVID-19 population of 257 348. The most commonly reported symptoms were fatigue, dyspnea, sleep disorder, and difficulty concentrating (32%, 25%, 24%, and 22%, respectively, at 3- to <6-month follow-up); effort intolerance, fatigue, sleep disorder, and dyspnea (45%, 36%, 29%, and 25%, respectively, at 6- to <9-month follow-up); fatigue (37%) and dyspnea (21%) at 9 to <12 months; and fatigue, dyspnea, sleep disorder, and myalgia (41%, 31%, 30%, and 22%, respectively, at >12-month follow-up). There was substantial between-study heterogeneity for all reported symptom prevalences. Meta-regressions identified statistically significant effect modifiers: world region, male sex, diabetes mellitus, disease severity, and overall study quality score. Five of six studies including a comparator group consisting of COVID-19-negative cases observed significant adjusted associations between COVID-19 and several long-term symptoms. CONCLUSIONS This systematic review found that a large proportion of patients experience post-acute COVID-19 syndrome 3 to 12 months after recovery from the acute phase of COVID-19. However, available studies of post-acute COVID-19 syndrome are highly heterogeneous. Future studies need to have appropriate comparator groups, standardized symptom definitions and measurements, and longer follow-up.
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Affiliation(s)
| | - Osama Ali Omrani
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom,Barts and the London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - Nader A. Fawzy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Muhammad Riaz
- Center for Trial Research, School of Medicine, Cardiff University, United Kingdom
| | - Mustafa Obeidat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Yasin Obeidat
- UMass Chan Medical School–Baystate, Springfield, MA, USA
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - Rand M. Taha
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zakaria Kashour
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Elie F. Berbari
- Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Imad M. Tleyjeh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia,Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA,Department of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA,Corresponding author. Imad M. Tleyjeh, Section of Infectious Diseases, King Fahd Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia
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16
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Panahi Y, Dadkhah M, Talei S, Gharari Z, Asghariazar V, Abdolmaleki A, Matin S, Molaei S. Can anti-parasitic drugs help control COVID-19? Future Virol 2022. [PMID: 35359702 PMCID: PMC8940209 DOI: 10.2217/fvl-2021-0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/28/2022] [Indexed: 01/18/2023]
Abstract
Novel COVID-19 is a public health emergency that poses a serious threat to people worldwide. Given the virus spreading so quickly, novel antiviral medications are desperately needed. Repurposing existing drugs is the first strategy. Anti-parasitic drugs were among the first to be considered as a potential treatment option for this disease. Even though many papers have discussed the efficacy of various anti-parasitic drugs in treating COVID-19 separately, so far, no single study comprehensively discussed these drugs. This study reviews some anti-parasitic recommended drugs to treat COVID-19, in terms of function and in vitro as well as clinical results. Finally, we briefly review the advanced techniques, such as artificial intelligence, that have been used to find effective drugs for the treatment of COVID-19.
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Affiliation(s)
- Yasin Panahi
- Department of Pharmacology & Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Masoomeh Dadkhah
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sahand Talei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Gharari
- Department of Biotechnology, Faculty of Biological Sciences, Al-Zahra University, Tehran, Iran
| | - Vahid Asghariazar
- Deputy of Research & Technology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Arash Abdolmaleki
- Department of Engineering Sciences, Faculty of Advanced Technologies, University of Mohaghegh Ardabili, Namin, Iran.,Bio Science & Biotechnology Research center (BBRC), Sabalan University of Advanced Technologies (SUAT), Namin, Iran
| | - Somayeh Matin
- Department of Internal Medicine, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Soheila Molaei
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.,Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
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Roberti A, Chaffey LE, Greaves DR. NF-κB Signaling and Inflammation-Drug Repurposing to Treat Inflammatory Disorders? BIOLOGY 2022; 11:biology11030372. [PMID: 35336746 PMCID: PMC8945680 DOI: 10.3390/biology11030372] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 12/15/2022]
Abstract
Simple Summary Since its first description 35 years ago, the transcription factor NF-κB (nuclear factor κ-light-chain-enhancer of activated B cells) has been shown to be a key mediator of immune cell responses to inflammatory mediators, oxidative stress and genotoxic injury. Dysregulated NF-κB signalling drives inflammation in inflammatory disorders such as multiple sclerosis, rheumatoid arthritis or inflammatory bowel disease. Thus, re-establishing the appropriate regulation of NF-κB activity seems like a promising approach to treat inflammatory diseases. Current anti-inflammatory drugs have many, often serious, side effects. Thus, there is an unmet clinical need for safe and effective anti-inflammatory medicines that both decrease inflammatory mediator production and enhance endogenous anti-inflammatory and prorepair pathways. So far, traditional de novo drug discovery has fallen short of satisfying this need. Drug repurposing is a cost- and time-effective alternative to de novo drug development for the identification of novel applications and has already resulted in the identification of effective anti-inflammatories in the ongoing COVID-19 pandemic. In this paper we critically review NF-κB as a potential target for the development of anti-inflammatory drugs with an emphasis on drug repurposing as a strategy to identify new approaches to treat inflammatory diseases. Abstract NF-κB is a central mediator of inflammation, response to DNA damage and oxidative stress. As a result of its central role in so many important cellular processes, NF-κB dysregulation has been implicated in the pathology of important human diseases. NF-κB activation causes inappropriate inflammatory responses in diseases including rheumatoid arthritis (RA) and multiple sclerosis (MS). Thus, modulation of NF-κB signaling is being widely investigated as an approach to treat chronic inflammatory diseases, autoimmunity and cancer. The emergence of COVID-19 in late 2019, the subsequent pandemic and the huge clinical burden of patients with life-threatening SARS-CoV-2 pneumonia led to a massive scramble to repurpose existing medicines to treat lung inflammation in a wide range of healthcare systems. These efforts continue and have proven to be controversial. Drug repurposing strategies are a promising alternative to de novo drug development, as they minimize drug development timelines and reduce the risk of failure due to unexpected side effects. Different experimental approaches have been applied to identify existing medicines which inhibit NF-κB that could be repurposed as anti-inflammatory drugs.
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18
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Tan Z, Huang S, Mei K, Liu M, Ma J, Jiang Y, Zhu W, Yu P, Liu X. The Prevalence and Associated Death of Ventricular Arrhythmia and Sudden Cardiac Death in Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:795750. [PMID: 35127861 PMCID: PMC8814312 DOI: 10.3389/fcvm.2021.795750] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/07/2021] [Indexed: 12/31/2022] Open
Abstract
Background Arrhythmia is a very common complication of coronavirus disease 2019 (COVID-19); however, the prevalence of ventricular arrhythmia and associated outcomes are not well-explored. Here, we conducted a systematic review and meta-analysis to determine the prevalence and associated death of ventricular arrhythmia and sudden cardiac death (SCD) in patients with COVID-19. Methods Databases of PubMed, Cochrane Library, Embase, and MdeRxiv were searched. Studies that could calculate the prevalence of ventricular arrhythmia/SCD during hospital admission or associated death in patients with COVID-19 were included. The study was registered with the PROSPERO (CRD42021271328). Results A total of 21 studies with 13,790 patients were included. The pooled prevalence of ventricular arrhythmia was 5% (95% CI: 4–6%), with a relatively high-SCD prevalence (1.8% in hospitalized COVID-19 and 10% in deceased cases of COVID-19). Subgroup analysis showed that ventricular arrhythmia was more common in patients with elevated cardiac troponin T [ES (effect size): 10%, 95% CI: −0.2 to 22%] and in European (ES: 20%, 95% CI: 11–29%) populations. Besides, ventricular arrhythmia was independently associated with an increased risk of death in patients with COVID-19 [odds ratio (OR) = 2.83; 95% CI: 1.78–4.51]. Conclusion Ventricular arrhythmia and SCD resulted as a common occurrence with a high prevalence in patients with COVID-19 admitted to the hospital. Furthermore, ventricular arrhythmia significantly contributed to an increased risk of death in hospitalized patients with COVID-19. Clinicians might be vigilant of ventricular arrhythmias for patients with COVID-19, especially for severe cases. Systematic Review Registration www.york.ac.uk/inst/crd, identifier: CRD42021271328.
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Affiliation(s)
- Ziqi Tan
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shan Huang
- Department of Psychiatry, The Third People's Hospital of Ganzhou, Ganzhou, China
| | - Kaibo Mei
- Department of Anesthesiology, The People's Hospital of Shangrao, Shangrao, China
| | - Menglu Liu
- Department of Cardiology, The Seventh People's Hospital of Zhengzhou, Zhengzhou, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Yuan Jiang
- Department of Pharmacy, Harbin Medical University, Harbin, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peng Yu
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Peng Yu
| | - Xiao Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Xiao Liu
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19
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Rúa-Figueroa I, Rúa-Figueroa D, Pérez-Veiga N, Anzola AM, Galindo-Izquierdo M, Calvo-Alén J, Fernández-Nebro A, Sangüesa C, Menor-Almagro R, Tomero E, Del Val N, Uriarte-Isazelaya E, Blanco R, Andreu JL, Boteanu A, Narváez J, Cobo T, Bohórquez C, Montilla C, Salas E, Toyos FJ, Bernal JA, Salgado E, Freire M, Mas AJ, Expósito L, Hernández-Beriain JA, Ibarguengoitia O, Velloso-Feijoo ML, Lozano-Rivas N, Bonilla G, Moreno M, Jiménez I, Quevedo-Vila V, Pecondón A, Aurrecoechea E, Valls E, Mouriño C, Vázquez-Rodríguez T, Pego-Reigosa JM. Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure. Semin Arthritis Rheum 2022; 52:151946. [PMID: 35033377 PMCID: PMC8720299 DOI: 10.1016/j.semarthrit.2021.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. METHODS Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. RESULTS The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01-15.48], p < 0.0001), cardiac arrhythmia (7.38 [4.00-13.42], p < 0.0001), pulmonary hypertension (3.71 [1.84-7.25], p < 0.0002), valvulopathy (6.33 [3.41-11.62], p < 0.0001), non-cardiovascular damage (1.29 [1.16-1.44], p < 0.000) and calcium/vitamin D treatment (5.29 [2.07-16.86], p = 0.0015). Female sex (0.46 [0.25-0.88], p = 0.0147) and antimalarials (0.28 [0.17-0.45], p < 0.000) proved to be protective factors. CONCLUSIONS Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect.
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Affiliation(s)
| | - David Rúa-Figueroa
- Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas GC, Spain.
| | | | - Ana M Anzola
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José L Andreu
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | | | - Cristina Bohórquez
- Hospital Universitario Príncipe de Asturias (Alcalá de Henares), Madrid, Spain.
| | | | - Esteban Salas
- Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
| | | | - José A Bernal
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Eva Salgado
- Complejo Hospitalario De Orense, Orense, Spain.
| | | | | | - Lorena Expósito
- Hospital Universitario de Canarias, La Laguna (Tenerife), Spain
| | | | | | | | | | | | | | | | | | | | | | - Elia Valls
- Hospital Universitario Doctor Peset, Valencia, Spain
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Desmarais J, Rosenbaum JT, Costenbader KH, Ginzler EM, Fett N, Goodman S, O'Dell J, Pineau CA, Schmajuk G, Werth VP, Link MS, Kovacs R. American College of Rheumatology White Paper on Antimalarial Cardiac Toxicity. Arthritis Rheumatol 2021; 73:2151-2160. [PMID: 34697918 DOI: 10.1002/art.41934] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022]
Abstract
Hydroxychloroquine (HCQ) and chloroquine (CQ) are well-established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)-prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID-19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus-based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long-term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk-benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases.
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Affiliation(s)
| | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
| | | | - Ellen M Ginzler
- State University of New York Downstate Health Sciences University, Brooklyn
| | - Nicole Fett
- Oregon Health & Science University, Portland
| | - Susan Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - James O'Dell
- University of Nebraska Medical Center and Omaha VA Hospital, Omaha, Nebraska
| | | | - Gabriela Schmajuk
- University of California San Francisco, San Francisco VA Medical Center, and Philip R. Lee Institute for Health Policy, San Francisco, California
| | - Victoria P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas
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21
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Thomet U, Amuzescu B, Knott T, Mann SA, Mubagwa K, Radu BM. Assessment of proarrhythmogenic risk for chloroquine and hydroxychloroquine using the CiPA concept. Eur J Pharmacol 2021; 913:174632. [PMID: 34785211 PMCID: PMC8590616 DOI: 10.1016/j.ejphar.2021.174632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022]
Abstract
Chloroquine and hydroxychloroquine have been proposed recently as therapy for SARS-CoV-2-infected patients, but during 3 months of extensive use concerns were raised related to their clinical effectiveness and arrhythmogenic risk. Therefore, we estimated for these compounds several proarrhythmogenic risk predictors according to the Comprehensive in vitro Proarrhythmia Assay (CiPA) paradigm. Experiments were performed with either CytoPatch™2 automated or manual patch-clamp setups on HEK293T cells stably or transiently transfected with hERG1, hNav1.5, hKir2.1, hKv7.1+hMinK, and on Pluricyte® cardiomyocytes (Ncardia), using physiological solutions. Dose-response plots of hERG1 inhibition fitted with Hill functions yielded IC50 values in the low micromolar range for both compounds. We found hyperpolarizing shifts of tens of mV, larger for chloroquine, in the voltage-dependent activation but not inactivation, as well as a voltage-dependent block of hERG current, larger at positive potentials. We also found inhibitory effects on peak and late INa and on IK1, with IC50 of tens of μM and larger for chloroquine. The two compounds, tested on Pluricyte® cardiomyocytes using the β-escin-perforated method, inhibited IKr, ICaL, INa peak, but had no effect on If. In current-clamp they caused action potential prolongation. Our data and those from literature for Ito were used to compute proarrhythmogenic risk predictors Bnet (Mistry HB, 2018) and Qnet (Dutta S et al., 2017), with hERG1 blocking/unblocking rates estimated from time constants of fractional block. Although the two antimalarials are successfully used in autoimmune diseases, and chloroquine may be effective in atrial fibrillation, assays place these drugs in the intermediate proarrhythmogenic risk group.
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Affiliation(s)
- Urs Thomet
- Anaxon A.G., Brünnenstrasse 90, 3018, Bern, Switzerland
| | - Bogdan Amuzescu
- Dept. Anatomy, Animal Physiology & Biophysics, Faculty of Biology, University of Bucharest, Splaiul Independentei 91-95, 050095, Bucharest, Romania.
| | - Thomas Knott
- CytoBioScience Inc., 3463 Magic Drive, San Antonio, TX, 78229, USA
| | - Stefan A Mann
- Cytocentrics Bioscience GmbH, Nattermannallee 1, 50829, Cologne, Germany
| | - Kanigula Mubagwa
- Dept. Cardiovascular Sciences, Faculty of Medicine, K U Leuven, B-3000, Leuven, Belgium; Dept. Basic Sciences, Faculty of Medicine, Université Catholique de Bukavu, Bukavu, DR Congo
| | - Beatrice Mihaela Radu
- Dept. Anatomy, Animal Physiology & Biophysics, Faculty of Biology, University of Bucharest, Splaiul Independentei 91-95, 050095, Bucharest, Romania
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22
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Gumilang RA, Siswanto, Anggraeni VY, Trisnawati I, Budiono E, Hartopo AB. QT interval and repolarization dispersion changes during the administration of hydroxychloroquine/chloroquine with/without azithromycin in early COVID 19 pandemic: A prospective observational study from two academic hospitals in Indonesia. J Arrhythm 2021; 37:1184-1195. [PMID: 34621417 PMCID: PMC8485784 DOI: 10.1002/joa3.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hydroxychloroquine/chloroquine (HCQ/CQ) treatment for COVID-19 was associated with QT interval prolongation and arrhythmia risks. This study aimed to investigate QTc interval and ventricular repolarization dispersion changes, as markers of arrhythmia risks, after HCQ/CQ administration with/without azithromycin (AZT) during COVID-19 pandemic. METHODS A prospective observational study was performed in two academic hospitals in Indonesia. Adult patients who received HCQ/CQ alone and HCQ/CQ + AZT concomitant treatments for COVID-19 infection were enrolled. Baseline and post HCQ/CQ treatment electrocardiograms were obtained. Baseline and post HCQ/CQ treatment QT interval by Bazett (B-QTc) and Fridericia (F-QTc) formulas and ventricular repolarization dispersion indices by Tpeak-Tend (Tp-e) interval and Tpeak-Tend/QT (Tp-e/QT) ratio were calculated and analyzed. RESULTS The study enrolled 55 (HCQ/CQ alone) and 77 subjects (HCQ/CQ + AZT concomitant). F-QTc interval significantly lengthened in subjects with HCQ/CQ + AZT (mean difference 11.89 ms [P = .028]). The incidences of severe B-QTc and F-QTc lengthening were 13.1% and 12.3%, B-QTc and F-QTc prolongation were 25.4% and 12.3%, and severe B-QTc and F-QTc prolongation were 6.2% and 3.2%. Tp-e interval lengthened significantly from baseline to posttreatment in HCQ/CQ alone and HCQ/CQ + AZT (mean difference 10.83 ms [P = .006] and 18.73 ms [P < .001], respectively). Tp-e/QT ratio increased significantly from baseline to posttreatment in HCQ/CQ + AZT concomitant (mean difference 0.035 [P < .001]). No fatal arrhytmia occurred. CONCLUSIONS During COVID-19 pandemic, HCQ/CQ + AZT concomitant treatment caused significant F-QTc lengthening, significantly increased Tp-e interval and increased Tp-e/QT ratio. HCQ/CQ alone only caused significant increase of Tp-e interval. Incidences of severe QTc lengthening and prolongation were low in both HCQ/CQ alone and HCQ/CQ + AZT concomitant.
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Affiliation(s)
- Rizki A Gumilang
- Department of Cardiology and Vascular Medicine Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Universitas Gadjah Mada Academic Hospital Yogyakarta Indonesia
| | - Siswanto
- Department of Physiology Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Universitas Gadjah Mada Academic Hospital Yogyakarta Indonesia
| | - Vita Y Anggraeni
- Division of Cardiology Department of Internal Medicine Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Dr. Sardjito Hospital Yogyakarta Indonesia
| | - Ika Trisnawati
- Division of Pulmonology Department of Internal Medicine Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Dr. Sardjito Hospital Yogyakarta Indonesia
| | - Eko Budiono
- Division of Pulmonology Department of Internal Medicine Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Dr. Sardjito Hospital Yogyakarta Indonesia
| | - Anggoro B Hartopo
- Division of Cardiology Department of Internal Medicine Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Dr. Sardjito Hospital Yogyakarta Indonesia
- Department of Cardiology and Vascular Medicine Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Dr. Sardjito Hospital Yogyakarta Indonesia
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23
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Risk versus Benefit of Using Hydroxychloroquine to Treat Patients with COVID-19. ACTA ACUST UNITED AC 2021; 2021:5942366. [PMID: 34557260 PMCID: PMC8455223 DOI: 10.1155/2021/5942366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 12/27/2022]
Abstract
Hydroxychloroquine (HCQ), also known by its trade name Plaquenil®, has been used for over 50 years as a treatment for malaria, systemic lupus erythematosus, and rheumatoid arthritis. As the COVID-19 pandemic emerged in the United States and globally in early 2020, HCQ began to garner attention as a potential treatment and as prophylaxis against COVID-19. Preliminary data indicated that HCQ as well as chloroquine (CQ) possessed in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early clinical data from China and France reported that HCQ and CQ were associated with viral load reduction and clinical improvement in patients with COVID-19 compared to control groups; however, an overwhelming number of randomized controlled trials, meta-analyses, and systematic reviews have since concluded that HCQ used alone, or in combination with azithromycin (AZ), provides no mortality or time-to-recovery benefit in hospitalized patients with COVID-19. Additionally, these same trials reported adverse events including cardiac, neuropsychiatric, hematologic, and hepatobiliary manifestations in patients with COVID-19 whom had been treated with HCQ. This review article summarizes the available data pertaining to the adverse events associated with HCQ use, alone or in combination with azithromycin, in patients with COVID-19 in order to fully assess the risk versus benefit of treating COVID-19 patients with these agents. The results of this review lead us to conclude that the risks of adverse events associated with HCQ use (with or without AZ) outweigh the potential clinical benefits and thus recommend against its use in the treatment or prevention of COVID-19.
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24
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Iturricastillo G, Ávalos Pérez-Urría E, Couñago F, Landete P. Scientific evidence in the COVID-19 treatment: A comprehensive review. World J Virol 2021; 10:217-228. [PMID: 34631473 PMCID: PMC8474978 DOI: 10.5501/wjv.v10.i5.217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/12/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
In December 2019, cases of unknown origin pneumonia appeared in Wuhan, China; the causal agent of this pneumonia was a new virus of the coronaviridae family called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). According to the clinical severity, symptoms and response to the different treatments, the evolution of the disease is divided in three phases. We analysed the most used treatments for coronavirus disease 2019 and the phase in which they are supposed to be effective. In the viral phase, remdesivir has demonstrated reduction in recovery time but no mortality reduction. Other drugs proposed for viral phase such as convalescent plasma and lopinavir/ritonavir did not demonstrate to be effective. In the inflammatory phase, corticosteroids demonstrated reduction of 28-d mortality in patients who needed oxygen, establishing that a corticosteroid regimen should be part of the standard treatment of critically ill patients. There are other immunosuppressive and immunomodulatory treatments such as anakinra, sarilumab, tocilizumab, colchicine or baricitinib that are being studied. Other treatments that were proposed at the beginning, like hydroxichloroquine or azithromycin, demonstrated no efficacy and increased mortality when combined.
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Affiliation(s)
- Gorane Iturricastillo
- Department of Pulmonology, Hospital Universitario de La Princesa, Madrid 28006, Spain
| | | | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Department of Radiation Oncology Universidad Europea de Madrid, Madrid 28670, Spain
| | - Pedro Landete
- Department of Pulmonology, Hospital Universitario de La Princesa, Madrid 28006, Spain
- Department of Pulmonology, Universidad Autónoma de Madrid, Madrid 28049, Spain
- Department of Pulmonology, Instituto Investigación Princesa, Madrid 28006, Spain
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25
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Italia L, Tomasoni D, Bisegna S, Pancaldi E, Stretti L, Adamo M, Metra M. COVID-19 and Heart Failure: From Epidemiology During the Pandemic to Myocardial Injury, Myocarditis, and Heart Failure Sequelae. Front Cardiovasc Med 2021; 8:713560. [PMID: 34447795 PMCID: PMC8382715 DOI: 10.3389/fcvm.2021.713560] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
A close and intriguing relationship has been suggested between heart failure (HF) and coronavirus disease 2019 (COVID-19). First, COVID-19 pandemic represented a global public health emergency in the last year and had a catastrophic impact on health systems worldwide. Several studies showed a reduction in HF hospitalizations, ranging from 30 to 66% in different countries and leading to a subsequent increase in HF mortality. Second, pre-existing HF is a risk factor for a more severe clinical course of COVID-19 and an independent predictor of in-hospital mortality. Third, patients hospitalized for COVID-19 may develop both an acute decompensation of chronic HF and de-novo HF as a consequence of myocardial injury and cardiovascular (CV) complications. Myocardial injury occurred in at least 10% of unselected COVID-19 cases and up to 41% in critically ill patients or in those with concomitant CV comorbidities. Few cases of COVID-19-related acute myocarditis, presenting with severe reduction in the left ventricular (LV) ejection fraction and peculiar histopathological findings, were described. However, recent data suggested that COVID-19 may be associated with both systolic and diastolic LV dysfunction, with LV diastolic impairment, pulmonary hypertension, and right ventricular dysfunction representing the most frequent findings in echocardiographic studies. An overview of available data and the potential mechanisms behind myocardial injury, possibly leading to HF, will be presented in this review. Beyond the acute phase, HF as a possible long-term consequence of cardiac involvement in COVID-19 patients has been supposed and need to be investigated yet.
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Affiliation(s)
- Leonardo Italia
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Bisegna
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Pancaldi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lorenzo Stretti
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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26
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Eveleens Maarse BC, Graff C, Kanters JK, van Esdonk MJ, Kemme MJB, In 't Veld AE, Jansen MAA, Moerland M, Gal P. Effect of hydroxychloroquine on the cardiac ventricular repolarization: A randomized clinical trial. Br J Clin Pharmacol 2021; 88:1054-1062. [PMID: 34327732 PMCID: PMC8444885 DOI: 10.1111/bcp.15013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022] Open
Abstract
Aims Hydroxychloroquine has been suggested as possible treatment for severe acute respiratory syndrome‐coronavirus‐2. Studies reported an increased risk of QTcF‐prolongation after treatment with hydroxychloroquine. The aim of this study was to analyse the concentration‐dependent effects of hydroxychloroquine on the ventricular repolarization, including QTcF‐duration and T‐wave morphology. Methods Twenty young (≤30 y) and 20 elderly (65–75 y) healthy male subjects were included. Subjects were randomized to receive either a total dose of 2400 mg hydroxychloroquine over 5 days, or placebo (ratio 1:1). Follow‐up duration was 28 days. Electrocardiograms (ECGs) were recorded as triplicate at baseline and 4 postdose single recordings, followed by hydroxychloroquine concentration measurements. ECG intervals (RR, QRS, PR, QTcF, J‐Tpc, Tp‐Te) and T‐wave morphology, measured with the morphology combination score, were analysed with a prespecified linear mixed effects concentration–effect model. Results There were no significant associations between hydroxychloroquine concentrations and ECG characteristics, including RR‐, QRS‐ and QTcF‐interval (P = .09, .34, .25). Mean ΔΔQTcF‐interval prolongation did not exceed 5 ms and the upper limit of the 90% confidence interval did not exceed 10 ms at the highest measured concentrations (200 ng/mL). There were no associations between hydroxychloroquine concentration and the T‐wave morphology (P = .34 for morphology combination score). There was no significant effect of age group on ECG characteristics. Conclusion In this study, hydroxychloroquine did not affect ventricular repolarization, including the QTcF‐interval and T‐wave morphology, at plasma concentrations up to 200 ng/mL. Based on this analysis, hydroxychloroquine does not appear to increase the risk of QTcF‐induced arrhythmias.
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Affiliation(s)
- Boukje C Eveleens Maarse
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Aliede E In 't Veld
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
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27
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Çetin Z. Targeting the PANoptosome with miRNA Loaded Mesenchymal Stem Cell Derived Extracellular Vesicles; a New Path to Fight Against the Covid-19? Stem Cell Rev Rep 2021; 17:1074-1077. [PMID: 33851324 PMCID: PMC8043422 DOI: 10.1007/s12015-021-10166-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Zafer Çetin
- School of Medicine, Department of Medical Biology and Genetics, SANKO University, Gaziantep, Turkey. .,Department of Biological and Biomedical Sciences, Graduate Education Institute, SANKO University, Gaziantep, Turkey.
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28
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Klouwer FCC, Falkenberg KD, Ofman R, Koster J, van Gent D, Ferdinandusse S, Wanders RJA, Waterham HR. Autophagy Inhibitors Do Not Restore Peroxisomal Functions in Cells With the Most Common Peroxisome Biogenesis Defect. Front Cell Dev Biol 2021; 9:661298. [PMID: 33869228 PMCID: PMC8047214 DOI: 10.3389/fcell.2021.661298] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/05/2021] [Indexed: 12/16/2022] Open
Abstract
Peroxisome biogenesis disorders within the Zellweger spectrum (PBD-ZSDs) are most frequently associated with the c.2528G>A (p.G843D) mutation in the PEX1 gene (PEX1-G843D), which results in impaired import of peroxisomal matrix proteins and, consequently, defective peroxisomal functions. A recent study suggested that treatment with autophagy inhibitors, in particular hydroxychloroquine, would be a potential therapeutic option for PBD-ZSD patients carrying the PEX1-G843D mutation. Here, we studied whether autophagy inhibition by chloroquine, hydroxychloroquine and 3-methyladenine indeed can improve peroxisomal functions in four different cell types with the PEX1-G843D mutation, including primary patient cells. Furthermore, we studied whether autophagy inhibition may be the mechanism underlying the previously reported improvement of peroxisomal functions by L-arginine in PEX1-G843D cells. In contrast to L-arginine, we observed no improvement but a worsening of peroxisomal metabolic functions and peroxisomal matrix protein import by the autophagy inhibitors, while genetic knock-down of ATG5 and NBR1 in primary patient cells resulted in only a minimal improvement. Our results do not support the use of autophagy inhibitors as potential treatment for PBD-ZSD patients, whereas L-arginine remains a therapeutically promising compound.
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Affiliation(s)
- Femke C. C. Klouwer
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Pediatric Neurology, Emma Children’s Hospital, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kim D. Falkenberg
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rob Ofman
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Janet Koster
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Démi van Gent
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sacha Ferdinandusse
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ronald J. A. Wanders
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hans R. Waterham
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam University Medical Centers – Location AMC, University of Amsterdam, Amsterdam, Netherlands
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29
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Nissen CB, Sciascia S, de Andrade D, Atsumi T, Bruce IN, Cron RQ, Hendricks O, Roccatello D, Stach K, Trunfio M, Vinet É, Schreiber K. The role of antirheumatics in patients with COVID-19. LANCET RHEUMATOLOGY 2021; 3:e447-e459. [PMID: 33817665 PMCID: PMC8009617 DOI: 10.1016/s2665-9913(21)00062-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has resulted in more than 2 million deaths globally. Two interconnected stages of disease are generally recognised; an initial viral stage and a subsequent immune response phase with the clinical characteristics of hyperinflammation associated with acute respiratory distress syndrome. Therefore, many immune modulators and immunosuppressive drugs, which are widely used in rheumatological practice, have been proposed as treatments for patients with moderate or severe COVID-19. In this Review, we provide an overview of what is currently known about the efficacy and safety of antirheumatic therapies for the treatment of patients with COVID-19. Dexamethasone has been shown to reduce COVID-19 related mortality, interleukin-6 inhibitors to reduce risk of cardiovascular or respiratory organ support, and baricitinib to reduce time to recovery in hospitalised patients requiring oxygen support. Further studies are needed to identify whether there is any role for glucocorticoids in patients with less severe COVID-19. Although evidence on the use of other antirheumatic drugs has suggested some benefits, results from adequately powered clinical trials are urgently needed. The heterogeneity in dosing and the absence of uniform inclusion criteria and defined stage of disease studied in many clinical trials have affected the conclusions and comparability of trial results. However, after the success of dexamethasone in proving the anti-inflammatory hypothesis, the next 12 months will undoubtedly bring further clarity about the clinical utility and optimal dose and timing of other anti-rheumatic drugs in the management of COVID-19.
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Affiliation(s)
- Christoffer B Nissen
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Danmark
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Danieli de Andrade
- Department of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Medicine and Health, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - Randy Q Cron
- Division of Rheumatology, Children's of Alabama and Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Danmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Ksenija Stach
- Fifth Department of Medicine and European Center for Angioscience, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mattia Trunfio
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo di Savoia Hospital, Torino, Italy
| | - Évelyne Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Karen Schreiber
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Danmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK
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30
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Tleyjeh IM, Kashour T. Letter About: Risk Factors for Mortality in Patients with COVID-19 in New York City. J Gen Intern Med 2021; 36:811-812. [PMID: 33432434 PMCID: PMC7799422 DOI: 10.1007/s11606-020-06369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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31
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Giudicessi JR. Excess out-of-hospital sudden deaths during the COVID-19 pandemic: A direct or indirect effect of SARS-CoV-2 infections? Heart Rhythm 2021; 18:219-220. [PMID: 33472766 PMCID: PMC7836415 DOI: 10.1016/j.hrthm.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022]
Affiliation(s)
- John R Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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32
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Kashour Z, Riaz M, Garbati MA, AlDosary O, Tlayjeh H, Gerberi D, Murad MH, Sohail MR, Kashour T, Tleyjeh IM. Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis. J Antimicrob Chemother 2021; 76:30-42. [PMID: 33031488 PMCID: PMC7665543 DOI: 10.1093/jac/dkaa403] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Clinical studies of chloroquine (CQ) and hydroxychloroquine (HCQ) in COVID-19 disease reported conflicting results. We sought to systematically evaluate the effect of CQ and HCQ with or without azithromycin on outcomes of COVID-19 patients. METHODS We searched multiple databases, preprints and grey literature up to 17 July 2020. We pooled only adjusted-effect estimates of mortality using a random-effect model. We summarized the effect of CQ or HCQ on viral clearance, ICU admission/mechanical ventilation and hospitalization. RESULTS Seven randomized clinical trials (RCTs) and 14 cohort studies were included (20 979 patients). Thirteen studies (1 RCT and 12 cohort studies) with 15 938 hospitalized patients examined the effect of HCQ on short-term mortality. The pooled adjusted OR was 1.05 (95% CI 0.96-1.15, I2 = 0%). Six cohort studies examined the effect of the HCQ+azithromycin combination with a pooled adjusted OR of 1.32 (95% CI 1.00-1.75, I2 = 68.1%). Two cohort studies and four RCTs found no effect of HCQ on viral clearance. One small RCT demonstrated improved viral clearance with CQ and HCQ. Three cohort studies found that HCQ had no significant effect on mechanical ventilation/ICU admission. Two RCTs found no effect for HCQ on hospitalization risk in outpatients with COVID-19. CONCLUSIONS Moderate certainty evidence suggests that HCQ, with or without azithromycin, lacks efficacy in reducing short-term mortality in patients hospitalized with COVID-19 or risk of hospitalization in outpatients with COVID-19.
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Affiliation(s)
- Zakariya Kashour
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Muhammad Riaz
- Department of Statistics, Quaid-i-Azam University Islamabad, Islamabad, Pakistan
| | - Musa A Garbati
- Infectious Diseases Unit, Department of Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Oweida AlDosary
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Haytham Tlayjeh
- Department of Intensive Care, King Abdulaziz Medical City, King Saud bin Abdulaziz for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - M Hassan Murad
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Preventive, Occupational and Aerospace Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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33
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Schreiber K, Sciascia S, Bruce IN, Giles I, Cuadrado MJ, Cohen H, Gordon C, Isenberg D, Jacobsen S, Middeldorp S, Mosca M, Pavord S, Radin M, Roccatello D, Salmon J, Vinet E, Voss A, Watkins L, Hunt BJ. Hydroxychloroquine in patients with rheumatic diseases during the COVID-19 pandemic: a letter to clinicians. THE LANCET. RHEUMATOLOGY 2020; 2:e735-e736. [PMID: 33163976 PMCID: PMC7598898 DOI: 10.1016/s2665-9913(20)30382-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Karen Schreiber
- Danish Hospital for Rheumatic Diseases, 6200 Sonderborg, Denmark
- Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy
- Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Italy
- School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - Ian Giles
- Centre for Rheumatology Research, UCL Division of Medicine, University College London, London, UK
- Women's Health, University College London Hospital, London, UK
| | - Maria J Cuadrado
- Rheumatology Department, Clinica Universidad de Navarra, Madrid, Spain
| | - Hannah Cohen
- Department of Haematology, Haemostasis Research Unit, University College London, London, UK
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - Saskia Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sue Pavord
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Massimo Radin
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy
- Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Italy
- School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy
- Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Italy
- School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Jane Salmon
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Evélyne Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Anne Voss
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Linda Watkins
- Liverpool Women's Hospital, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Beverley J Hunt
- Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK
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34
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Kashour T, Tleyjeh IM. It is time to drop hydroxychloroquine from our COVID-19 armamentarium. Med Hypotheses 2020; 144:110198. [PMID: 33254507 PMCID: PMC7430273 DOI: 10.1016/j.mehy.2020.110198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/14/2020] [Indexed: 12/27/2022]
Abstract
Chloroquine (CQ) and hydroxychloroquine (HCQ) were among the first drugs repurposed for the treatment of SARS-CoV-2 infection. A few in vitro studies confirmed that both drugs exhibited dose dependent anti-SARS-CoV-2 activities. These observations and the encouraging results from early poorly conducted observational studies created a major hype about the therapeutic potential of these drugs in the treatment of COVID-19 disease. This was further catalyzed by media and political influences leading to a widespread use of these agents. Subsequent randomized trials revealed lack of efficacy of these agents in improving the outcomes of COVID-19 or in preventing infection in post-exposure prophylaxis studies. Nevertheless, many ongoing trials continue to actively recruit tens of thousands of patients to receive HCQ worldwide. In this perspective, we address the possible mechanisms behind the lack of efficacy and the increased risk of cardiac toxicity of HCQ in COVID-19 disease. For the lack of efficacy, we discuss the fundamental differences of treatment initiation between in vitro and in vivo studies, the pitfalls of the pharmacological calculations of effective blood drug concentrations and related dosing regimens, and the possible negative effect of HCQ on the antiviral type-I interferon response. Although it has been repeatedly claimed that HCQ has a longstanding safety track record for many decades in use, we present counterarguments for this contention due to disease-drug and drug-drug interactions. We discuss the molecular mechanisms and the cumulative epidemiological evidence of HCQ cardiac toxicity.
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Affiliation(s)
- Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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35
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Oscanoa TJ, Vidal X, Kanters JK, Romero-Ortuno R. Frequency of Long QT in Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine: A Meta-analysis. Int J Antimicrob Agents 2020; 56:106212. [PMID: 33164789 PMCID: PMC7584880 DOI: 10.1016/j.ijantimicag.2020.106212] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/28/2020] [Accepted: 10/17/2020] [Indexed: 02/07/2023]
Abstract
Introduction Hydroxychloroquine (HCQ) has been proposed as a SARS-CoV-2 treatment but the frequency of long QT (LQT) during use is unknown. Objective To conduct a meta-analysis of the frequency of LQT in patients with SARS-CoV-2 infection treated with HCQ. Data Sources PubMed, EMBASE, Google Scholar, the Cochrane Database of Systematic Reviews and preprint servers (medRxiv, Research Square) were searched for studies published between December 2019 and June 30, 2020. Methods Effect statistics were pooled using random effects. The quality of observational studies and randomized controlled trials was appraised with STROBE and the Cochrane Risk of Bias Assessment tools, respectively. Outcomes Critical LQT was defined as: (1) maximum QT corrected (QTc)≥500 ms (if QRS<120 ms) or QTc≥550 ms (if QRS≥120 ms), and (2) QTc increase ≥60 ms. Results In the 28 studies included (n=9124), the frequency of LQT during HCQ treatment was 6.7% (95% confidence interval [CI]: 3.7-10.2). In 20 studies (n=7825), patients were also taking other QT-prolonging drugs. The frequency of LQT in the other 8 studies (n=1299) was 1.7% (95% CI: 0.3-3.9). Twenty studies (n=6869) reported HCQ discontinuation due to LQT, with a frequency of 3.7% (95% CI: 1.5-6.6). The frequency of ventricular arrhythmias during HCQ treatment was 1.68% (127/7539) and that of arrhythmogenic death was 0.69% (39/5648). Torsades de Pointes occurred in 0.06% (3/5066). Patients aged >60 years were at highest risk of HCQ-associated LQT (P<0.001). Conclusions HCQ-associated cardiotoxicity in SARS-CoV-2 patients is uncommon but requires ECG monitoring, particularly in those aged >60 years and/or taking other QT-prolonging drugs.
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Affiliation(s)
- Teodoro J Oscanoa
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Drug Safety Research Center, Facultad de Medicina Humana, Universidad de San Martín de Porres. Hospital Almenara, ESSALUD, Lima, Perú.
| | - Xavier Vidal
- Clinical Pharmacology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland
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