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Pradelle A, Mainbourg S, Provencher S, Massy E, Grenet G, Lega JC. Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate. Biomed Pharmacother 2024; 171:116055. [PMID: 38171239 DOI: 10.1016/j.biopha.2023.116055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND During the first wave of COVID-19, hydroxychloroquine (HCQ) was used off-label despite the absence of evidence documenting its clinical benefits. Since then, a meta-analysis of randomised trials showed that HCQ use was associated with an 11% increase in the mortality rate. We aimed to estimate the number of HCQ-related deaths worldwide. METHODS AND FINDINGS We estimated the worldwide in-hospital mortality attributable to HCQ use by combining the mortality rate, HCQ exposure, number of hospitalised patients, and the increased relative risk of death with HCQ. The mortality rate in hospitalised patients for each country was calculated using pooled prevalence estimated by a meta-analysis of published cohorts. The HCQ exposure was estimated using median and extreme estimates from the same systematic review. The number of hospitalised patients during the first wave was extracted from dedicated databases. The systematic review included 44 cohort studies (Belgium: k = 1, France: k = 2, Italy: k = 12, Spain: k = 6, Turkey: k = 3, USA: k = 20). HCQ prescription rates varied greatly from one country to another (range 16-84%). Overall, using median estimates of HCQ use in each country, we estimated that 16,990 HCQ-related in-hospital deaths (range 6267-19256) occurred in the countries with available data. The median number of HCQ-related deaths in Belgium, Turkey, France, Italy, Spain, and the USA was 240 (range not estimable), 95 (range 92-128), 199 (range not estimable), 1822 (range 1170-2063), 1895 (range 1475-2094) and 12739 (3244- 15570), respectively. CONCLUSIONS Although our estimates are limited by their imprecision, these findings illustrate the hazard of drug repurposing with low-level evidence.
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Affiliation(s)
- Alexiane Pradelle
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France
| | - Sabine Mainbourg
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Unité bases de données cliniques et épidémiologiques, Hospices Civils de Lyon, Lyon F-69310, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France
| | - Steeve Provencher
- Pulmonary Hypertension Research Group (http://phrg.ca), Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Department of medicine, Université Laval, Québec City, Canada
| | - Emmanuel Massy
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France
| | - Guillaume Grenet
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France
| | - Jean-Christophe Lega
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France.
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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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Damiani S, Fiorentino M, De Palma A, Foschini MP, Lazzarotto T, Gabrielli L, Viale PL, Attard L, Riefolo M, D'Errico A. Pathological post-mortem findings in lungs infected with SARS-CoV-2. J Pathol 2020; 253:31-40. [PMID: 32930394 DOI: 10.1002/path.5549] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022]
Abstract
Italy was the first European nation to be massively infected by SARS-CoV-2. Up to the end of May 2020, more than 33,000 deaths had been recorded in Italy, with a large prevalence among males, those over 75 years of age, and in association with co-morbidities. We describe the lung pathological and immunohistochemical post-mortem findings at the autopsy of nine patients who died of SARS-CoV-2-associated disease. We found in the lung tissues of all patients histological changes consistent with diffuse alveolar damage in various evolution phases ranging from acute exudative to acute proliferative to fibrotic phase. Alveolar damage was associated with prominent involvement of the vascular component in both the interstitial capillaries and the mid-size vessels, with capillary fibrin micro-thrombi, as well as organized thrombi even in medium-sized arteries, in most cases not related to sources of embolism. Eosinophilic infiltrate was also seen, probably reactive to pharmacological treatment. Viral RNA of SARS-CoV-2 was detected from the lung tissues of all the nine patients. Immunohistochemistry for the receptor of the SARS-CoV-2, ACE2, and its priming activator TMPRSS2 revealed that both proteins co-localize in airway cells. In particular, the ACE2 protein was expressed in both endothelial cells and alveolar type I and II pneumocytes in the areas of histological diffuse alveolar damage (DAD). Pneumocytes, but not endothelial cells, also expressed TMPRSS2. There are no distinctive histological features of SARS-CoV-2 infection with respect to SARS-CoV-1 and other DAD with different aetiology. The identification of the cause of death in the course of SARS-CoV-2 infection is more likely multi-factorial. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Stefania Damiani
- Department of Pathology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Michelangelo Fiorentino
- Azienda Ospedaliero-Universitaria di Bologna and the Department of Pathology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Alessandra De Palma
- Department of Forensic Medicine, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Maria Pia Foschini
- Department of Forensic Medicine, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Tiziana Lazzarotto
- Department of Microbiology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Liliana Gabrielli
- Department of Microbiology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Pier Luigi Viale
- Department of Infectious Diseases, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Luciano Attard
- Department of Infectious Diseases, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Mattia Riefolo
- Department of Pathology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Antonia D'Errico
- Department of Pathology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy
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