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Grygiel-Górniak B. Antimalarial drugs-are they beneficial in rheumatic and viral diseases?-considerations in COVID-19 pandemic. Clin Rheumatol 2021; 41:1-18. [PMID: 34218393 PMCID: PMC8254634 DOI: 10.1007/s10067-021-05805-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 02/06/2023]
Abstract
The majority of the medical fraternity is continuously involved in finding new therapeutic schemes, including antimalarial medications (AMDs), which can be useful in combating the 2019-nCoV: coronavirus disease (COVID-19). For many decades, AMDs have been widely used in the treatment of malaria and various other anti-inflammatory diseases, particularly to treat autoimmune disorders of the connective tissue. The review comprises in vitro and in vivo studies, original studies, clinical trials, and consensus reports for the analysis, which were available in medical databases (e.g., PubMed). This manuscript summarizes the current knowledge about chloroquine (CQ)/hydroxychloroquine (HCQ) and shows the difference between their use, activity, recommendation, doses, and adverse effects on two groups of patients: those with rheumatic and viral diseases (including COVID-19). In the case of connective tissue disorders, AMDs are prescribed for a prolonged duration in small doses, and their effect is observed after few weeks, whereas in the case of viral infections, they are prescribed in larger doses for a short duration to achieve a quick saturation effect. In rheumatic diseases, AMDs are well tolerated, and their side effects are rare. However, in some viral diseases, the effect of AMDs is questionable or not so noticeable as suggested during the initial prognosis. They are mainly used as an additive therapy to antiviral drugs, but recent studies have shown that AMDs can diminish the efficacy of some antiviral drugs and may cause respiratory, kidney, liver, and cardiac complications.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
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Biguetti CC, Junior JFS, Fiedler MW, Marrelli MT, Brotto M. The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis. Sci Rep 2021; 11:6589. [PMID: 33758324 PMCID: PMC7988151 DOI: 10.1038/s41598-021-86079-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/23/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected according to the following inclusion criteria: English language; size of sample (> 5 patients), adult (> age of 18) patients, treated with CQ/HCQ for inflammatory diseases, and presenting and not presenting with toxic effects on skeletal muscles. We collected data published from 1990 to April 2020 using PubMed, Cochrane Library, EMBASE, and SciELO. Risk of bias for observational studies was assessed regarding the ROBIN-I scale. Studies with less than five patients (case reports) were selected for an additional qualitative analysis. We used the software Comprehensive Meta-Analysis at the confidence level of 0.05. We identified 23 studies for qualitative analysis (17 case-reports), and five studies were eligible for quantitative analysis. From case reports, 21 patients presented muscle weakness and confirmatory biopsy for CQ/HCQ induced myopathy. From observational studies, 37 patients out of 1,367 patients from five studies presented muscle weakness related to the use of CQ/HCQ, and 252 patients presented elevated levels of muscle enzymes (aldolase, creatine phosphokinase, and lactate dehydrogenase). Four studies presented data on 34 patients with confirmatory biopsy for drug-induced myopathy. No study presented randomized samples. The chronic use of CQ/HCQ may be a risk for drug-induced myopathy. There is substantiated need for proper randomized trials and controlled prospective studies needed to assess the clinical and subclinical stages of CQ/HCQ -induced muscle myopathy.
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Affiliation(s)
- Claudia Cristina Biguetti
- Bone-Muscle Research Center, College of Nursing & Health Innovation, University of Texas-Arlington, 655 W. Mitchell Street, Arlington, TX, 76010, USA
- Department of Bioengineering, University of Texas-Dallas, 800 W. Campbell Road, Richardson, TX, 75080, USA
| | | | - Matthew William Fiedler
- Bone-Muscle Research Center, College of Nursing & Health Innovation, University of Texas-Arlington, 655 W. Mitchell Street, Arlington, TX, 76010, USA
| | - Mauro Toledo Marrelli
- Bone-Muscle Research Center, College of Nursing & Health Innovation, University of Texas-Arlington, 655 W. Mitchell Street, Arlington, TX, 76010, USA
- Department of Epidemiology, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, São Paulo, SP, 01246‑904, Brazil
| | - Marco Brotto
- Bone-Muscle Research Center, College of Nursing & Health Innovation, University of Texas-Arlington, 655 W. Mitchell Street, Arlington, TX, 76010, USA.
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Shuai Y, Wang J, Jiang H, Yu Y, Jin L. Oral-maxillofacial adverse events related to antimalarials. Oral Dis 2020; 27:1376-1382. [PMID: 32497401 DOI: 10.1111/odi.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/21/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022]
Abstract
Malaria is a worldwide parasitic disease, which affects millions of lives every year. Various medications are recommended by WHO for prevention and treatment of malaria. However, adverse events caused by antimalarials were frequently reported, some of which were severe and fatal. Disorders of many organs related to antimalarials have been well recognized, whereas few studies concentrated on the relationship between antimalarials and oral-maxillofacial system health. Current review generalized the relevance of antimalarials to the health of oral-maxillofacial part and raised an urgent need to form a standard management for antimalarial-related oral-maxillofacial adverse events.
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Affiliation(s)
- Yi Shuai
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Stomatology, General Hospital of Eastern Theater Command, PLA, Nanjing, China
| | - Junlan Wang
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Stomatology, General Hospital of Eastern Theater Command, PLA, Nanjing, China
| | - Huijuan Jiang
- Department of Stomatology, Air Force Hospital of Eastern Theater Command, PLA, Nanjing, China
| | - Yang Yu
- Department of Endodontics, Affiliated Stomatology Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Jin
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Stomatology, General Hospital of Eastern Theater Command, PLA, Nanjing, China
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Sharma A. Chloroquine paradox may cause more damage than help fight COVID-19. Microbes Infect 2020; 22:154-156. [PMID: 32305500 PMCID: PMC7162740 DOI: 10.1016/j.micinf.2020.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/21/2022]
Abstract
Novel coronavirus disease 2019 (COVID-19) pandemic is the most recent health care crisis without specific prophylactic or therapeutic drugs. Antimalarial drug chloroquine (CHL) and its safer derivative hydroxychloroquine (HCHL) have been proposed to be repurposed to treat SARS coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19. CHL/HCHL have anti-inflammatory activity and are used to treat rheumatoid arthritis, osteoarthritis and lupus. Although, CHL/HCHL have an anti-viral activity against several viruses in cell-cultures, the anti-viral activity in-vivo is questionable. Repurposing of CHL/HCHL to treat SARS-CoV-2 infection is appealing. However, there is empirical evidence from animal studies with other viruses suggesting that CHL/HCHL may have an untoward paradoxical effect. One thus cannot exclude the possibility that CHL may increase the severity of the disease and prove deleterious both for the patients and public health efforts to contain the highly contagious and explosive spread of SARS-CoV-2.
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Affiliation(s)
- Anuj Sharma
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States of America
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Zamora LD, Collante MTM, Navarra SV. Risk factors for herpes zoster infection among Filipinos with systemic lupus erythematosus. Int J Rheum Dis 2019; 23:197-202. [DOI: 10.1111/1756-185x.13725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Leonid D. Zamora
- Section of Rheumatology University of Santo Tomas Manila Philippines
| | | | - Sandra V. Navarra
- Section of Rheumatology University of Santo Tomas Manila Philippines
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Olivo Pallo PA, de Souza FHC, Miossi R, Shinjo SK. Mycophenolate mofetil in patients with refractory systemic autoimmune myopathies: case series. Adv Rheumatol 2018; 58:34. [DOI: 10.1186/s42358-018-0035-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 10/07/2018] [Indexed: 11/10/2022] Open
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Robinson ES, Payne AS, Pappas-Taffer L, Feng R, Werth VP. The incidence of herpes zoster in cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP). J Am Acad Dermatol 2017; 75:42-8. [PMID: 27317514 DOI: 10.1016/j.jaad.2016.02.1153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Herpes zoster is a common condition that causes significant morbidity. OBJECTIVE This study determined the incidence of zoster in patients with cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP). METHODS In this retrospective cohort study the electronic medical records of 186 patients with CLE, 103 with DM, 83 with PV, 44 with BP, and 152 healthy control patients were reviewed to confirm positive diagnoses of zoster. RESULTS The incidence of zoster per 1000 person-years was 29.4 in CLE, 55.4 in DM, 18.6 in PV, 10.2 in BP, and 3.9 in healthy control subjects. The mean age (SD) in years was 46.1 (14.9) for CLE, 52.2 (14.5) for DM, 51.8 (13.5) for PV, 71.44 (11.8) for BP, and 48.2 (18.2) for healthy control subjects. The incidence of zoster was significantly higher in the CLE (P = .0177) and DM (P = .0070) groups than the healthy control subjects, all of whom were of a similar mean age. LIMITATIONS The limitations of this study are the sample size, referral bias, and retrospective nature. CONCLUSION The incidence of zoster in patients with CLE and, particularly, DM was significantly higher than that of the healthy control subjects.
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Affiliation(s)
- Elizabeth S Robinson
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; College of Physicians and Surgeons, Columbia University, New York, New York
| | - Aimee S Payne
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Lisa Pappas-Taffer
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rui Feng
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Tsai SY, Lin CL, Wong YC, Yang TY, Kuo CF, Cheng JM, Wang JS, Kao CH. Increased Risk of Herpes Zoster Following Dermatomyositis and Polymyositis: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1138. [PMID: 26181551 PMCID: PMC4617095 DOI: 10.1097/md.0000000000001138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study explored the possible association between dermatomyositis or polymyositis (DM or PM) and the subsequent risk of herpes zoster (HZ). We used data from the Taiwan National Health Insurance (NHI) system to address the research topic. The exposure cohort comprised 2023 patients with new diagnoses of DM or PM. Each patient was frequency matched according to age, sex, index year, and comorbidities including diabetes, renal disease, obesity, malignancy, rheumatoid arthritis, immunodeficiency virus infection, autoimmune disease not elsewhere classified, mixed connective tissue disease, or vasculitis with 4 participants from the general population who did not have a history of HZ (control cohort). Cox proportional hazards regression analysis was conducted to estimate the relationship between DM or PM and the risk of subsequent HZ. The incidence of HZ in the exposure and control cohorts was 35.8 and 7.01 per 1000 person-years, respectively. The exposure cohort had a significantly higher overall risk of subsequent HZ than did the control cohort (adjusted hazard ratio [HR] = 3.90, 95% confidence interval [CI] = 3.18-4.77). The risk of HZ in patients with DM or PM in whichever stratification (including sex, age, and comorbidity) was also higher than that of the control cohort. The findings from this population-based retrospective cohort study suggest that DM or PM is associated with an increased risk of subsequent HZ. A synergistic effect was observed between DM or PM and one of the comorbidities.
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Affiliation(s)
- Shin-Yi Tsai
- From the Department of Laboratory Medicine, Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan (S-YT); Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, USA (S-YT); Management Office for Health Data, China Medical University Hospital (C-LL); College of Medicine, China Medical University, Taichung (C-LL); Department of Medicine, National Defense Medical Center, Taipei (Y-CW); Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung (T-YY); Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua (T-YY); Division of Infectious Disease, Department of Medicine, Mackay Memorial Hospital (C-FK); Institute of Biomedical Engineering, National Taiwan University, Taipei (J-MC); Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung (J-SW); Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung (C-HK); and Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (C-HK)
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