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Ruiz S, Concordet D, Lanot T, Georges B, Goudy P, Baklouti S, Mané C, Losha E, Vinour H, Rousset D, Lavit M, Minville V, Conil JM, Gandia P. Hydroxychloroquine lung pharmacokinetics in critically ill patients with COVID-19. Int J Antimicrob Agents 2020; 57:106247. [PMID: 33259916 PMCID: PMC7698654 DOI: 10.1016/j.ijantimicag.2020.106247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 12/27/2022]
Abstract
HCQ pharmacokinetics in COVID-19 patients cannot be predicted using data from lupus or rheumatoid arthritis patients. Bronchoalveolar lavage fluid may be a more instructive matrix than plasma on the degree of HCQ lung exposure. Low plasma concentrations should not induce an increase in drug dosage because lung exposure could already be high.
Different dosage regimens of hydroxychloroquine (HCQ) have been used to manage COVID-19 (coronavirus disease 2019) patients, with no information on lung exposure in this population. The aim of our study was to evaluate HCQ concentrations in the lung epithelial lining fluid (ELF) in patients infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the virus that causes COVID-19. This was a retrospective, observational, multicentre, pharmacokinetic study of HCQ in critically ill COVID-19 patients. No additional interventions or additional samples compared with standard care of these patients were conducted in our teaching hospital. We included all intubated COVID-19 patients treated with crushed HCQ tablets, regardless of the dosage administered by nasogastric tube. Blood and bronchoalveolar lavage samples (n = 28) were collected from 22 COVID-19 patients and total HCQ concentrations in ELF were estimated. Median (interquartile range) HCQ plasma concentrations were 0.09 (0.06–0.14) mg/L and 0.07 (0.05–0.08) mg/L for 400 mg × 1/day and 200 mg × 3/day, respectively. Median HCQ ELF concentrations were 3.74 (1.10–7.26) mg/L and 1.81 (1.20–7.25) for 400 mg × 1/day and 200 mg × 3/day, respectively. The median ratio of ELF/plasma concentrations was 40.0 (7.3–162.7) and 21.2 (18.4–109.5) for 400 mg × 1/day and 200 mg × 3/day, respectively. ELF exposure is likely to be underestimated from HCQ concentrations in plasma. In clinical practice, low plasma concentrations should not induce an increase in drug dosage because lung exposure may already be high.
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Affiliation(s)
- S Ruiz
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France.
| | - D Concordet
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, BP 87614, 31076, Toulouse cedex 3, France
| | - T Lanot
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - B Georges
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France
| | - P Goudy
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France
| | - S Baklouti
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - C Mané
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - E Losha
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - H Vinour
- CHU de Toulouse, Réanimation Polyvalente URM, Pôle d'Anesthésie-Réanimation, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - D Rousset
- CHU de Toulouse, Réanimation Neurochirurgicale, Pôle d'Anesthésie-Réanimation, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - M Lavit
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
| | - V Minville
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France
| | - J-M Conil
- CHU de Toulouse, Réanimation Polyvalente Hôpital Rangueil, Pôle d'Anesthésie-Réanimation, 1 avenue du Professeur Jean Poulhès, 31059, Toulouse cedex 9, France
| | - P Gandia
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, BP 87614, 31076, Toulouse cedex 3, France; CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330 avenue de Grande-Bretagne, 31059, Toulouse cedex 9, France
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