Antimalarial drugs—are they beneficial in rheumatic and viral diseases?—considerations in COVID-19 pandemic

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.

Decrease in Visual Acuity in a 77-Year-old Woman with Age-Related Macular Degeneration after a SARS-CoV-2 Infection Treated with Hydroxychloroquine

“…As of today, there is no consistent evidence regarding HCQ toxicity in SARS-CoV-2 infected patients that were treated with HCQ 25 . Side effects, including HCQ retinopathy, should not be neglected 1 , 2 , 3 , 4 , 5 . Further investigations are needed to assess this matter in more patients reporting vision loss after a SARS-CoV-2 infection being treated with HCQ.…”

“…To date, hydroxychloroquine (HCQ) is a well-established antimalarial and immunomodulatory drug used as a treatment for several autoimmune and infectious diseases including rheumatoid arthritis, lupus erythematosus, and malaria 1 , 2 . Recently, HCQ has been used as pre-/postexposure prophylaxis and treatment for the coronavirus disease 2019 (COVID-19) 3 , 4 , 5 , 6 .…”

“…Recently, HCQ has been used as pre-/postexposure prophylaxis and treatment for the coronavirus disease 2019 (COVID-19) 3 , 4 , 5 , 6 . However, despite the potential antiviral effects and its anti-inflammatory profile, the results based on clinical studies regarding HCQ as a treatment for SARS-CoV-2 are contradictory, and main concerns exist for its efficacy and safety profile 1 , 2 , 3 , 7 , 8 . In addition, studies have shown that the benefits of treating SARS-CoV-2 patients are limited and do not seem to outweigh side effects 2 , 3 , 5 , 7 .…”

“…However, despite the potential antiviral effects and its anti-inflammatory profile, the results based on clinical studies regarding HCQ as a treatment for SARS-CoV-2 are contradictory, and main concerns exist for its efficacy and safety profile 1 , 2 , 3 , 7 , 8 . In addition, studies have shown that the benefits of treating SARS-CoV-2 patients are limited and do not seem to outweigh side effects 2 , 3 , 5 , 7 . Thus, the World Health Organization (WHO) no longer recommends HCQ to prevent or treat patients with SARS-CoV-2 9 .…”

Risk factors for lipid disorders in systemic lupus erythematosus

“…In SLE with moderate disease activity, patients usually need low-to medium-dose GCSs in addition to AMDs. AMDs are drugs with pleiotropic effects and reports in recent decades have emphasised their beneficial effects on lipid disorders [58]. Regular ophthalmological follow-up is recommended to monitor the adverse effects of AMDs and GCS [41,42,59,60].…”