Diagnostic pitfalls and laboratory test interference after hydroxychloroquine intoxication: A case report

Radke, Joshua B.; Kingery, Jennie M.; Maakestad, Jon; Krasowski, Matthew D.

doi:10.1016/j.toxrep.2019.10.006

Cited by 43 publications

(51 citation statements)

References 38 publications

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“…HCQ alone can cause QT prolongation and is known to cause torsades de pointes, especially among patients with a history of cardiac dysfunction. 60 The use of HCQ in patients with COVID-19 has been associated with cardiac toxicity. 19 It is known that patients with a history of cardiovascular disease are more likely to develop into severe cases, as COVID-19 can promote acute cardiac injury.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis

Wang

Zuo

et al. 2020

BMJ Support Palliat Care

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BackgroundBecause of the lack of vaccination, it is urgent to find effective antiviral agents for COVID-19 treatment.MethodOnline databases were searched for articles published before or on 22 June 2020. Studies reporting the effectiveness and safety of antiviral agents for COVID-19 were analysed.ResultsA total of 42 studies were included in this analysis. Hydroxychloroquine (HCQ) was not associated with the incidence of death (risk ratio (RR)=1.08; 95% CI 0.81 to 1.44) and severe cases (RR=1.05; 95% CI 0.61 to 1.81). Patients treated with HCQ obtained few benefits with respect to the clearance of viral RNA and were more likely to have adverse reactions. HCQ treatment could shorten the body temperature recovery time (weighted mean difference = −1.04; 95% CI −1.64 to −0.45). Lopinavir/ritonavir (LPV/r) (RR=0.90; 95% CI 0.76 to 1.07) and Arbidol (RR=1.09; 95% CI 0.92 to 1.29) were not associated with the negative conversion rate. Integrative Chinese-Western medicine alleviated clinical symptoms and decreased the incidence of severe cases (RR=0.38; 95% CI 0.25 to 0.59). Remdesivir treatment reduced the 14-day mortality rate of patients with severe COVID-19 (RR=0.64; 95% CI 0.44 to 0.94). Convalescent plasma (CP) tended to increase the negative conversion rate (RR=2.47; 95% CI 1.70 to 3.57).ConclusionHCQ, LPV/r and Arbidol bring little benefit in COVID-19 treatment. Integrative Chinese-Western medicine improved the clinical symptoms of patients with COVID-19. Remdesivir and CP might be the potential treatments for patients with severe COVID-19. However, large-scale clinical randomised trials are needed to validate our conclusions.

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Section: Discussionmentioning

confidence: 99%

Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis

Wang

Zuo

et al. 2020

BMJ Support Palliat Care

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“…However, the efficiency and safety of CQ and HCQ for treating COVID-19 remain uncertain due to recent controversial results [87], especially its' potential cardiac toxicity. CQ/HCQ alone can cause QT prolongation and is known to cause torsades de pointes, especially among patients with a history of cardiac dysfunction and when administered in combination with other drugs such as lopinavir/ritonavir (LPV/r); [88]. It was reported that 30% of patients treated with HCQ + azithromycin developed new QT prolongation of > 40 ms [89].…”

Section: Treatment Suggestionsmentioning

confidence: 99%

Multi-organ Dysfunction in Patients with COVID-19: A Systematic Review and Meta-analysis

Wu¹,

Zuo²,

Kang³

et al. 2020

Aging and disease

110

100

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This study aimed to provide systematic evidence for the association between multiorgan dysfunction and COVID-19 development. Several online databases were searched for articles published until May 13, 2020. Two investigators independently selected trials, extracted data, and evaluated the quality of individual trials. Single-arm meta-analysis was performed to summarize the clinical features of confirmed COVID-19 patients. Fixed effects meta-analysis was performed for clinically relevant parameters that were closely related to the patients' various organ functions. A total of 73 studies, including 171,108 patients, were included in this analysis. The overall incidence of severe COVID-19 and mortality were 24% (95% confidence interval [CI], 20%-28%) and 2% (95% CI, 1%-3%), respectively. Patients with hypertension (odds ratio [OR] = 2.40; 95% CI, 2.08-2.78), cardiovascular disease (CVD) (OR = 3.54; 95% CI, 2.68-4.68), chronic obstructive pulmonary disease (COPD) (OR=3.70; 95% CI, 2.93-4.68), chronic liver disease (CLD) (OR=1.48; 95% CI, 1.09-2.01), chronic kidney disease (CKD) (OR = 1.84; 95% CI, 1.47-2.30), chronic cerebrovascular diseases (OR = 2.53; 95% CI, 1.84-3.49) and chronic gastrointestinal (GI) disease (OR = 2.13; 95% CI, 1.12-4.05) were more likely to develop severe COVID-19. Increased levels of lactate dehydrogenase (LDH), creatine kinase (CK), highsensitivity cardiac troponin I (hs-cTnI), myoglobin, creatinine, urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin were highly associated with severe COVID-19. The incidence of acute organ injuries, including acute cardiac injury (ACI); (OR = 11.87; 95% CI, 7.64-18.46), acute kidney injury (AKI); (OR=10.25; 95% CI, 7.60-13.84), acute respiratory distress syndrome (ARDS); (OR=27.66; 95% CI, 18.58-41.18), and acute cerebrovascular diseases (OR=9.22; 95% CI, 1.61-52.72) was more common in patients with severe COVID-19 than in patients with non-severe COVID-19. Patients with a history of organ dysfunction are more susceptible to severe conditions. COVID-19 can aggravate an acute multiorgan injury.

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“…Case reports have noted prolonged QTc values with hydroxychloroquine toxicity. [73][74][75][76][77][78] In a study of 85 patients with connective tissue disorders who were receiving hydroxychloroquine, the investigators concluded that QT intervals did not appear to be different from what would be considered normal in these patients. 79 Recently there are emerging QT data from 84 patients with SARS-CoV-2 infection treated with a combination of hydroxychloroquine and azithromycin.…”

Section: Effects Of Chloroquine and Hydroxychloroquine On Qtc Prolongmentioning

confidence: 99%

Pharmacokinetics and Pharmacological Properties of Chloroquine and Hydroxychloroquine in the Context of COVID‐19 Infection

Nicol

Joshi

Rizk

et al. 2020

Clin Pharma and Therapeutics

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Chloroquine and hydroxychloroquine are quinoline derivatives used to treat malaria. To date, these medications are not approved for the treatment of viral infections, and there are no well‐controlled, prospective, randomized clinical studies or evidence to support their use in patients with coronavirus disease 2019 (COVID‐19). Nevertheless, chloroquine and hydroxychloroquine are being studied alone or in combination with other agents to assess their effectiveness in the treatment or prophylaxis for COVID‐19. The effective use of any medication involves an understanding of its pharmacokinetics, safety, and mechanism of action. This work provides basic clinical pharmacology information relevant for planning and initiating COVID‐19 clinical studies with chloroquine or hydroxychloroquine, summarizes safety data from healthy volunteer studies, and summarizes safety data from phase II and phase II/III clinical studies in patients with uncomplicated malaria, including a phase II/III study in pediatric patients following administration of azithromycin and chloroquine in combination. In addition, this work presents data describing the proposed mechanisms of action against the severe acute respiratory distress syndrome coronavirus–2 and summarizes clinical efficacy to date.

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Diagnostic pitfalls and laboratory test interference after hydroxychloroquine intoxication: A case report

Cited by 43 publications

References 38 publications

Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis

Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis

Multi-organ Dysfunction in Patients with COVID-19: A Systematic Review and Meta-analysis

Pharmacokinetics and Pharmacological Properties of Chloroquine and Hydroxychloroquine in the Context of COVID‐19 Infection

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