The friendly use of chloroquine in the COVID-19 disease: a warning for the 
 G6PD
 -deficient males and for the unaware carriers of pathogenic alterations of the G6PD gene

Capoluongo, Ettore; Amato, Felice; Castaldo, Giuseppe

doi:10.1515/cclm-2020-0442

Cited by 12 publications

(11 citation statements)

References 8 publications

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“…Further studies need to confirm our findings as a recent work documents NLR predictive value on both I st and II nd waves (21). However, at the state of the art, there is not a clear consensus on the role of such drugs, frequently used friendly without medical supervision (22) and on their impact on COVID-19 patients. In any case, the present data suggest that such therapies impair the use of NLR as a marker of outcome and disease severity in COVID-19 patients, and its use should be limited to naïve patients before starting potential interfering therapies.…”

Section: Discussionsupporting

confidence: 54%

Prognostic Role of Neutrophil to Lymphocyte Ratio in COVID-19 Patients: Still Valid in Patients That Had Started Therapy?

Gelzo

Cacciapuoti

Pinchera

et al. 2021

Front. Public Health

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COVID-19 may appear with a widely heterogeneous clinical expression. Thus, predictive markers of the outcome/progression are of paramount relevance. The neutrophil/lymphocyte ratio (NLR) has been suggested as a good predictive marker of disease severity and mortality. Accordingly, we found that NLR significantly increased in parallel with the WHO severity stage in COVID-19 patients during the Ist wave (March-May 2020; n = 49), due to the significant reduction of lymphocyte and the significant increase of neutrophil in severe COVID-19 patients. While, we did not observe significant differences of NLR between the WHO severity stage among COVID-19 patients of the IInd wave (September 2020-April 2021; n = 242). In these patients, the number of lymphocytes and neutrophils did not change significantly between patients of different severity subgroups. This difference likely depends on the steroids therapy that the patients of the IInd wave performed before hospitalization while most patients of the Ist wave were hospitalized soon after diagnosis. This is also confirmed by serum interleukin (IL)-6 and myeloperoxidase (MPO) that gradually increased with the disease stage in patients of the Ist wave, while such biomarkers (whose production is inhibited by steroids) did not show differences among patients of the IInd wave in different stages. Thus, the NLR could be tested at diagnosis in naïve patients before starting therapies.

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Section: Discussionsupporting

confidence: 54%

Prognostic Role of Neutrophil to Lymphocyte Ratio in COVID-19 Patients: Still Valid in Patients That Had Started Therapy?

Gelzo

Cacciapuoti

Pinchera

et al. 2021

Front. Public Health

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“…It is also worth remembering that both drugs have been shown to cause severe side effects, such as cardiotoxicity and hypoglycemia [53,54] that, as described previously, could cause harm in particular subjects with cardiovascular disease or diabetes who are more at risk of developing severe COVID-19 infection. Furthermore, more precautions should be used in subjects with Glucose-6-phosphate dehydrogenase deficiency [55]. Remdesivir (AV) , proposed as a treatment for Ebola, blocks viral RNA replication through the inhibition of RdRp and has been demonstrated to control SARS-CoV-2 infection in vitro and in vivo [56].…”

Section: Potential Treatments For Covid19: the Need To Find Multiple Therapeutic Optionsmentioning

confidence: 99%

SARS-CoV-2: One Year in the Pandemic. What Have We Learned, the New Vaccine Era and the Threat of SARS-CoV-2 Variants

et al. 2021

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Since the beginning of 2020, the new pandemic caused by SARS-CoV-2 and named coronavirus disease 19 (COVID 19) has changed our socio-economic life. In just a few months, SARS-CoV-2 was able to spread worldwide at an unprecedented speed, causing hundreds of thousands of deaths, especially among the weakest part of the population. Indeed, especially at the beginning of this pandemic, many reports highlighted how people, suffering from other pathologies, such as hypertension, cardiovascular diseases, and diabetes, are more at risk of severe outcomes if infected. Although this pandemic has put the entire academic world to the test, it has also been a year of intense research and many important contributions have advanced our understanding of SARS-CoV-2 origin, its molecular structure and its mechanism of infection. Unfortunately, despite this great effort, we are still a long way from fully understanding how SARS-CoV-2 dysregulates organismal physiology and whether the current vaccines will be able to protect us from possible future pandemics. Here, we discuss the knowledge we have gained during this year and which questions future research should address.

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“…Some of the most serious HCQ-related side effects include retinal toxicity [ 12 , 79 ], neuromyotoxicity [ 80 – 85 ] and cardiotoxic effects leading to potentially lethal heart rhythm disorders, such as prolonged QT interval and ventricular arrhythmias [ 12 , 86 – 88 ]. Besides excluding subjects with known hypersensitivity to HCQ or 4-aminoquinoline compounds, upcoming trials investigating the use of HCQ should also consider to exclude the enrollment of patients with underlying coexisting conditions that increase the risk of HCQ-related side effects, such as: i) patients with preexisting retinopathy/maculopathy or history or risk for macular edema [ 89 , 90 ]; ii) patients with preexisting cardiomyopathy, heart failure, ventricular hypertrophy, left ventricular dysfunction, coronary artery disease and/or heart rhythm disorders such as long QT syndrome [ 27 , 91 – 93 ]; iii) diabetic patients with macrovascular and/or microvascular complications [ 42 ]; iv) electrolyte abnormalities such as hypokalemia and hypomagnesemia [ 93 ]; v) family history of premature sudden cardiac death or cardiac ion channelopathies [ 91 – 93 ]; vi) patients with preexisting myopathy and/or neuropathy; vii) patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency [ 94 , 95 ], although chloroquine- and HCQ-induced hemolysis in subjects with G6PD-deficiency has not been conclusively proven [ 96 ]; viii) patients using certain concomitant QT interval-prolonging medications such as azithromycin [ 22 , 91 – 93 ]. Thus, baseline and follow-up electrocardiography to evaluate for prolonged QT interval may be advisable prior to and following the initiation of HCQ, even in clinical trial settings.…”

Section: Expert Opinionmentioning

confidence: 99%

Hydroxychloroquine in the COVID-19 pandemic era: in pursuit of a rational use for prophylaxis of SARS-CoV-2 infection

Infante

Ricordi

Alejandro

et al. 2020

Expert Review of Anti-infective Therapy

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Introduction Over the last few months, coronavirus disease 2019 (COVID-19) pandemic caused by the novel coronavirus SARS-CoV-2 has posed a serious threat to public health on a global scale. Given the current lack of an effective vaccine, several drugs have been repurposed for treatment and prophylaxis of COVID-19 in an attempt to find an effective cure. Areas covered The antimalarial drug hydroxychloroquine (HCQ) initially garnered widespread attention following the publication of preliminary results showing that this drug exerts an anti-SARS-CoV-2 activity in vitro. Expert opinion To date, clinical evidence suggests lack of benefit from HCQ use for the treatment of hospitalized patients with COVID-19. In such patients, HCQ also appears to be associated with an increased risk of QT interval prolongation and potentially lethal ventricular arrhythmias. Therefore, FDA has recently revoked the Emergency Use Authorization (EUA) for emergency use of HCQ and chloroquine to treat COVID-19. Conversely, whether HCQ use may represent an effective prophylactic strategy against COVID-19 is a separate question that still remains to be answered. In addition, relevant aspects regarding the potential risks and benefits of HCQ need to be clarified, in pursuit of a rational use of this drug in the COVID-19 pandemic era.

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The friendly use of chloroquine in the COVID-19 disease: a warning for the G6PD -deficient males and for the unaware carriers of pathogenic alterations of the G6PD gene

Cited by 12 publications

References 8 publications

Prognostic Role of Neutrophil to Lymphocyte Ratio in COVID-19 Patients: Still Valid in Patients That Had Started Therapy?

Prognostic Role of Neutrophil to Lymphocyte Ratio in COVID-19 Patients: Still Valid in Patients That Had Started Therapy?

SARS-CoV-2: One Year in the Pandemic. What Have We Learned, the New Vaccine Era and the Threat of SARS-CoV-2 Variants

Hydroxychloroquine in the COVID-19 pandemic era: in pursuit of a rational use for prophylaxis of SARS-CoV-2 infection

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