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      Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know

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      Author(s): , MD, MPH, , MD, PhD
      Publication date (Electronic):
      Journal: Annals of Internal Medicine
      Publisher: American College of Physicians

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          Abstract

          Two medications often used for treatment of immune-mediated conditions, hydroxychloroquine and chloroquine, have recently attracted widespread interest as potential therapies for coronavirus disease 2019. The authors of this commentary provide guidance for clinical decision making for patients with coronavirus disease 2019 as well as for patients with rheumatologic conditions, such as systemic lupus erythematosus and rheumatoid arthritis

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          A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group.

          J Sampalis, V Bykerk, JM Esdaile (1991)
          The antimalarial drug hydroxychloroquine is thought to be effective in controlling some of the manifestations of systemic lupus erythematosus, but its effectiveness has not been demonstrated conclusively. We conducted a six-month, randomized, double-blind, placebo-controlled study of the effect of discontinuing hydroxychloroquine sulfate treatment in 47 patients with clinically stable systemic lupus erythematosus. The patients were randomly assigned to continue their same dose of hydroxychloroquine (n = 25) or to receive placebo (n = 22) for 24 weeks. Ten patients in each group were also taking prednisone. The relative risk of a clinical flare-up, defined as the development of specific clinical manifestations of systemic lupus erythematosus or an increase in their severity, was 2.5 times higher (95 percent confidence interval, 1.08 to 5.58) in the patients taking placebo than in those continuing to take hydroxychloroquine (16 of 22 patients vs. 9 of 25 had flare-ups), and the time to a flare-up was shorter (P = 0.02). The relative risk of a severe exacerbation of disease that required withdrawal from the study was 6.1 times higher (95 percent confidence interval, 0.72 to 52.44) for the patients taking placebo (5 of 22 patients vs. 1 of 25 had severe exacerbations of disease). Changes in the dose of prednisone were not different in the two groups. Patients with quiescent systemic lupus erythematosus who are taking hydroxychloroquine are less likely to have a clinical flare-up if they are maintained on the drug.
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            Author and article information

            Journal
            Journal ID (nlm-ta): Ann Intern Med
            Journal ID (iso-abbrev): Ann. Intern. Med
            Journal ID (publisher-id): aim
            Title: Annals of Internal Medicine
            Publisher: American College of Physicians
            ISSN (Print): 0003-4819
            ISSN (Electronic): 1539-3704
            Publication date (Electronic): 31 March 2020
            Electronic Location Identifier: M20-1334
            Affiliations
            [1 ]Zuckerberg San Francisco General Hospital, University of California, San Francisco, California (J.Y.)
            [2 ]Washington University School of Medicine, St. Louis, Missouri (A.H.K.)
            Article
            Publisher ID: aim-olf-M201334
            DOI: 10.7326/M20-1334
            PMC ID: 7138336
            PubMed ID: 32232419
            SO-VID: 2261ba90-6b28-4a77-b2af-2e9943b33277
            Copyright statement: Copyright @ 2020
            License:

            This article is made available via the PMC Open Access Subset for unrestricted re-use for research, analyses, and text and data mining through PubMed Central. Acknowledgement of the original source shall include a notice similar to the following: "© 2020 American College of Physicians. Some rights reserved. This work permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited." These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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