Eficacia y seguridad de cloroquina, hidroxicloroquina y azitromicina en pacientes con COVID-19: Resumen de evidencia

Palabras clave: COVID-19, hidroxicloroquina, azitromicina, eventos adversos, profilaxis

Resumen

Antecedentes: La emergencia sanitaria por enfermedad COVID-19, aún no tiene tratamiento demostrado. Objetivo: Presentar la evidencia disponible respecto a la eficacia y seguridad del uso de hidroxicloquina y azitromicina en la profilaxis y manejo de paciente con COVID-19.

Métodos: Se realizó una revisión rápida de literatura, consultando bases de datos Medline, scopus y pubmed, para hidroxicloroquina y azitromicina en pacientes COVID-19.

Resultados: Se incluyeron 10 estudios entre revisiones rápidas de literatura, estudios observacionales y ensayos clínicos. No se encontró información que estudie la profilaxis con hidroxicloroquina y azitromicina para SARS-CoV-2. Reportes de eventos adversos incluyen episodios de emesis, dolor abdominal, náuseas, diarrea, erupción cutánea y picazón.

Conclusiones: La evidencia recopilada sugiere que el uso de hidroxicloroquina y azitromicina en paciente con COVID-19 podría generar alteraciones en el electrocardiograma y presentación de otros eventos adversos. La efectividad sigue sin estar esclarecido.

Descargas

La descarga de datos todavía no está disponible.

Referencias

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis [Internet]. 2020;20(5):533–4. Available from: http://dx.doi.org/10.1016/S1473-3099(20)30120-1
2. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020 Mar;
3. Gautret P, Lagier J-C, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 Mar;105949.
4. Sahraei Z, Shabani M, Shokouhi S, Saffaei A. Aminoquinolines against coronavirus disease 2019 (COVID-19): chloroquine or hydroxychloroquine. Int J Antimicrob Agents. 2020 Apr;55(4):105945.
5. Chauhan A, Tikoo A. The enigma of the clandestine association between chloroquine and HIV-1 infection. HIV Med. 2015 Nov;16(10):585–90.
6. Keyaerts E, Li S, Vijgen L, Rysman E, Verbeeck J, Van Ranst M, et al. Antiviral activity of chloroquine against human coronavirus OC43 infection in newborn mice. Antimicrob Agents Chemother. 2009 Aug;53(8):3416–21.
7. Vincent MJ, Bergeron E, Benjannet S, Erickson BR, Rollin PE, Ksiazek TG, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005 Aug;2:69.
8. Touret F, de Lamballerie X. Of chloroquine and COVID-19. Antiviral Res. 2020 May;177:104762.
9. FDA. EUA Choroquine Phosphate Hea th Care Provider Fact Sheet, version date 4/3/2020 1. 2020;1–8.
10. Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020;6:16.
11. Lane JCE, Weaver J, Kostka K, Duarte-Salles T, Abrahao MTF, Alghoul H, et al. Safety of hydroxychloroquine, alone and in combination with azithromycin, in light of rapid wide-spread use for COVID-19: a multinational, network cohort and self-controlled case series study. medRxiv [Internet]. 2020 Jan 1;2020.04.08.20054551. Available from: http://medrxiv.org/content/early/2020/04/10/2020.04.08.20054551.abstract
12. World Health Organization (WHO). The Cardiotoxicity of Antimalarials. World Health Organization- Malaria Policy Advisory Committee Meeting. 2017. 2017.
13. Ray W, Murray K, Hall K, Arbogast P, Stein C. Azithromycin and the Risk of Cardiovascular Death. N Engl J Med [Internet]. 2012 Aug 22;367(8):772–5. Available from: https://doi.org/10.1056/NEJMc1207269
14. Chen C-Y, Wang F-L, Lin C-C. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin Toxicol (Phila). 2006;44(2):173–5.
15. Yang Z, Prinsen JK, Bersell KR, Shen W, Yermalitskaya L, Sidorova T, et al. Azithromycin Causes a Novel Proarrhythmic Syndrome. Circ Arrhythm Electrophysiol. 2017 Apr;10(4).
16. American College of Cardiology. Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-19 [Internet]. 2020.
17. Instituto Global de Excelencia Clínica (IGEC). Metodología de revisiones sistemáticas rápidas para la toma de decisiones en organizaciones de salud. 2019.
18. Chang R, Sun W. Repositioning Chloroquine as Ideal Antiviral Prophylactic against COVID-19 - Time is Now. Preprints. 2020;
19. Delvecchio R, Higa LM, Pezzuto P, Valadão AL, Garcez PP, Monteiro FL, et al. Chloroquine, an Endocytosis Blocking Agent, Inhibits Zika Virus Infection in Different Cell Models. Viruses [Internet]. 2016 Nov 29;8(12):322. Available from: https://pubmed.ncbi.nlm.nih.gov/27916837
20. Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020 Mar;14(1):72–3.
21. Huang M, Tang T, Pang P, Li M, Ma R, Lu J, et al. Treating COVID-19 with Chloroquine. J Mol Cell Biol [Internet]. 2020 Apr 1; Available from: https://doi.org/10.1093/jmcb/mjaa014
22. Borba MGS, Val F de A, Sampaio VS, Alexandre MAA, Melo GC, Brito M, et al. Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb cl. medRxiv [Internet]. 2020 Jan 1;2020.04.07.20056424. Available from: http://medrxiv.org/content/early/2020/04/16/2020.04.07.20056424.abstract
23. Magagnoli J, Narendran S, Pereira F, Cummings T, Hardin JW, Sutton SS, et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. medRxiv [Internet]. 2020 Jan 1;2020.04.16.20065920. Available from: http://medrxiv.org/content/early/2020/04/23/2020.04.16.20065920.abstract
24. Molina JM, Delaugerre C, Le Goff J, Mela-Lima B, Ponscarme D, Goldwirt L, et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Medecine et maladies infectieuses. France; 2020.
25. Mercuro NJ, Yen CF, Shim DJ, Maher TR, McCoy CM, Zimetbaum PJ, et al. Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 May;
26. Bessière F, Roccia H, Delinière A, Charrière R, Chevalier P, Argaud L, et al. Assessment of QT Intervals in a Case Series of Patients With Coronavirus Disease 2019 (COVID-19) Infection Treated With Hydroxychloroquine Alone or in Combination With Azithromycin in an Intensive Care Unit. JAMA Cardiol [Internet]. 2020 May 1; Available from: https://doi.org/10.1001/jamacardio.2020.1787
27. Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA [Internet]. 2020 May 11; Available from: https://doi.org/10.1001/jama.2020.8630
28. Chowdhury MDS, Rathod J, Gernsheimer J. A Rapid Systematic Review of Clinical Trials Utilizing Chloroquine and Hydroxychloroquine as a Treatment for COVID-19. Acad Emerg Med [Internet]. 2020 May 2;n/a(n/a). Available from: https://doi.org/10.1111/acem.14005
Publicado
2020-06-11
Cómo citar
1.
Chacón Acevedo KR, Pinzón C, Barrera A, Low Padilla E, Yomayusa González N. Eficacia y seguridad de cloroquina, hidroxicloroquina y azitromicina en pacientes con COVID-19: Resumen de evidencia. Rev. Colomb. Nefrol. [Internet]. 11 de junio de 2020 [citado 14 de julio de 2020];7(Supl.2). Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/469
Sección
Artículo de investigación original