Eficacia y seguridad de la cloroquina, la hidroxicloroquina y la azitromicina en pacientes con COVID-19. Resumen de evidencia
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Palabras clave

COVID-19, hidroxicloroquina, azitromicina, evento adverso, profilaxis

Cómo citar

1.
Chacón Acevedo K, Pinzón C, Barrera A, Low Padilla E, Yomayusa González N. Eficacia y seguridad de la cloroquina, la hidroxicloroquina y la azitromicina en pacientes con COVID-19. Resumen de evidencia. Rev. Colomb. Nefrol. [Internet]. 11 de junio de 2020 [citado 3 de julio de 2024];7(Supl.2). Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/469

Resumen

Introducción: hasta el momento, no se ha demostrado la efectividad de ningún tratamiento para afrontar la emergencia sanitaria por COVID-19.

Objetivo: presentar la evidencia disponible respecto a la eficacia y seguridad del uso de cloroquina, hidroxicloroquina y azitromicina en la profilaxis y el manejo de pacientes con COVID-19.

Materiales y métodos: se realizó una revisión de la literatura en las bases de datos MEDLINE, Scopus y PubMed sobre publica- ciones que registraran el uso de cloroquina, hidroxicloroquina y azitromicina en pacientes con COVID-19.

Resultados: se seleccionaron 12 publicaciones que incluyeron revisiones rápidas de literatura, estudios observacionales y ensayos clínicos. No se encontró información sobre la profilaxis con cloroquina, hidroxicloroquina ni azitromicina para SARS-CoV-2. Los eventos adversos reportados incluyeron emesis, dolor abdominal, náuseas, diarrea, erupción cutánea y picazón.

Conclusiones: según la evidencia recopilada el uso de hidroxicloroquina o de cloroquina sola o en combinación con azitromicina en pacientes con COVID-19 no ha mostrado beneficio. Además, cada uno de estos esquemas de tratamiento se asocia con un mayor riesgo de muerte y de episodios de arritmias. En síntesis, la efectividad de estos medicamentos sigue sin estar esclarecida, por lo cual se sugiere evitar su uso en el tratamiento de personas con infección por SARS-CoV-2/COVID-19.

https://doi.org/10.22265/acnef.7.Supl.2.469
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Citas

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533-4. http://dx.doi.org/10.1016/S1473-3099(20)30120-1.

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. http://dx.doi.org/10.1093/cid/ciaa237.

Gautret P, Lagier JC, 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;105949. http://dx.doi.org/10.1016/j.ijantimicag.2020.105949.

Sahraei Z, Shabani M, Shokouhi S, Saffaei A. Aminoquinolines against coronavirus disease 2019 (COVID-19): chloroquine or hydroxychloroquine. Int J Antimicrob Agents. 2020;55(4):105945. http://dx.doi.org/10.1016/j.ijantimicag.2020.105945.

Chauhan A, Tikoo A. The enigma of the clandestine association between chloroquine and HIV-1 infection. HIV Med. 2015;16(10):585-90. http://dx.doi.org/10.1111/hiv.12295.

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;53(8):3416-21. http://dx.doi.org/10.1128/AAC.01509-08.

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;2:69. http://dx.doi.org/10.1186/1743-422X-2-69.

Touret F, de Lamballerie X. Of chloroquine and COVID-19. Antiviral Res. 2020;177:104762. http://dx.doi.org/10.1016/j.antiviral.2020.104762.

Food and Drog Administration (FDA). EUA Choroquine Phosphate Hea th Care Provider Fact Sheet, version date 4/3/2020. FDA; 2020.

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. http://dx.doi.org/10.1038/s41421-020-0156-0.

Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269-71. https://doi.org/10.1038/s41422-020-0282-0.

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. 2020. https://doi.org/10.1101/2020.04.08.20054551.

World Health Organization (WHO). The Cardiotoxicity of Antimalarials. World Health Organization.Geneva: WHO; 2017.

Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the Risk of Cardiovascular Death. N Engl J Med. 2012;367(8):772-5. https://doi.org/10.1056/NEJMc1207269.

Chen CY, Wang FL, Lin CC. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin Toxicol (Phila). 2006;44(2):173-5. http://dx.doi.org/10.1080/15563650500514558.

Yang Z, Prinsen JK, Bersell KR, Shen W, Yermalitskaya L, Sidorova T, et al. Azithromycin Causes a Novel Proarrhythmic Syndrome. Circ Arrhythm Electrophysiol. 2017;10(4):e003560. http://dx.doi.org/10.1161/CIRCEP.115.003560.

Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-19. Marzo 29 de 2020. Cardiology Magazine. 2020 [citado Jul 2 2020]. Disponible en: https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular- arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19.

Chang R, Sun W. Repositioning Chloroquine as Ideal Antiviral Prophylactic against COVID-19 - Time is Now. Preprints. 2020. http://dx.doi.org/10.20944/preprints202003.0279.v1.

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;14(1):72-3. http://dx.doi.org/10.5582/bst.2020.01047.

. Huang M, Tang T, Pang P, Li M, Ma R, Lu J, et al. Treating COVID-19 with Chloroquine. J Mol Cell Biol. 2020;12(4):322-5. https://doi.org/10.1093/jmcb/mjaa014.

1 . 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 clinical trial (CloroCovid-19 Study). medRxiv. 2020. https://doi.org/10.1101/2020.04.07.20056424.

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. 2020 https://doi.org/10.1101/2020.04.16.20065920.

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. Med Mal Infect. 2020;50(4):384. http://dx.doi.org/10.1016/j.medmal.2020.03.006.

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;e201834. http://dx.doi.org/10.1001/jamacardio.2020.1834.

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. 2020;e201787. https://doi.org/10.1001/jamacardio.2020.1787.

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. 2020;323(24):2493-2502. https://doi.org/10.1001/jama.2020.8630.

Chowdhury MS, Rathod J, Gernsheimer J. A Rapid Systematic Review of Clinical Trials Utilizing Chloroquine and Hydroxychloroquine as a Treatment for COVID-19. Acad Emerg Med. 2020;27(6):493-504. https://doi.org/10.1111/acem.14005.

Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19?: a multinational registry analysis. Lancet. 2020;6736(20):1-10. http://dx.doi.org/10.1016/S0140-6736(20)31180-6.

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