key: cord-0958568-kufs0fxe
authors: Malviya, Amit
title: The continued dilemma about usage of Hydroxychloroquine: Respite is in randomized control trials
date: 2020-07-29
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.07.054
sha: 85b0f1dd0b056310a9905183f1f93b8de6dea0bf
doc_id: 958568
cord_uid: kufs0fxe

nan

is notable that in the present study, concomitant use of steroid in patients receiving hydroxychloroquine, was more than non-treated group. So, in absence of this critical information about the duration between the onset of symptoms and administration of first dose of HCQ, it seems difficult to interpret that the positive effects were due to HCQ or steroids.

HCQ is touted for treatment of Covid 19 primarily based on its anti-viral properties, thus the timing of administration becomes very important for a meaning full assessment of study results.

Secondly, HCQ concentrates in lungs after initial doses 3 and that is the time when its effect is supposed to be maximum. Administration of HCQ late in the course of disease may not be that effective.

Thirdly, they utilised maximal modified Sequential Organ Failure Assessment (mSOFA )scores for classifying patient severity of disease . Recently it been shown that this score is not accurate for predicting severity of disease in Covid 19 patients . 4 Fourthly , a QTc interval-based algorithm specifically designed to ensure the safe use of hydroxychloroquine was utilised . This is a very safe practice but it might have resulted in exclusion of high cardiac risk patients . Covid 19 is a multisystem disease and the disease itself promotes proarrhythmic milieu with prolonged QT intervals at baseline .5,6 Risk assessment of HCQ therapy is not complete if such patients are excluded.

Finally , mechanism of action of HCQ against is a part of its broad anti-viral and immunomodulatory properties and no specific pharmacologic actions are described for SARS-CoV-2 infection. 7, 8 Majority of publications in the recent times on HCQ , for usage in Covid 19, are limited by low methodical quality and by and large have shown negative or neutral results . 9,10 Weather HCQ as initial anti-viral agent prevents progression to severe disease is not known clearly . In severe disease with multi system involvement and pro arrhythmic milieu

COVID-19: immunopathology and its implications for therapy

Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review

Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology

Critically ill SARS-CoV2-infected patients are not stratified as sepsis by the qSOFA

Chloroquine and hydroxychloroquine in covid-19

Ventricular arrhythmia risk due to chloroquine / hydroxychloroquine treatment for COVID-19: Should it be given

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)

Effects of chloroquine on viral infections: an old drug against today's diseases? The Lancet. Infectious Diseases

The Urgency of Care during the Covid-19

Pandemic -Learning as We Go

COVID-19 coronavirus research has overall low methodological quality thus far: case in point for chloroquine/hydroxychloroquine