Cloroquina y sus derivados en el manejo de la COVID-19: una revisión exploratoria

Juan Pimentel, Neil Andersson, .

Palabras clave: cloroquina, hidroxicloroquina, coronavirus, revisión sistemática, ensayo clínico, pandemias, SARS-CoV-2

Resumen

Introducción. Recientemente, investigadores chinos y franceses reportaron eficacia de la cloroquina e hidroxicloroquina para inhibir la replicación in vitro del virus SARS-CoV-2. La diseminación oportuna de la información científica es clave en tiempos de pandemia. Es urgente contar con una revisión sistemática sobre el efecto y seguridad de estos medicamentos en el COVID-19.

Objetivo. Describir el estado actual de la literatura científica publicada hasta marzo 25 de 2020, sobre el uso de la cloroquina o sus derivados en el manejo de pacientes con COVID-19.

Material y métodos. Revisión sistemática exploratoria que incluyó PubMed, Embase, Lilacs y 15 bases de datos de Plataforma de Registros Internacionales de Ensayos Clínicos de la OMS. Incluimos publicaciones empíricas y teóricas en inglés, español, italiano, francés, o portugués. Realizamos una síntesis narrativa de los resultados.

Resultados. Se incluyeron 19 documentos y 24 registros de ensayos clínicos, (n=43) sumando 18,059 pacientes. 66% (16/24) de los ensayos están registrados en China. Nueve ensayos evaluarán la cloroquina exclusivamente, y ocho la hidroxicloroquina exclusivamente. Los documentos son comentarios (n=9), estudios in vitro (n=3), revisiones narrativas (n=2), guías de práctica clínica (n=2), y revisión sistemática, consenso de expertos y ensayo controlado (n=1, respectivamente).

Conclusiones. Un ensayo clínico pequeño (n=26) no aleatorizado y con fallos, soporta el uso de hidroxicloroquina en pacientes con COVID-19. Se requiere de manera urgente tener acceso a resultados de ensayos clínicos adicionales para determinar la efectividad y seguridad de la cloroquina y sus derivados en pacientes con COVID-19.

Descargas

La descarga de datos todavía no está disponible.
  • Juan Pimentel CIET/PRAM, Department of Family Medicine, McGill University, Montreal, Canada; Facultad de Medicina, Universidad de La Sabana, Chía, Colombia; Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C., Colombia https://orcid.org/0000-0002-6842-3064
  • Neil Andersson CIET/PRAM, Department of Family Medicine, McGill University, Montreal, Canada;Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, México https://orcid.org/0000-0003-1121-6918

Citas

World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19. [Fecha de consulta: 23 de marzo de 2020]. Disponible en: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020

World Health Organization. Coronavirus disease 2019. [Fecha de consulta: 8 de abril de 2020]. Disponible en: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Savarino A, Di Trani L, Donatelli I, Cauda R, Cassone A. New insights into the antiviral effects of chloroquine. Lancet Infect Dis. 2006;6:67-9. https://doi.org/10.1016/S1473-3099(06)70361-9

Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348:1953-66. https://doi.org/10.1056/NEJMoa030781

Keyaerts E, Vijgen L, Maes P, Neyts J, Ranst M Van. In vitro inhibition of severe acute respiratory syndrome coronavirus by chloroquine. Biochem Biophys Res Commun. 2004;323:264-8. https://doi.org/10.1016/j.bbrc.2004.08.085

Yu IT-S, Qiu H, Tse LA, Wong TW. Severe acute respiratory syndrome beyond Amoy gardens: completing the incomplete legacy. Clin Infect Dis. 2014;58:683-6. https://doi.org/10.1093/cid/cit797

Colson P, Rolain J-M, Raoult D. Chloroquine for the 2019 novel coronavirus SARS-CoV-2. Int J Antimicrob Agents. 2020;55:105923. https://doi.org/10.1016/j.ijantimicag.2020.105923

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;53:3416-21. https://doi.org/10.1128/AAC.01509-08

de Wilde AH, Jochmans D, Posthuma CC, Zevenhoven-Dobbe JC, van Nieuwkoop S, Bestebroer TM, et al. Screening of an FDA-approved compound library identifies four small-molecule inhibitors of Middle East respiratory syndrome coronavirus replication in cell culture. Antimicrob Agents Chemother. 2014;58:4875-84. https://doi.org/10.1128/AAC.03011-14

Rolain J-M, Colson P, Raoult D. Recycling of chloroquine and its hydroxyl analogue to face bacterial, fungal and viral infections in the 21st century. Int J Antimicrob Agents. 2007;30:297-308. https://doi.org/10.1016/j.ijantimicag.2007.05.015

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;30:269-71. https://doi.org/10.1038/s41422-020-0282-0.

Devaux CA, Rolain J-M, Colson P, Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? Int J Antimicrob Agents. 2020;105938. https://doi.org/10.1016/j.ijantimicag.2020.105938

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506. https://doi.org/10.1016/S0140-6736(20)30183-5

Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020;395:683-4. https://doi.org/10.1016/S0140-6736(20)30361-5

Ministerio de Salud y Protección Social - República de Colombia. Hidroxicloroquina y cloroquina se podrán usar para tratamiento de covid – 19. 2020 [Fecha de consulta: 8 de abril de 2020]. Disponible en: https://www.minsalud.gov.co/Paginas/Hidroxicloroquina-y-cloroquina-se-podran-usar-para-tratamiento-de-covid-–-19.aspx

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

Song P, Karako T. COVID-19: Real-time dissemination of scientific information to fight a public health emergency of international concern. Biosci Trends. 2020;14:1–2. https://doi.org/10.5582/bst.2020.01056

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19-32. https://doi.org/10.1093/geront/gnz021

Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69

World Health Organization. WHO Registry Network. 2020 [Fecha de consulta: 25 de marzo de 2020]. Disponible en: https://www.who.int/ictrp/network/primary/en/

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. https://doi.org/10.1186/s13643-016-0384-4

Grudniewicz A, Nelson M, Kuluski K, Lui V, Cunningham H V., X Nie J, et al. Treatment goal setting for complex patients: protocol for a scoping review. BMJ Open. 2016;6:e011869. https://doi.org/10.1136/bmjopen-2016-011869.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169:467. https://doi.org/10.7326/M18-0850

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;14:72-73. https://doi.org/10.5582/bst.2020.01047

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. https://doi.org/10.1093/cid/ciaa237

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. https://doi.org/10.1038/s41421-020-0156-0

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;105949. https://doi.org/10.1016/j.ijantimicag.2020.105949

Wilson P. COVID-19, Hydroxychloroquine, and the Death of Evidence-Based Medicine. The Methods Man. 2020 [Fecha de consulta: 2 de abril de 2020]. Disponible en: https://www.methodsman.com/blog/covid-19-evidence

Hinton DM. US Food & Drug Administration Emergency Use Autorization for chloroquine phosphate and hydroxychloroquine sulfate use for the treatment of COVID-19. 2020. p. 1–8. [Fecha de consulta: 2 de abril de 2020]. Disponible en: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f398f8a9-92f3-47cb-81c2-6078806a464d

U.S. Department of Health and Human Services (HHS). HHS accepts donations of medicine to Strategic National Stockpile as possible treatments for COVID-19 patients | HHS.gov. News. 2020 [Fecha de consulta: 2 de abril de 2020]. Disponible en: https://www.hhs.gov/about/news/2020/03/29/hhs-accepts-donations-of-medicine-to-strategic-national-stockpile-as-possible-treatments-for-covid-19-patients.html#

O’Brien N, Hong QN, Law S, Massoud S, Carter A, Kaida A, et al. Health system features that enhance access to comprehensive primary care for women living with hiv in high-income settings: a systematic mixed studies review. AIDS Patient Care STDS. 2018;32:129-48. https://doi.org/10.1089/apc.2017.0305

Alvarado-Castro V, Paredes-Solís S, Nava-Aguilera E, Morales-Pérez A, Alarcón-Morales L, Balderas-Vargas NA, et al. Assessing the effects of interventions for Aedes aegypti control: systematic review and meta-analysis of cluster randomised controlled trials. BMC Public Health. 2017;17(Supl.1):384. https://doi.org/10.1186/s12889-017-4290-z

Shalabi D, Mitchell S, Andersson N. Review of Gender Violence Among Arab Immigrants in Canada: Key Issues for Prevention Efforts. J Fam Violence. 2015;30:817–25. https://doi.org/10.1007/s10896-015-9718-6

Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7. https://doi.org/10.1186/1471-2288-7-10

Pimentel J, Arias A, Ramírez D, Molina A, Chomat A-M, Cockcroft A, et al. Game-based learning interventions to foster cross-cultural care training: a scoping review. Games Health J. 2020. https://doi.org/10.1089/g4h.2019.0078.

Pimentel J, Ansari U, Omer K, Gidado Y, Baba MC, Andersson N, et al. Factors associated with short birth interval in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2020;20:156. https://doi.org/10.1186/s12884-020-2852-z

Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13:141-6. https://doi.org/10.1097/XEB.0000000000000050.

Cómo citar
Pimentel, J., & Andersson, N. (2020). Cloroquina y sus derivados en el manejo de la COVID-19: una revisión exploratoria. Biomédica, 40(Supl. 2). https://doi.org/10.7705/biomedica.5478
Publicado
2020-04-09
Sección
Artículos originales