This important experimental paper has been recently published:
Wang, M., Cao, R., Zhang, L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 30, 269–271 (2020). https://doi.org/10.1038/s41422-020-0282-0
THIS IS THE PDF OF Wang, M., Cao, R., Zhang, L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 30, 269–271 (2020). https://doi.org/10.1038/s41422-020-0282-0
Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies Jianjun Gao1,*, Zhenxue Tian2 , Xu Yang2 1 Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, China; 2 Department of Pharmacy, Qingdao Municipal Hospital, Qingdao, China.
Medicine showed promise in a small study, but lack of deeper tests still worries experts Health Minister Luiz Henrique Mandetta revealed on Friday (20) at a conference with President Jair Bolsonaro that the country has validated the use of chloroquine to treat Covid-19. The drug has shown positive results in a small study conducted in France and could be used in the most severe cases of the disease in Brazil. According to Mandetta, the country has the capacity to produce the drug, and that it is already being produced to be available for the treatment of the disease.
google translation "Chloroquine: dose that would block Covid-19 would kill the patient Amilcar Tanuri does not see the drug as hope of treatment for cases of coronavirus infection Considered one of the greatest virus specialists in Brazil, Amilcar Tanuri does not see chloroquine as a hope of treatment for cases of infection with the new coronavirus. A member of the Molecular Virology Laboratory at the Federal University of Rio de Janeiro (UFRJ), where diagnostic tests are carried out for covid-19, he says that the dose of the drug needed to block (the virus) could kill patients. The presidents of the U.S., Donald Trump, and Brazil, Jair Bolsonaro, have referred to the substance as promising in facing the disease. "The dose of chloroquine to block (the virus) is very high," he said in an interview with the State. "There would be no way to achieve this in the blood of patients or they would die from poisoning" Some preliminary studies show that chloroquine would impact the volume of viruses circulating in the blood. Did you manage to prove it? The works that exist were done with very few patients, they are not robust in terms of numbers (of volunteers) and random enrollment. You can't be sure of the effect of chloroquine. The best way to do this would be with longer studies. Unfortunately, it will not be possible to do this until the end of this epidemic. The best thing to do now is not to use it, because this drug tends to do more harm than good. And it has high auditory and visual toxicity if used on a large scale. In tests carried out in the test tube, chloroquine inhibits several viruses, prevents them from injecting their genetic material into the cell (entering cells is the mechanism of virus invasion in the body). However, the dose of chloroquine needed to block this action is very high. There would be no way to achieve this in the blood of patients. They would die intoxicated. If chloroquine has any action, it would be immunoregulatory (which enhances the body's immune response). But I think, for now, it is better not to use it because it will be lacking for those who need it. So the best approach is not to use it, except in clinical studies. "
Collaborative clinical Research Group in Brazil try to answer prospectively the effect of hidroxichloquine in Covid-19 patients
https://www.uol.com.br/vivabem/noticias/redacao/2020/03/26/cerca-de-mil-pessoas-farao-teste-com-hidroxicloroquina-brasil -sera-util.htm? cmpid = copiaecola "Research with the drug hydroxychloroquine, widely used to combat lupus and rheumatoid arthritis, has increased hope in combating covid-19. Although there is still no conclusive evidence on the drug's effectiveness, scientists from different countries devote time and efforts to studying its effects in patients with the new coronavirus. This is the case in Brazil. Here, researchers from Hospital Israelita Albert Einstein, HCor, Sírio Libânes and BRICNet, a network that conducts clinical studies in the field of intensive care medicine, joined efforts to find answers about the safety and efficacy of the medicine
Otávio Berwanger, director of clinical research at Hospital Israelita Albert Einstein, who answered the main questions about the research: How will the research work? OB: The study will be done collaboratively. We believe that it is not the time for one institution to compete with another, but to come together to achieve results as quickly as possible. We designed a project that involves hundreds of patients - so far, the studies carried out are very small - and will be divided into three:
Coalization covid-19 Brasil I, which will test drugs in patients who are not in a serious condition but have symptoms such as shortness of breath, fever and persistent cough. These are cases that we cannot treat at home, but that do not require intensive care. For this phase, 600 people will be tested with three different strategies: one group will receive hydroxychloroquine with azithromycin, the other will receive only hydroxychloroquine and the last 200 will receive neither drug, only the other therapies already used to control symptoms. Coalization covid-19 Brasil II, our first project to be ready and the one that should start the tests first. It is aimed at 440 patients of greater severity, who need assistance with oxygen and are in the semi-intensive or intensive unit. We will divide into two groups: one will receive the combined therapy and the other half, only hydroxychloroquine. As they are more worrying cases, we think it is better not to have participants who do not receive at least one of the drugs. And the Coalização covid-19 Brasil III, in which we will evaluate the effectiveness of dexamethasone, a medication with anti-inflammatory action, for 284 patients with severe respiratory failure, who need support from devices (mechanical ventilator) to breathe .... -
It’s a first victory for Professor Didier Raoult. An infectious disease specialist and director of the Mediterranean University Hospital Institute in Marseille, this French doctor is the source of the hope that the use of this antimalarial to fight against the coronavirus has given rise to worldwide. On Thursday, the French government authorized the use of hydroxychloroquine for patients suffering from coronavirus and who are treated in hospitals or in nursing homes.
Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study
Philippe Gautret, Jean-Christophe Lagier, Philippe Parola, Van Thuan Hoang, Line Meddeb, Jacques Sevestre , Morgane Mailhe, Barbara Doudier , Camille Aubry, Sophie Amrane, Piseth Seng, Marie Hocquart, Julie Finance, Vera Esteves Vieira, Hervé Tissot Dupont, Stéphane Honoré, Andreas Stein, Matthieu Million, Philippe Colson, Bernard La Scola, Véronique Veit, Alexis Jacquier, Jean-Claude Deharo, Michel Drancourt, Pierre Edouard Fournier, Jean-Marc Rolain, Philippe Brouqui, Did
Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study
Philippe Gautret, Jean-Christophe Lagier, Philippe Parola, Van Thuan Hoang, Line Meddeb, Jacques Sevestre , Morgane Mailhe, Barbara Doudier , Camille Aubry, Sophie Amrane, Piseth Seng, Marie Hocquart, Julie Finance, Vera Esteves Vieira, Hervé Tissot Dupont, Stéphane Honoré, Andreas Stein, Matthieu Million, Philippe Colson, Bernard La Scola, Véronique Veit, Alexis Jacquier, Jean-Claude Deharo, Michel Drancourt, Pierre Edouard Fournier, Jean-Marc Rolain, Philippe Brouqui, Did
https://portugues.medscape.com/verartigo/6504597 Medscape Logo
News and Perspectives
Covid-19: Brazil starts tests with hydroxychloroquine in critically ill patients
Monica Tarantino
NOTIFICATION March 24, 2020
9
Editor's note: Find the latest news and guidance about Covid-19 in our Information Center on the new SARS-CoV-2 coronavirus.
São Paulo - This Tuesday (24th), the first large Brazilian study with patients affected by Covid-19 in serious condition begins to evaluate the results of treatment protocols with hydroxychloroquine and azithromycin. The research design was sent to the National Commission for Ethics in Research (Conep) on the morning of last Sunday and was approved on the same day, with agility never seen before.
The research will be conducted by a coalition of institutions formed by Hospital Israelita Albert Einstein (HIAE), Hospital Sírio-Libanês (HSL), Hospital do Coração (HCor) and BRICnet, an independent and collaborative Brazilian network for conducting clinical studies in the area of intensive medicine. The Ministry of Health will be responsible for distribution logistics. The hydroxychloroquine used in the research will be supplied by the EMS laboratory, which is buying the salt to manufacture the medicine from India.
The researchers wait for the approval of a second study in the coming days only with inpatients with moderate symptoms and who do not require intensive care. The research coalition will also make a third protocol with the use of corticosteroids in very severe patients on ventilation
Both Dr Raoult and Zelenko advocates the therapeutic before the SARS are installed!!
Dr Zelenko used in more than 500 old patients(> 60 years) a schema before initiation of the respiratory syndrome, using Hydroxychloroquine, Zinc supplementation and Azithromycin !!
PREVENT SENIOR GROUP IN BRAZIL REPORT TREATMENT MORE EFFICIENT IN INITIAL SYMPTONS OF COVID WITH HYDROXYCLHROQUINE PLUS AZYTROMYCINE THAN IN SEVERELY AFFECTED PATIENTS.
The novel coronavirus pneumonia (COVID-19) is an infectious acute respiratory infection caused by the novel coronavirus. The virus is a positive-strand RNA virus with high homology to bat coronavirus. In this study, conserved domain analysis, homology modeling, and molecular docking were used to compare the biological roles of certain proteins of the novel coronavirus. The results showed the ORF8 and surface glycoprotein could bind to the porphyrin, respectively. At the same time, orf1ab, ORF10, and ORF3a proteins could coordinate attack the heme on the 1-beta chain of hemoglobin to dissociate the iron to form the porphyrin. The attack will cause less and less hemoglobin that can carry oxygen and carbon dioxide. The lung cells have extremely intense poisoning and inflammatory due to the inability to exchange carbon dioxide and oxygen frequently, which eventually results in ground-glass-like lung images. The mechanism also interfered with the normal heme anabolic pathway of the human body, is expected to result in human disease. According to the validation analysis of these finds, chloroquine could prevent orf1ab, ORF3a, and ORF10 to attack the heme to form the porphyrin, and inhibit the binding of ORF8 and surface glycoproteins to porphyrins to a certain extent, effectively relieve the symptoms of respiratory distress. Favipiravir could inhibit the envelope protein and ORF7a protein bind to porphyrin, prevent the virus from entering host cells, and catching free porphyrins. Because the novel coronavirus is dependent on porphyrins, it may originate from an ancient virus. Therefore, this research is of high value to contemporary biological experiments, disease prevention, and clinical treatment.
Hydroxychloroquine alone or with Azithromycin for COVID-19: No benefit but increased risk
No significant benefit with Hydroxychloroquine and Azithromycin either alone or in combination on in-hospital mortality in COVID-19 patients in USA. However, increased risk of prolonged QT-interval with risk of ventricular arrhythmias.
References
Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State
Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing