Hydroxychloroquine (HCQ) is an antimalarial drug. The drug is used to prevent and treat acute attacks of malaria. Additionally, HCQ is used to treat systemic lupus erythematosus (SLE) patients whose symptoms have not improved with other treatments. Most (up to 70%) SLE patients exhibit the type I interferon signature (increase in the levels of interferon-induced mRNAs) in their blood cells. Type I interferons (T1 IFNs) are produced in response to bacterial or viral infections. Studies using animal models and ex vivo studies using blood cells from SLE patients have indicated that HCQ can reduce production of T1 IFNs. Notably, T1 IFNs can promote inflammation as well as suppress inflammation (as a part of our immune defense against inflammation after an infection). Further, HCQ inhibited activation of certain inflammasomes (also activated by infections). Activation of an inflammasome (a protein complex) in cells increases production of proinflammatory cytokines (proteins), which cause inflammation. After infection with COVID-19 virus, the infected cells and immune cells are predicted to produce type I interferons and proinflammatory cytokines (through activation of an inflammasome) causing severe lung inflammation. Therefore, HCQ therapy in COVID-19 patients is predicted to reduce severe lung inflammation. However, the production of type I IFNs and activation of inflammasome in individuals is predicted to depend on several factors, including the genetic factors, age, gender, and race. Consequently, all COVID-19 patients are not likely to benefit from HCQ therapy. Therefore, a well-controlled clinical trial is needed to determine which group of COVID-19 patients could benefit from HCQ therapy to reduce severe lung inflammation effectively.
Article Acquired Long QT Syndrome: A Review of the Literature
This review discusses the points I outline below.
A note of caution
Several medications that have been recommended for the treatment of Covid-19 are associated with prolongation of the QTc interval and therefore torsade de pointes and sudden cardiac death.
The evidence of the potential benefit of chloroquine and hydroxychloroquine in the treatment of Covid-19 is increasing.
Other medications which may be used in this cohort include the macrolide antibiotics (e.g. azithromycin). These can also prolong the QTc interval. Administering several medications that may prolong the QT interval is associated with a high risk of complications.
In medicine risks and benefits must be balanced. Safety netting is important whenever there is a great potential benefit but also a very significant risk. In that context QTc intervals, renal and liver function must be monitored closely in patients treated with chloroquine and or macrolides. They should probably not be started if the baseline QTc is more than 450 ms. It should probably be stopped if the QTc increases 25% above baseline. It should definitely be stopped if QTc is above 500 ms. This is an evolving situation and recommendations may change as the potential risks and benefits become clearer.
Beta-blockade is used in the treatment of congenital and acquired long QT syndrome, so may be beneficial in this setting.
You make some interesting points and its important to point out the initial French paper that came out and began this media and research issues had many issues.
Pasted below is a previous reply I made on that paper.
" I would take this paper with a large dose of salt. It is a poorly constructed study unfortunately, in the statistics 6 of the 26 patients in the testing group were lost to follow up which included worsening of symptoms and in once case a death (no loss to follow up in controls)(" three patients were transferred to intensive care unit" of which one who lost to follow up tested negative on day 2 (PCR) yet died on day 3). This will irreparably skew the statistics positively towards the treatment. As well as this they did not look at clinical endpoints such as clinically cured and discharged but just Covid PCR titers. This does not equate to a cure and was conducted over a very short time frame. There is also a very real risk of severe QT prolongation (heart rhythm) as the couple in America found out when they self administered.
I also think it was a bit short sighted to publish the pre-print prior to any peer review as it has pushed a media cycle where these results have been over blown. This is a very small scale study with a low strength behind its results, there may be something there but we do not know what it is at present"
There was an editorial published in the Annals of Internal Medicine with considerations as to why this may not be a good approach at the current time.
shih-Wen Huang
Drug repurposing is an attractive approach for novel treatments. In vitro data have suggested the effect of chloroquine against COVID-19. A few observational studies contribute some information. FDA has approved the use of chloroquine against COVID-19 infection as an emergent action.
Undoubtedly clinical trials are needed in order to prove the effect of chloroquine against COVID-19.
Logic times is the relation between frequencies(our known logic times) and from any point at our sky(times) so ' analysis and action is at one circle of time intervals of scientific spectrum & frequency of imorted colours from it in now always. I think it may an exit frequency (activation) from timers of groups of scientific frequency
With respect to content in molecular technology in aclosed loop Feedback rewriting by means of light and timers we have mechanical power of scientific spectrum in human history
This drug can be recommended in mild cases alone or in combination with another drugs
In molecular times there are three elements which are data and frequency and capacity may be the mathematical model of reaction in Flow of time
In spectrum of drugs and biology analog with frequency in satellite of television channel. This analog conversion to digital by orders of pixels frequency According to spectrum of light and anew reading to our knowledge of drugs and biology and so on
And gate = ( not gate * or gate)
It is logic model of time
Mass of time = frequency phase * velocity
It is mathematical model of time
So now quantum and relativity is dynamics of time content
NEW UPDATE
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
https://jamanetwork.com/journals/jama/fullarticle/2766117
Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19
https://www.nejm.org/doi/full/10.1056/NEJMoa2012410
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).
https://www.ncbi.nlm.nih.gov/pubmed/32356863