Role of Chloroquine and Hydroxychloroquine in the Treatment of COVID-19 Infection- A Systematic Literature Review

Krishan Mohan Kapoor; Aanandita Kapoor

The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03. 24.20042366 doi: medRxiv preprint So far, results of more than 100 patients treated with CQ has shown that chloroquine phosphate is superior to the control treatment as it inhibits the worsening of pneumonia, improves the lung imaging findings, promotes a virus-negative conversion, and shortens the course of the disease. Severe adverse reactions to CQ were not seen in these patients. The drug has been recommended for inclusion in the next version of the Guidelines for the Prevention, Diagnosis, and Treatment of Pneumonia Caused by COVID-19, issued by the National Health Commission of the People's Republic of China. 14 This would be the first successful use of CQ in humans for treating acute viral disease. However, this information should be carefully considered before drawing any definitive conclusion as no supporting clinical data has been released yet. 16 As of 23rd February 2020, seven clinical trial registries have been found in the Chinese Clinical Trial Registry for using HCQ to COVID-19 treatment. It has been reported that the safe dosage of HCQ (6-6.5 mg/kg per day) could reach serum levels of 1.4-1.5 μ M in humans. In animals, CQ and HCQ share similar tissue distribution, with concentrations in the liver, spleen, kidney, and lung reaching levels, which are 200-700 times higher than those in the plasma. Therefore a very high concentration in the above tissues is likely to be achieved with the safe dosage of HCQ for inhibiting SARS-CoV-2 infection. This possibility, however, awaits confirmation by clinical trials. 15 In patients with COVID-19 infection, CQ can interact with lopinavir/ritonavir, Causing QT interval prolongation. Hence HCQ can be considered instead of CQ when the latter is not available for COVID-19 treatment 17 .