Comment to: Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection

Corrêa, Thiago Domingos; Matos, Gustavo Faissol Janot de; Bravim, Bruno de Arruda; Cordioli, Ricardo Luiz; Garrido, Alejandra del Pilar Gallardo; Assuncao, Murillo Santucci Cesar de; Barbas, Carmen Silvia Valente; Timenetsky, Karina Tavares; Rodrigues, Roseny dos Reis; Guimarães, Hélio Penna; Rabello Filho, Roberto; Lomar, Frederico Polito; Scarin, Farah Christina de La Cruz; Batista, Carla Luciana; Pereira, Adriano José; Guerra, João Carlos de Campos; Carneiro, Bárbara Vieira; Nawa, Ricardo Kenji; Brandão, Rodrigo Martins; Pesaro, Antônio Eduardo Pereira; Silva Júnior, Moacyr; Carvalho, Fabricio Rodrigues Torres de; Silva, Cilene Saghabi de Medeiros; Almeida, Ana Claudia Ferraz de; Franken, Marcelo; Pesavento, Marcele Liliane; Eid, Raquel Afonso Caserta; Ferraz, Leonardo José Rolim

doi:10.31744/einstein_journal/2020CE5931

Dear Editor,

In this issue of einstein journal (São Paulo), Corrêa et al., reported intensive support recommendations for critically-ill patients with suspected or confirmed infection by the new coronavirus (COVID-19).(¹) Based on preliminary demonstration of efficacy of chloroquine, the authors suggested the use of hydroxychloroquine in monotherapy or combined with a macrolide (azithromycin or clarithromycin), to treat severe patients with COVID-19, admitted to the intensive care unit (ICU), to inhibit in vitro replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).(²)

However, evidence from observational studies(³,⁴) involving hospitalized COVID-19 patients demonstrated the use of hydroxychloroquine in monotherapy(³) or combined with a macrolide(⁴)was not associated with reduced mortality when compared to patients who did not receive such medications (controls). Yet, the use of hydroxychloroquine in monotherapy or combined with a macrolide may be associated with greater incidence of major cardiovascular complications.(⁴)

Therefore, based on new evidence available, we exclude the recommendation to use hydroxychloroquine in monotherapy or combined with a macrolide for treating inpatients with severe acute respiratory syndrome caused by COVID-19.

REFERENCES

¹ Corrêa TD, Matos GF, Bravim BA, Cordioli RL, Garrido AD, Assuncao MS, et al. Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection. einstein (São Paulo). 2020;18:eAE5793.
² 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. doi: 10.1038/s41421-020-0156-0
» https://doi.org/10.1038/s41421-020-0156-0
³ Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med. 2020;382(25):2411-8.
⁴ Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State. JAMA. 2020;323(24):2493-502.

Publication Dates

Publication in this collection
05 Aug 2020
Date of issue
2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹ Corrêa TD, Matos GF, Bravim BA, Cordioli RL, Garrido AD, Assuncao MS, et al. Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection. einstein (São Paulo). 2020;18:eAE5793.

[2] ² 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. doi: 10.1038/s41421-020-0156-0
» https://doi.org/10.1038/s41421-020-0156-0

[3] ³ Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med. 2020;382(25):2411-8.

[4] ⁴ Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State. JAMA. 2020;323(24):2493-502.