Treatment Strategies: Antimalarial Treatments
Twenty trials are currently studying the use of chloroquine and hydroxychloroquine anti-malarial drugs (Table 2: Antimalarials). Chloroquine has been found to have important inhibitory effects on the input and in vitro replication of viral cells [10]. An early study of clinical experience with chloroquine care in 100 COVID- 19 patients reported both beneficial clinical and virological outcomes [62]. More recently, a non-randomized open-label study investigating the impact of hydroxychloroquine (EU Clinical Trial Numbervii: 2020-000890-25; recruitment target specified as 25 registry participants) published on a cohort of 36 patients [63]. Six days after inclusion in the hydroxychloroquine community compared with control it showed a substantial reduction in nasopharyngeal swab viral positivity. However, 16 patients were assigned as controls in a departure from their registry-described protocol, and six patients received concomitant azithromycin treatment to avoid bacterial superinfection. Patients receiving azithromycin were chosen based on clinical judgment. After 6 days, the subgroup receiving azithromycin all had negative viral swabs, compared to 57% (8/14) of hydroxychloroquine alone and 12.5% (2/16) of control [63]. This research is constrained by its lack of blinding and randomization, and low sample size. There is a great deal of interest in chloroquine or hydroxychloroquine for COVID-19 diagnosis, with another 34 studies reported (Table 2: Antimalarials); however, only four reports using a rigorous double-blind randomized controlled study to examine effectiveness.