Chloroquine and Hydroxychloroquine for the Prevention and Treatment of
COVID-19; a Fiction, Hope or Hype? An Updated Review
Abstract
In December 2019, the novel coronavirus disease pandemic (COVID-19) that
began in China had infected more than 56 million individuals worldwide
and accounted for more than 1.344.000 fatalities. With the dawn of this
novel coronavirus (SARS-CoV-2), there was a requirement to select
potential therapies that might effectively kill the virus, accelerate
the recovery, or decrease the case fatality rate. Besides the currently
available antiviral medications for HIV and HCV, the
chloroquine/hydroxychloroquine (CQ/HCQ) regimen with or without
azithromycin has been repurposed in China and was recommended by the
National Health Commission, China in mid-February 2020. By this time,
the selection of this regimen was based on its efficacy against the
previous SARS-CoV-1 virus and its potential to inhibit viral replication
of the SARS-CoV-2 in vitro. There was a shortage of robust clinical
proof about the effectiveness of this regimen against the novel
SARS-CoV-2. Therefore, extensive research effort has been made by
several researchers worldwide to investigate whether this regimen is
safe and effective for the management of COVID-19. This review article
provides a comprehensive overview of the CQ/HCQ regimen. It summarizes
the evaluating data from in vitro studies and clinical studies either
for the protection or the treatment against SARS-CoV-2. There is a sharp
difference of opinion about the role of CQ/HCQ regimen in treatment of
COVID-19. The literature data are controversial and contradictory due to
the diverse study design, population selection, dosage, regimen, and
outcome measures. Current evidence from the two largest
randomized-controlled trials (recovery and solidarity) suggests that the
HCQ regimen does not decrease COVID-19 patients’ mortality. However,
conflicting data were published from observational studies showing that
the drug might be sufficient. Therefore, more investigations are needed
to emphasize these findings.