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Critical Care Medicine

Caution Needed on the Use of Chloroquine and Hydroxychloroquine for Coronavirus Disease 2019

Educational Objective
To understand the need for rigorous testing regarding potential treatments for COVID-19

1 Credit CME

JAMA Network Open

Published Online: April 24, 2020

Editorial

Article Information and Disclosures

Stephan D. Fihn, MD, MPH^1,2,3;

Eli Perencevich, MD, MS^4,5,6;

Steven M. Bradley, MD, MPH^6,7

Author Affiliations

¹Department of Medicine, Harborview Medical Center, University of Washington, Seattle
²Department of Health Services, Harborview Medical Center, University of Washington, Seattle
³Deputy Editor, JAMA Network Open
⁴Center for Access an Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
⁵Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
⁶Associate Editor, JAMA Network Open
⁷Healthcare Delivery Innovation Center, Minneapolis Heart Institute, Minneapolis, Minnesota

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Original Investigation

Effect of High vs Lose Dosage of Chloroquine Diphosphate on SARS-CoV-2 Infection

Mayla Gabriela Silva Borba, MD; Fernando Fonseca Almeida Val, PhD; Vanderson Souza Sampaio, PhD; Marcia Almeida Araújo Alexandre, MD; Gisely Cardoso Melo, PhD; Marcelo Brito, MSc; Maria Paula Gomes Mourão, MD; José Diego Brito-Sousa, MSc; Djane Baía-da-Silva, PhD; Marcus Vinitius Farias Guerra, MD; Ludhmila Abrahão Hajjar, MD; Rosemary Costa Pinto, BSc; Antonio Alcirley Silva Balieiro, MSc; Antônio Guilherme Fonseca Pacheco, MD; James Dean Oliveira Santos Jr, PhD; Felipe Gomes Naveca, PhD; Mariana Simão Xavier, MSc; André Machado Siqueira, MD; Alexandre Schwarzbold, MD; Júlio Croda, MD; Maurício Lacerda Nogueira, MD; Gustavo Adolfo Sierra Romero, MD; Quique Bassat, MD; Cor Jesus Fontes, MD; Bernardino Cláudio Albuquerque, MD; Cláudio-Tadeu Daniel-Ribeiro, MD; Wuelton Marcelo Monteiro, PhD; Marcus Vinícius Guimarães Lacerda, MD; for the CloroCovid-19 Team
Original Investigation

Treatment With Hydroxychloroquine or Azithromycin and In-Hospital Mortality in Patients With COVID-19

Eli S. Rosenberg, PhD; Elizabeth M. Dufort, MD; Tomoko Udo, PhD; Larissa A. Wilberschied, MS; Jessica Kumar, DO; James Tesoriero, PhD; Patti Weinberg, PA; James Kirkwood, MPH; Alison Muse, MPH; Jack DeHovitz, MD; Debra S. Blog, MD; Brad Hutton, MPH; David R. Holtgrave, PhD; Howard A. Zucker, MD
Viewpoint

Emergency Use Authorizations During the COVID-19 Pandemic—Lessons From Hydroxychloroquine for Upcoming Vaccine Approval

Kyle Thomson, JD, MPH; Herschel Nachlis, PhD

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The coronavirus disease 2019 (COVID-19) pandemic has propagated global shock waves that have disrupted nearly every aspect of human endeavor. Nowhere has this been more evident than in health care. Health care delivery systems in some locations have been overwhelmed, and even those not so severely affected have had to reorganize and restructure to concentrate resources to meet an anticipated surge of patients who are critically ill. In the absence of rapid and reliable testing, proven therapies, or even standard protocols for treatment, physicians and other clinicians have been forced to improvise, in some cases relying on the thinnest of evidence, to treat patients who are desperately ill.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Fihn SD et al. JAMA Network Open.

Published: April 24, 2020. doi:10.1001/jamanetworkopen.2020.9035

Correction: This article was corrected on April 27, 2020, to fix an incorrect drug name in the third paragraph.

Corresponding Author: Stephan D. Fihn, MD, MPH, Department of Medicine, Harborview Medical Center, University of Washington, 325 Ninth Ave, PO Box 359780, Seattle, WA 98104 (sfihn@uw.edu).

Conflict of Interest Disclosures: None reported.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

References

The DataLab. Covid-19 trials tracker. Accessed April 21, 2020. http://covid19.trialstracker.net/

Borba MGS , Val FFA , Sampaio VS , et al; CloroCovid-19 Team. Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial. JAMA Netw Open. 2020;3(4):e208857. doi:10.1001/jamanetworkopen.2020.8857 Google Scholar

Gao J , Tian Z , Yang X . Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72-73. doi:10.5582/bst.2020.01047 PubMed Google Scholar Crossref

Gautret P , Lagier J-C , Parola P , et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. March 2020:105949. doi:10.1016/j.ijantimicag.2020.105949 PubMed Google Scholar

International Society of Antimicrobial Chemotherapy. Statement on IJAA paper. Accessed April 21, 2020. https://www.isac.world/news-and-publications/official-isac-statement

US Food and Drug Administration. FDA drug safety communication: azithromycin (Zithromax or Zmax) and the risk of potentially fatal heart rhythms. Updated March 12, 2013. Accessed April 21, 2020. https://www.fda.gov/Drugs/DrugSafety/ucm341822.htm

Neuman S . Man dies, woman hospitalized after taking form of chloroquine to prevent COVID-19. National Public Radio. March 24, 2020. Accessed April 21, 2020. https://www.npr.org/sections/coronavirus-live-updates/2020/03/24/820512107/man-dies-woman-hospitalized-after-taking-form-of-chloroquine-to-prevent-covid-19

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.