One of the more difficult facts about the current status of treatments for the COVID-19 virus is that there are no treatments. The best we can do today is to treat the symptoms.
One of the potential treatments that have received a lot of press is Chloroquine. Chloroquine is an older drug used to treat illnesses like malaria and some other autoimmune disease like lupus and rheumatoid arthritis. Chloroquine is being evaluated as a possible treatment for the Coronavirus, COVID-19, because it inhibits the proliferation of the virus in cell cultures. This inhibition indicates that it could reduce the viral load of patients with more severe disease progressions. Also, there have been some clinicians in France who had reported that when they gave their COVID-19 patients chloroquine, they seemed to improve.
In a systematic review (https://www.sciencedirect.com/science/article/pii/S0883944120303907?via%3Dihub) of the evidence regarding Chloroquine for the treatment of COVID-19 using PubMed, EMBASE, and three trials, six articles (one narrative letter, one in-vitro study, one editorial, expert consensus paper, two national guideline documents) and 23 ongoing clinical trials in China. Chloroquine seems to be effective in limiting the replication of SARS-CoV-2 (the virus causing COVID-19) in vitro.
The review concluded that there is a rationale, preclinical evidence of effectiveness, and evidence of safety from long-time clinical use to justify clinical research on Chloroquine in patients with COVID-19. However, clinical use should either adhere to the Monitored Emergency Use of Unregistered Interventions (MEURI) framework or be ethically approved as a trial, as stated by the World Health Organization. Safety data and data from high-quality clinical trials are urgently needed.
Since this study was completed, a small phase II study in Brazil, in which 11 patients died of fatal arrhythmias or heart muscle damage, shows how risky providing high-dose treatment of COVID-19 patients with Chloroquine can be, especially in combination with the antibiotic azithromycin or other drugs.
The study, which was financed by the Brazilian government and whose preliminary results were published on the scientific portal MedRxiv, involved 81 hospital patients. Altogether 440 patients were ultimately supposed to participate in the phase IIb study "CloroCovid-19.
There should still be interest in further studies of Chloroquine for the treatment of COVID-19; however, the trials should proceed carefully given the risk of death from high doses of Chloroquine itself.
