Acessibilidade / Reportar erro

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

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).(11. 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.) 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).(22. 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-...
)

However, evidence from observational studies(33. 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.,44. 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.) involving hospitalized COVID-19 patients demonstrated the use of hydroxychloroquine in monotherapy(33. 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.) or combined with a macrolide(44. 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.)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.(44. 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.)

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
Instituto Israelita de Ensino e Pesquisa Albert Einstein Avenida Albert Einstein, 627/701 , 05651-901 São Paulo - SP, Tel.: (55 11) 2151 0904 - São Paulo - SP - Brazil
E-mail: revista@einstein.br