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).(¹) 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).(²)

However, evidence from observational studies(³,⁴) involving hospitalized COVID-19 patients demonstrated the use of hydroxychloroquine in monotherapy(³) or combined with a macrolide(⁴)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.(⁴)

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