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Einstein (São Paulo)

Print version ISSN 1679-4508On-line version ISSN 2317-6385

Einstein (São Paulo) vol.18  São Paulo  2020  Epub Aug 05, 2020

https://doi.org/10.31744/einstein_journal/2020ce5931 

LETTER TO THE EDITOR

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

Thiago Domingos Corrêa1 
http://orcid.org/0000-0001-9546-3910

Gustavo Faissol Janot de Matos1 
http://orcid.org/0000-0001-9996-7040

Bruno de Arruda Bravim1 
http://orcid.org/0000-0001-8290-8554

Ricardo Luiz Cordioli1 
http://orcid.org/0000-0001-7521-399X

Alejandra del Pilar Gallardo Garrido1 
http://orcid.org/0000-0002-2469-185X

Murillo Santucci Cesar de Assuncao1 
http://orcid.org/0000-0002-0741-4869

Carmen Silvia Valente Barbas1 
http://orcid.org/0000-0002-3922-6256

Karina Tavares Timenetsky1 
http://orcid.org/0000-0002-4176-2445

Roseny dos Reis Rodrigues1 
http://orcid.org/0000-0002-3796-5952

Hélio Penna Guimarães1 
http://orcid.org/0000-0001-5523-1015

Roberto Rabello Filho1 
http://orcid.org/0000-0001-7018-224X

Frederico Polito Lomar1 
http://orcid.org/0000-0002-7856-0716

Farah Christina de La Cruz Scarin1 
http://orcid.org/0000-0001-5724-6448

Carla Luciana Batista1 
http://orcid.org/0000-0001-8628-0792

Adriano José Pereira1 
http://orcid.org/0000-0002-9467-6516

João Carlos de Campos Guerra1 
http://orcid.org/0000-0002-4156-529X

Bárbara Vieira Carneiro1 
http://orcid.org/0000-0001-7858-9730

Ricardo Kenji Nawa1 
http://orcid.org/0000-0002-0852-7013

Rodrigo Martins Brandão1 
http://orcid.org/0000-0003-1442-9097

Antônio Eduardo Pereira Pesaro1 
http://orcid.org/0000-0003-3133-4989

Moacyr Silva Júnior1 
http://orcid.org/0000-0002-6479-1708

Fabricio Rodrigues Torres de Carvalho1 
http://orcid.org/0000-0001-8712-269X

Cilene Saghabi de Medeiros Silva1 
http://orcid.org/0000-0003-3544-6646

Ana Claudia Ferraz de Almeida1 
http://orcid.org/0000-0002-5339-0415

Marcelo Franken1 
http://orcid.org/0000-0002-4286-8559

Marcele Liliane Pesavento1 
http://orcid.org/0000-0001-7391-8208

Raquel Afonso Caserta Eid1 
http://orcid.org/0000-0002-8241-3241

Leonardo José Rolim Ferraz1 
http://orcid.org/0000-0003-1822-1568

1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.


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. [ Links ]

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 [ Links ]

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. [ Links ]

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. [ Links ]

Corresponding author: Thiago Domingos Corrêa Avenida Albert Einstein, 627/701, 5º andar – Morumbi Zip code: 05652-900 – São Paulo, SP, Brazil Phone: (55 11) 2151-0603 E-mail: thiago.correa@einstein.br

Creative Commons License  This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.