Antimalarials and macrolides

a review of off-label pharmacotherapies during the first wave of the SARS-CoV-2 pandemic

Authors

  • Paulo Michel Pinheiro Ferreira Department of Biophysics and Physiology http://orcid.org/0000-0001-6862-6497
  • Rayran Walter Ramos de Sousa Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Brazil,
  • Dalton Dittz Department of Biochemistry and Pharmacology, Federal University of Piauí, Teresina, Brazil,
  • João Marcelo de Castro e Sousa Department of Biochemistry and Pharmacology, Federal University of Piauí, Teresina, Brazil,
  • Francisco Leonardo Torres-Leal Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Brazil,
  • Daniel Pereira Bezerra Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil http://orcid.org/0000-0002-6774-2063

DOI:

https://doi.org/10.1590/s2175-97902023e21067

Keywords:

Aminoquinolines, Coronavirus, Comorbidity, Adverse effect, Hospitalization

Abstract

We critically analyzed clinical trials performed with chloroquine (CQ) and hydroxychloroquine (HCQ) with or without macrolides during the first wave of COVID-19 and discussed the design and limitations of peer-reviewed studies from January to July 2020. Seventeen studies were eligible for the discussion. CQ and HCQ did not demonstrate clinical advantages that justified their inclusion in therapeutic regimens of free prescription for treatment or prophylactic purposes, as suggested by health authorities, including in Brazil, during the first wave. Around August 2020, robust data had already indicated that pharmacological effects of CQ, HCQ and macrolides as anti-SARS-CoV-2 molecules were limited to in vitro conditions and largely based on retrospective trials with low quality and weak internal validity, which made evidence superficial for decision-making. Up to that point, most randomized and nonrandomized clinical trials did not reveal beneficial effects of CQ or HCQ with or without macrolides to reduce lethality, rate of intubation, days of hospitalization, respiratory support/mechanical ventilation requirements, duration, type and number of symptoms, and death and were unsuccessful in increasing virus elimination and/or days alive in hospitalized or ambulatory patients with COVID-19. In addition, many studies have demonstrated that side effects are more common in CQ-or HCQ-treated patients.

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2023-04-28

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Paulo Michel Pinheiro Ferreira, Rayran Walter Ramos de Sousa, Dalton Dittz, João Marcelo de Castro e Sousa, Francisco Leonardo Torres-Leal, & Daniel Pereira Bezerra. (2023). Antimalarials and macrolides: a review of off-label pharmacotherapies during the first wave of the SARS-CoV-2 pandemic. Brazilian Journal of Pharmaceutical Sciences, 59, e21067. https://doi.org/10.1590/s2175-97902023e21067

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