Hydroxychloroquine (HCQ) Update for 04/08/20

Hydroxychloroquine (HCQ) Update for 04/08/20

As you might expect, Natalie and I are receiving requests for prescriptions for HCQ. We’re refusing, based on the side-effect profile (especially for heart or kidney disease patients) and the lack of reliable data. And that doesn’t mean a randomized, double-blind, placebo controlled study. I’d go with the real-time experience of a group of NYC physicians, where more than 1,000 patients are being treated with HCQ as we speak. From a biochemist perspective, I can say that the drug is unlikely to be helpful in the early stages of infection. It is an immune-suppressing drug. And in the later stage, when immune cytokines are causing inflammation in the airways, DHEA has been shown to have similar activity without any of the risks. This is not my opinion. The evidence is in the medical literature for anyone who is interested.

REFS: DHEA as Immunmodulator
1. Eur J Immunol. 2015 Sep;45(9):2529-41. HIV-TB coinfection impairs CD8(+) T-cell differentiation and function while DHEA improves cytotoxic antitubercular immune responses.
Suarez GV, Angerami MT, et al.

2. FASEB J. 2013 Feb;27(2):725-37. Neurosteroid-mediated regulation of brain innate immunity in HIV/AIDS: DHEA-S suppresses neurovirulence. Maingat FG, Polyak MJ, et al.

3. J Med Virol. 1988 Nov;26(3):301-14.
Protection against acute lethal viral infections with the native steroid dehydroepiandrosterone (DHEA).
Loria RM, Inge TH, Cook SS, Szakal AK, Regelson W.

REFS. Hydroxychloroquine and cardiac adverse effects
1. Roos JM, Aubry MC, Edwards WD. Chloroquine cardiotoxicity: clinicopathologic features in three patients and comparison with three patients with Fabry disease. Cardiovasc Pathol 2002; 11: 277–283

2. Nord JE, Shah PK, Rinaldi RZ, et al. Hydroxychloroquine cardiotoxicity in systemic lupus erythematosus: a report of 2 cases and review of the literature. Semin Ann Rheum Dis 2004; 33: 336–351

3 Keating RJ, Bhatia S, Amin S, et al. Hydroxychloroquine-induced cardiotoxicity in a 39-year-old woman with systemic lupus erythematosus and systolic dysfunction. J Am Soc Echocardiogr 2005; 18: 981.

4. Cotroneo J, Sleik KM, Rene Rodriguez E, et al. Hydroxychloroquine-induced restrictive cardiomyopathy. Eur J Echocardiogr 2007; 8: 247–251

5. Soong TR, Barouch LA, Champion HC, et al. New clinical and ultrastructural findings in hydroxychloroquine-induced cardiomyopathy – a report of 2 cases. Hum Pathol 2007; 38: 1858–1863

6. Manohar VA, Moder KG, Edwards WD, et al. Restrictive cardiomyopathy secondary to hydroxychloroquine therapy. J Rheumatol 2009; 36: 440–441

7. Lee JH, Chung WB, Kang JH, et al. A case of chloroquine-induced cardiomyopathy that presented as sick sinus syndrome. Korean Circ J 2010; 40: 604–608 [PMC free article]

8. Muthukrishnan P, Roukoz H, Grafton G, et al. Hydroxychloroquine-induced cardiomyopathy: a case report. Circ Heart Fail 2011; 4: e7–e8

9. Newton-Cheh C, Lin AE, Baggish AL, et al. Case records of the Massachusetts General Hospital. Case 11-2011. A 47-year-old man with systemic lupus erythematosus and heart failure. N Engl J Med 2011; 364: 1450–1460

10. Hartmann M, Meek IL, van Houwelingen GK, et al. Acute left ventricular failure in a patient with hydroxychloroquine-induced cardiomyopathy. Neth Heart J 2011; 19: 482–485 [PMC free article] [PubMed] [Google Scholar]

11. Frustaci A, Morgante E, Antuzzi D, et al. Inhibition of cardiomyocyte lysosomal activity in hydroxychloroquine cardiomyopathy. Int J Cardiol 2012; 157: 117–119

12. Chen CY, Wang FL, Lin CC. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin Toxicol (Phila) 2006; 44: 173–175

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