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Hydroxychloroquine is protective to the heart, not harmful: A systematic review

Prodromos, C., New Microbes and New Infections, doi:10.1016/j.nmni.2020.100747
Aug 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 419 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments.
5,200+ studies for 112 treatments. c19hcq.org
Review concluding that HCQ/AZ does not cause Torsade de Pointes or related deaths, HCQ decreases cardiac events, and HCQ should not be restricted in use for COVID-19 patients because of fear of cardiac mortality.
Reviews covering hydroxychloroquine for COVID-19 include1-27.
Prodromos et al., 20 Aug 2020, peer-reviewed, 3 authors.
This PaperHCQAll
Hydroxychloroquine is protective to the heart, not harmful: a systematic review
C C Prodromos, T Rumschlag, T Perchyk
New Microbes and New Infections, doi:10.1016/j.nmni.2020.100747
Hydroxychloroquine (HCQ) has been shown to be at least somewhat effective in treating patients with coronavirus disease 2019 . Recently the US Food and Drug Administration and Centers for Disease Control and Prevention warnings of fatal cardiac toxicity from torsades de pointes (TDP) arrhythmia from HCQ receipt have been made, notwithstanding the long safe provision of HCQ to treat lupus and rheumatoid arthritis. This has resulted in restricted access of HCQ for COVID-19 treatment. We hypothesized that HCQ and azithromycin have not been reported to cause significant acute cardiac arrhythmic mortality. We performed a literature search for the effects of HCQ and azithromycin on the heart. No TDP or related deaths were found to have been reported as a result of HCQ and azithromycin receipt in the peer-reviewed literature. On the contrary, HCQ and azithromycin were both found to substantially reduce cardiac mortality and also decrease thrombosis, arrhythmia and cholesterol in treated patients in recent peer-reviewed studies and meeting presentations. HCQ and azithromycin do not cause TDP cardiac mortality; rather, HCQ decreases cardiac events. HCQ should not be restricted in COVID-19 patients out of fear of cardiac mortality.
Conflict of interest None declared.
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Abstract 2783', 'article-title': 'Hydroxychloroquine blood levels and risk of thrombotic events in ' 'systemic lupus erythematosus', 'author': 'Konig', 'year': '2019'}, { 'key': '10.1016/j.nmni.2020.100747_bib25', 'doi-asserted-by': 'crossref', 'first-page': '577', 'DOI': '10.1177/0961203306071872', 'article-title': 'Effect of antimalarials on thrombosis and survival in patients with ' 'systemic lupus erythematosus', 'volume': '15', 'author': 'Ruiz-Irastorza', 'year': '2006', 'journal-title': 'Lupus'}, { 'key': '10.1016/j.nmni.2020.100747_bib26', 'doi-asserted-by': 'crossref', 'first-page': '34', 'DOI': '10.1111/j.1753-5174.2009.00019.x', 'article-title': 'Drugs used in the treatment of rheumatoid arthritis: relationship ' 'between current use and cardiovascular risk factors', 'volume': '2', 'author': 'Rho', 'year': '2009', 'journal-title': 'Arch Drug Inf'}, { 'key': '10.1016/j.nmni.2020.100747_bib27', 'doi-asserted-by': 'crossref', 'DOI': '10.1002/cpt.1968', 'article-title': 'QT interval prolongation under hydroxychloroquine/azithromycin ' 'association for inpatients with SARS-CoV-2 lower respiratory tract ' 'infection', 'author': 'Bun', 'year': '2020', 'journal-title': 'Clin Pharmacol Ther'}, { 'key': '10.1016/j.nmni.2020.100747_bib28', 'doi-asserted-by': 'crossref', 'DOI': '10.1161/CIRCEP.120.008662', 'article-title': 'The effect of chloroquine, hydroxychloroquine and azithromycin on the ' 'corrected QT interval in patients with SARS-CoV-2 infection', 'volume': '13', 'author': 'Saleh', 'year': '2020', 'journal-title': 'Circ Arrhythm Electrophysiol'}, { 'key': '10.1016/j.nmni.2020.100747_bib29', 'doi-asserted-by': 'crossref', 'first-page': 'R151', 'DOI': '10.1186/ar2045', 'article-title': 'Disease-modifying antirheumatic drugs are associated with a reduced ' 'risk for cardiovascular disease in patients with rheumatoid arthritis: ' 'a case control study', 'volume': '8', 'author': 'Van Halm', 'year': '2006', 'journal-title': 'Arthritis Res Ther'}, { 'key': '10.1016/j.nmni.2020.100747_bib30', 'article-title': 'Hydroxychloroquine use is associated with decreased incident ' 'cardiovascular events in rheumatoid arthritis patients', 'volume': '5', 'author': 'Sharma', 'year': '2016', 'journal-title': 'J\xa0Am Heart Assoc'}, { 'key': '10.1016/j.nmni.2020.100747_bib31', 'first-page': '796', 'article-title': 'Long-term hydroxychloroquine therapy and risk of coronary artery ' 'disease in patients with systemic lupus erythematosus', 'volume': '8', 'author': 'Yang', 'year': '2019', 'journal-title': 'J\xa0Clin Med'}, { 'key': '10.1016/j.nmni.2020.100747_bib32', 'doi-asserted-by': 'crossref', 'first-page': '6615', 'DOI': '10.18632/oncotarget.23570', 'article-title': 'The association between hydroxychloroquine treatment and cardiovascular ' 'morbidity among rheumatoid arthritis patients', 'volume': '9', 'author': 'Shapiro', 'year': '2017', 'journal-title': 'Oncotarget'}, { 'key': '10.1016/j.nmni.2020.100747_bib33', 'series-title': 'Paper presented at: 2018 American College of Rheumatology ' '(ACR)/Association of Rheumatology Professionals (ARP) annual meeting; ' '19–24 October 2018; Chicago, IL. 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PulmCrit (EMCrit)', 'author': 'Farkas', 'year': '2015'}, { 'key': '10.1016/j.nmni.2020.100747_bib41', 'doi-asserted-by': 'crossref', 'first-page': '232', 'DOI': '10.1007/s12012-014-9289-4', 'article-title': 'Azithromycin can prolong QT interval and suppress ventricular ' 'contraction, but will not induce torsade de pointes', 'volume': '15', 'author': 'Ohara', 'year': '2015', 'journal-title': 'Cardiovasc Toxicol'}, { 'key': '10.1016/j.nmni.2020.100747_bib42', 'doi-asserted-by': 'crossref', 'DOI': '10.1371/journal.pone.0200474', 'article-title': 'Azithromycin therapy reduces cardiac inflammation and mitigates adverse ' 'cardiac remodeling after myocardial infarction: potential therapeutic ' 'targets in ischemic heart disease', 'volume': '13', 'author': 'Al-Darraji', 'year': '2018', 'journal-title': 'PLoS One'}, {'key': '10.1016/j.nmni.2020.100747_bib43', 'author': 'Swank'}, { 'key': '10.1016/j.nmni.2020.100747_bib44', 'doi-asserted-by': 'crossref', 'first-page': '1343', 'DOI': '10.1046/j.1538-7836.2003.00261.x', 'article-title': 'Inflammation and thrombosis', 'volume': '1', 'author': 'Esmon', 'year': '2003', 'journal-title': 'J\xa0Thromb Haemost'}, { 'key': '10.1016/j.nmni.2020.100747_bib45', 'doi-asserted-by': 'crossref', 'first-page': '155', 'DOI': '10.1038/s41584-020-0372-x', 'article-title': 'Mechanisms of action of hydroxychloroquine and chloroquine: ' 'implications for rheumatology', 'volume': '16', 'author': 'Schrezenmeier', 'year': '2020', 'journal-title': 'Nat Rev Rheumatol'}, { 'key': '10.1016/j.nmni.2020.100747_bib46', 'doi-asserted-by': 'crossref', 'first-page': '358', 'DOI': '10.1016/j.autrev.2014.12.006', 'article-title': 'Hydroxychloroquine as an antithrombotic in antiphospholipid syndrome', 'volume': '14', 'author': 'Belizna', 'year': '2015', 'journal-title': 'Autoimmun Rev'}], 'container-title': 'New Microbes and New Infections', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://api.elsevier.com/content/article/PII:S2052297520300998?httpAccept=text/xml', 'content-type': 'text/xml', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://api.elsevier.com/content/article/PII:S2052297520300998?httpAccept=text/plain', 'content-type': 'text/plain', 'content-version': 'vor', 'intended-application': 'text-mining'}], 'deposited': { 'date-parts': [[2020, 10, 9]], 'date-time': '2020-10-09T00:04:48Z', 'timestamp': 1602201888000}, 'score': 1, 'resource': {'primary': {'URL': 'https://linkinghub.elsevier.com/retrieve/pii/S2052297520300998'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 9]]}, 'references-count': 43, 'alternative-id': ['S2052297520300998'], 'URL': 'http://dx.doi.org/10.1016/j.nmni.2020.100747', 'relation': {}, 'ISSN': ['2052-2975'], 'subject': [], 'container-title-short': 'New Microbes and New Infections', 'published': {'date-parts': [[2020, 9]]}, 'article-number': '100747'}
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