Role for antimalarials in the management of COVID-19

Curr Opin Rheumatol. 2020 Sep;32(5):449-457. doi: 10.1097/BOR.0000000000000731.

Abstract

Purpose of review: The current review highlights recent insights into direct antiviral effects by antimalarials against severe acute respiratory syndrome (SARS)-CoV-2 and other viruses and their potential indirect effects on the host by avoiding exaggerated immune responses (reduced cytokine release, Toll-like receptor response, antigen presentation related to lysosomal processing).

Recent findings: Currently, there is a large debate on the use of antimalarials for prophylaxis and treatment of SARS-CoV-2-induced disease based on preclinical in-vitro data, small case series and extrapolation from earlier studies of their effect on intracellular pathogens, including many viruses. Hydroxychloroquine (HCQ) or chloroquine have not demonstrated robust efficacy in prior randomized controlled studies against several other viruses. In-vitro data indicate a reduced viral replication of SARS-CoV-2. Especially immunomodulatory effects of antimalarials might also contribute to a clinical efficacy. For SARS-CoV-2 various large studies will provide answers as to whether antimalarials have a place in prophylaxis or treatment of the acute virus infection with SARS-CoV-2 but compelling data are missing so far.

Summary: In-vitro data provide a theoretical framework for an efficacy of antimalarials in SARS-CoV-2-induced disease but clinical proof is currently missing.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Antimalarials / therapeutic use*
  • Antiviral Agents / therapeutic use
  • Betacoronavirus / drug effects*
  • COVID-19
  • Chloroquine / therapeutic use
  • Coronavirus Infections / drug therapy*
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • SARS-CoV-2

Substances

  • Antimalarials
  • Antiviral Agents
  • Hydroxychloroquine
  • Chloroquine

Supplementary concepts

  • COVID-19 drug treatment