Chloroquine and Hydroxychloroquine for the Prevention or Treatment of COVID-19 in Africa: Caution for Inappropriate Off-label Use in Healthcare Settings
Chloroquine and Hydroxychloroquine for the Prevention or Treatment of COVID-19 in Africa: Caution for Inappropriate Off-label Use in Healthcare Settings
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DOI：
10.4269/ajtmh.20-0290
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发表时间：
2020-06-01
影响因子：
3.3
通讯作者：
Nachega, Jean B.
中科院分区：
文献类型：
--
作者：
Abena, Pascale M.;Decloedt, Eric H.;Nachega, Jean B.
新型严重急性呼吸综合征--冠状病毒-2大流行已蔓延至非洲，那里几乎所有国家都报告了经实验室确认的新型冠状病毒病(新冠肺炎)病例。尽管目前正在进行抗病毒和免疫治疗的临床试验，但目前还没有经过科学验证的、临床有效的治疗新冠肺炎的药物。在重新调整用途的药物中，常用的抗疟药氯喹(CQ)和羟基氯喹(HCQ)已成为全球科学、媒体和政治关注的焦点，尽管缺乏支持其有效性的随机临床试验。氯喹在全球已经使用了大约75年，被世界卫生组织列为治疗疟疾的基本药物。羟氯喹主要用于治疗自身免疫性疾病。然而，CQ/HCQ治疗新冠肺炎的有效性和安全性仍有待确定。不分青红皂白地推广和广泛使用CQ/HCQ导致了广泛的短缺、自我治疗和致命的过量使用。短缺和市场价格上涨使所有国家都容易受到不合格和假冒医疗产品的影响，由于其医疗保健系统的限制，非洲的安全问题尤其令人担忧。非洲迫切需要一个跨洲合作网络，以协调生产、分销和上市后监督，并与任何经批准的新冠肺炎药物的低成本分销保持一致；这将是理想的，这将利用现有的全球援助努力。与此同时，非洲国家应大力考虑实施处方药监测计划，以确保在这场大流行期间，任何非标签的CQ/HCQ使用都是适当和有益的。
The novel severe acute respiratory syndrome-coronavirus-2 pandemic has spread to Africa, where nearly all countries have reported laboratory-confirmed cases of novel coronavirus disease (COVID-19). Although there are ongoing clinical trials of repurposed and investigational antiviral and immune-based therapies, there are as yet no scientifically proven, clinically effective pharmacological treatments for COVID-19. Among the repurposed drugs, the commonly used antimalarials chloroquine (CQ) and hydroxychloroquine (HCQ) have become the focus of global scientific, media, and political attention despite a lack of randomized clinical trials supporting their efficacy. Chloroquine has been used worldwide for about 75 years and is listed by the WHO as an essential medicine to treat malaria. Hydroxychloroquine is mainly used as a therapy for autoimmune diseases. However, the efficacy and safety of CQ/HCQ for the treatment of COVID-19 remains to be defined. Indiscriminate promotion and widespread use of CQ/HCQ have led to extensive shortages, self-treatment, and fatal overdoses. Shortages and increased market prices leave all countries vulnerable to substandard and falsified medical products, and safety issues are especially concerning for Africa because of its healthcare system limitations. Much needed in Africa is a cross-continental collaborative network for coordinated production, distribution, and post-marketing surveillance aligned to low-cost distribution of any approved COVID-19 drug; this would ideally be piggybacked on existing global aid efforts. Meanwhile, African countries should strongly consider implementing prescription monitoring schemes to ensure that any off-label CQ/HCQ use is appropriate and beneficial during this pandemic.