Chloroquine (CQ) and its structural analog hydroxychloroquine (HCQ) were used as the
primary and most successful drugs against malaria. They are also efficacious anti-inflammatory
agents for the treatment of rheumatoid arthritis and lupus erythematosus.[[1]]
CQ was reported in 2005 to be effective in preventing the spread of coronavirus (CoV)
that caused severe acute respiratory syndrome (SARS) in cell culture.[[2]] It was also found to inhibit HIV replication and glycosylation in CD4 cell lines
in a dose-dependent manner.[[3]] This broad-spectrum antiviral activity of CQ was suggested to be due to an increase
in the endosomal pH required for virus entry and replication,[[4]] and as well as to the reduced glycosylation of ACE2 which is believed to be the entry point of COVID-19 into the cell.[[5]]
The interest in HQ and HCQ has been raised again by the emergence of coronavirus disease
2019 (COVID-19) in Wuhan, China, in December 2019. Because of its previously reported
effectiveness against SARS CoV, CQ, and HCQ were suggested as a possible treatment
of COVID-19-associated pneumonia. The first multicenter clinical trials conducted
in China showed that CQ has apparent efficacy and acceptable safety against COVID-19-associated
pneumonia.[[5]],[[6]] Another study conducted on 36 patients in France showed that patients treated with
HCQ were significantly more likely to test negative for the virus on Day 6 than patients
in the control group (70% vs. 12.5% virologically cured, P < 0.001).[[7]] These clinical studies suffer from many limitations; most important is the small
number of patients included, which would lower the statistical power. Consequently,
many other countries, including Britain, Canada, USA, Germany, and France, are conducting
clinical trials on the use of CQ and HCQ in COVID-19 using a large number of patients
and well-defined endpoints.[[8]] The results of these studies will be available in a few months. Up-to-date, there
are no specific pharmacological treatments for COVID-19. Considering the current Libyan
situation, HQ and HCQ, with their known clinical safety profile from long-time clinical
use, would provide a rationale choice for patients with COVID-19. However, this off-label
use should be done as a clinical trial through a certain framework ethically approved
by the ministry of health and as stated by the World Health Organization.[[9]],[[10]]
