Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review
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CLINICAL PHARMACOLOGY (L BRUNETTI, SECTION EDITOR)
Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review Alzira Alves de Siqueira Carvalho 1 Accepted: 29 September 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Concerning adverse neuromuscular effects, there are quite a few reports about the incidence and prevalence of chloroquine (CQ) and hydroxychloroquine (HCQ) myopathy. Given the above, I decided to explore the relationships of these drugs with skeletal muscle in an attempt to clarify how they affect the muscle now and in the future, as millions of people are using CQ and HCQ. Recent Findings The literature review identified 28 publications about CQ/HCQ myopathy, totaling 56 patients, from 1963 to 2020. A compilation of all patients was carried out by computing demographic features, clinical aspects, laboratory exams, and clinical evolution. All articles but two represented a large series about incidence and prevalence of the myopathy. Fifty-nine percent used QC, mean daily dose was 393 mg per day, and mean duration of treatment was 37 months. The predominant underlying diseases were rheumatoid arthritis (42.8%) and lupus erythematosus (26.8%). Respiratory distress was present in 12.5% in patients with proximal muscle weakness (87.2%). Dysphagia and cervical and axial weakness were observed in a smaller percentage. Creatine kinase was elevated in 60.7%, and EMG showed a myopathic pattern in 54%. Muscle biopsy showed a vacuolar pattern in 53.7%, and curvilinear bodies (CB) were the predominant ultrastructural finding (86.8%). After drug withdrawal, 85.4% of patients improved, and 12.7% died from other causes than myopathy. Summary CQ and HCQ myopathy has been known for a long time, but the incidence is low, being described only with long-term use. The use of these drugs for a short period has not been reported, although a prolonged elimination half-life of these drugs actually exists. Keywords Chloroquine . Hydroxychloroquine . Myopathy . Myotoxicity
Introduction The world faces the deadly COVID-19 pandemic, the most challenging situation in a century that we have confronted. Currently, emerging therapies and repurposing of old drugs have been considered therapeutic strategies, including chloroquine (CQ) and hydroxychloroquine (HCQ) [1, 2], both drugs showing activity against COVID-19 in vitro [3]; however, the level of preclinical and clinical data is not strong and must be approved by a higher level of evidence [4, 5].
This article is part of the Topical Collection on Clinical Pharmacology * Alzira Alves de Siqueira Carvalho [email protected] 1
Department of Neurosciences - Neuromuscular Service, Centro Universitário Saúde ABC, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André, São Paulo 09060-870, Brazil
Specifically, at the beginning of 1943, the incidental repurposing of antimalarial drugs (quinacrine and CQ) was demonstrated after a crucial improvement of cutaneous rashes and arthritis in soldiers on malaria prophylaxis. Sometime
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