HCQ, Immune System, and COVID-19: Unanswered Questions

Researchers say that using hydroxychloroquine (HCQ) to treat COVID-19 is surrounded by more hype than the data and little is known about the effects of the virus on the immune system. I am.

“[T]He has a known strong immunomodulatory effect [HCQ and its close cousin chloroquine] Supporting their use in the treatment of autoimmune diseases, providing the original rationale component for their use in COVID-19 patients, and indeed their usefulness in the context of the treatment of this respiratory viral infection There is a possibility of damaging the property. Mark Poznansky, PhD, and colleagues at the Massachusetts General Hospital in Boston To FASEB journal.

Poznansky wants him to look into the literature because his own clinical experience is that there are many COVID-19 patients with hydroxychloroquine when he was undergoing clinical services and they are “not doing very well”. I said that is one of the reasons.

“It wasn’t a” wow, this drug keeps the patient away from the ICU “type of feeling,” he said. MedPage today Separately.

The widespread use of the immunosuppressant hydroxychloroquine made Poznansky unusual and pointed out that clinicians should carefully consider this particular drug in the context of acute viral infections.

“There’s a lot of literature on the fact that hydroxychloroquine is quite immunosuppressive. Even an article in the Journal of Immunology said it dramatically reduced immune function. And I said,” hey Wait, we’re using this in patients with acute viral infections, “Poznansky noted.

As the group’s paper points out, he was not the only one observing this phenomenon. “The first case report from China led to the first widespread adoption of HCQ, and less so. [chloroquine] For many hospitalized COVID-19 patients worldwide. “

In fact, Michael Liu, AB of Oxford University in the UK, combined Google search such as “buy” and “order” and retail sites such as Amazon and Walmart with hydroxychloroquine and chloroquine from February 1st to March 29th. The letter JAMA Internal MedicineThey said that the eccentric businessman Elon Musk approved the use of the drug on March 16, a publicly announced speech by President Trump on March 19, and a chloroquine-related addiction on March 22. We have identified important dates, such as the first report.

The researchers found that the biggest spike occurred after a prominent public talked very much about the drug: a search for hydroxychloroquine purchases was 1,389% higher than the previous six weeks, and a search for chloroquine was 442. % High, searches remained high even after news coverage Drug-related addiction.

“The findings on the clinical efficacy of chloroquine and hydroxychloroquine were not conclusive at the time these drugs were advertised,” Liu and colleagues said.

Poznansky and colleagues pointed to the lack of clinical evidence for this drug, for example, the “widespread secondary effects” of hydroxychloroquine, or “strong immune regulation,” which, although effective in regulating the immune system, It is not clear how these effects of affect people with acute COVID-19. ”

“We don’t fully understand the immune response to COVID-19, and it’s only a few months,” Poznansky said. “We don’t fully understand the immune response to HIV, which has been around for decades. We apply immunomodulators to diseases where the role of the immune system in fighting the virus is unknown. doing.”

In addition, the key immune function that you say is important for fighting the virus seems to be suppressed by hydroxychloroquine: “Whether hydroxychloroquine downregulates the COVID-19 immune response. I haven’t tested it directly. It’s a necessary gap and is bridged here. “

Clinical trials addressing the use of hydroxychloroquine hope to provide some of these answers. Poznansky said that research needs to determine the effect of hydroxychloroquine on the clinical progression of the disease, and the researchers “have a complete understanding of what needs to be measured in the context of hydroxychloroquine associated with immune function. No. “

“Does it suppress cytokine storms? Do patients with hydroxychloroquine have lower levels of cytokines than patients without hydroxychloroquine?” Poznansky asked. “This kind of thinking needs to be applied to the use of COVID-19 immunomodulators.”

Last updated: April 30, 2020