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Use of Chloroquine and Hydroxychloroquine on Patients with COVID-19 4/9/2020

Recently, the American Academy of Ophthalmology (AAO) made a statement about the use of Chloroquine and Hydroxychloroquine in patients with COVID19. In many of the ongoing studies, which are being conducted globally, they exceed the maximum daily amounts considered safe for patients with long-term therapy (usually this dose is <5mg/kg of the real weight for hydroxychloroquine) for rheumatic diseases and other chronic diseases (WF Mieler, MD, staff communication, March 25, 2020).

Furthermore, it was also highlighted that the risk of irreversible Maculopathy for these higher doses for short periods of time is unknown. Suggesting that patients should be informed of the potential for macular toxicity before starting therapy. In addition, the need for baseline fundus examination is recommended in patients who require the use of chloroquine or hydroxycloroquina in the long term, however, this is not known for patients who require it in short periods of time. Additional diagnostic testing, such as an Electroretinography (ERG), prior to placing a patient on hydroxychloroquine for treatment of COVID-19 is likely unnecessary due to the short treatment duration.

With regard to the use of Chloroquine and Hydroxychloroquine in patients with COVID-19, experiences in different countries such as Korea, India and France, among others, have shown the possibility that the use of Plaquenil (hydroxychloroquine) helps mitigate the inflammatory cascade of the lung which is what leads to the critical state of acute respiratory syndrome in COVID. However, there is no clinical study to support it.

Plaquenil is used extensively for the prevention of malaria in a healthy population, and for the treatment of rheumatological diseases. At CODET we have followed hundreds of rheumatological patients with chronic use of Plaquenil, and we have found the safe side of Plaquenil. However, because it is not an approved drug to treat viral diseases, it should be used with caution and only under strict prescription and medical supervision.

Therefore, the AAO has recommended that until more is learned about the toxicity associated with current regimens, decisions should be made on an individual basis, taking into consideration any pre-existing retinal disease. As in all cases, the Academy urges ophthalmologists to make decisions guided by available scientific evidence.

At CODET Vision Institute, we will be closely following all relevant updates regarding this issue and we’re here for all of your questions and concerns.

Source:
Important coronavirus updates for ophthalmologists. (2020) American Academy of Ophthalmology

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