Researchers across the globe are scrambling to come up with treatments for the potentially deadly COVID-19 virus affecting people on nearly every continent. While no vaccine or antiviral treatments are yet available, part of the virus’s impact is that infected people can develop pneumonia. Now, researchers in Shanghai are aiming to evaluate the efficacy and safety of Plaquenil (hydroxychloroquine, Sanofi-Aventis) to treat that pneumonia.1
They’re investigating a dose of 400mg per day—which is standard for patients using it for rheumatoid arthritis, lupus and other inflammatory conditions.1,2 Plaquenil toxicity can cause problems such as retinopathy and retinal atrophy that can lead to central vision loss.3 Of course, these complications only seem to develop in patients on a long course of the medication.3 The COVID-19 study is only looking into a five-day course, so it shouldn’t be alarming to optometrists, says Sara Wedimayer, OD, an optometrist with the Ann Arbor Healthcare System’s Veterans Administration and a clinical instructor at the University of Michigan. Additionally, adverse ocular affects are rare, but patients taking Plaquenil require more stringent optometric oversight.2-4
“Plaquenil toxicity is not common and it tends to occur in patients who have received a cumulative dose of >1,000g,” Dr. Weidmayer explains. These patients are “chronically on a dose >5mg/kg/d of their actual weight, or have other risk factors. I think it’s good for optometrists to be aware that this study is going on, as I’m sure they’ll be asked questions, but even if 400mg of Plaquenil a day for five days ends up being regularly used for those with pneumonia from COVID-19, it’s very unlikely that those patients would have any significant eye-related side effects or toxicity from taking that short a course of the medication.”
A similar study from earlier this year shows Plaquenil can, in fact, address pneumonia.5 Specifically, it’s been used to reduce the risk of pneumocystis pneumonia in lupus patients.5
Plaquenil is commonly used in rheumatoid arthritis, but was originally developed as an antimalarial medication. A number of immunodeficient conditions may be treated with Plaquenil, including Sjögren’s syndrome, a number of autoimmune diseases (such as lupus) and Coxiella burnetii-related heart infections.4-6
1. Hongzhou Lu, Shanghai Public Health Clinical Center. US National Library of Medicine. Clinical Trials. clinicaltrials.gov/ct2/show/study/NCT04261517. March 4, 2020. Accessed March 13, 2020.
2. Demeritt M, Reynolds S, Shechtman D, Davidson J. How to succeed in Plaquenil screenings. Rev Optom. 2019;156(2):56-63.
3. Pandya H, Robinson M, Mandal N, Shah V. Hydroxychloroquine retinopathy: A review of imaging. Indian J Ophthalmol. 2015;63(7):570–4.
4. Marmor MF, Kellner U, Lai TY, et al. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology. 2016;123(6):1386-94.
5. Yeo K, Chen H, Chen Y, et al. Hydroxychloroquine may reduce risk of pneumocystis pneumonia in lupus patients: a nationwide, population-based case-control study. BMC Infectious Diseases. February 10, 2020 [Epub ahead of print].
6. Kersh G. Antimicrobial therapies for Q fever. Expert Rev Anti Infect Ther. 2013;11(11):1207-14.