TY - JOUR
T1 - Extracorporeal treatment for chloroquine, hydroxychloroquine, and quinine poisoning
T2 - Systematic review and recommendations from the EXTRIP workgroup
AU - EXTRIP workgroup
AU - Berling, Ingrid
AU - King, Joshua D.
AU - Shepherd, Greene
AU - Hoffman, Robert S.
AU - Alhatali, Badria
AU - Lavergne, Valery
AU - Roberts, Darren M.
AU - Gosselin, Sophie
AU - Wilson, Gabrielle
AU - Nolin, Thomas D.
AU - Ghannoum, Marc
AU - Anseeuw, Kurt
AU - Bird, Steven
AU - Bunchman, Timothy
AU - Bouchard, Josée
AU - Calello, Diane
AU - Chin, Paul
AU - Doi, Kent
AU - Galvao, Tais
AU - Goldfarb, David
AU - Hassanian, Hossein
AU - Hoegberg, Lotte
AU - Kallab, Siba
AU - Kebede, Sofia
AU - Kielstein, Jan
AU - Lewington, Andrew
AU - Li, Yi
AU - Macedo, Etienne
AU - MacLaren, Rob
AU - Megarbane, Bruno
AU - Mowry, Jim
AU - Osterman, Marlies
AU - Peng, Ai
AU - Roy, Jean Philippe
AU - Vijayan, Anitha
AU - Walsh, Steven
AU - Wong, Anselm
AU - Wood, David
AU - Yates, Christopher
N1 - Funding Information:
Thomas D. Nolin reports personal fees from MediBeacon, personal fees from CytoSorbents, and other from McGraw-Hill Education outside the submitted work. Marc Ghannoum is a scholar of the Fonds de Recherche du Québec - Santé. Darren Roberts acknowledges support of St. Vincent’s Centre for Applied Medical Research Clinician “Buy-Out” Program. All remaining authors have nothing to disclose.
Publisher Copyright:
Copyright © 2020 by the American Society of Nephrology
PY - 2020/10
Y1 - 2020/10
N2 - Background Although chloroquine, hydroxychloroquine, and quinine are used for a range of medical conditions, recent research suggested a potential role in treating COVID-19. The resultant increase in prescribing was accompanied by an increase in adverse events, including severe toxicity and death. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup sought to determine the effect of and indications for extracorporeal treatments in cases of poisoning with these drugs. Methods We conducted systematic reviews of the literature, screened studies, extracted data, and summarized findings following published EXTRIP methods. Results A total of 44 studies (three in vitro studies, two animal studies, 28 patient reports or patient series, and 11 pharmacokinetic studies) met inclusion criteria regarding the effect of extracorporeal treatments. Toxicokinetic or pharmacokinetic analysis was available for 61 patients (13 chloroquine, three hydroxychloroquine, and 45 quinine). Clinical data were available for analysis from 38 patients, including 12 with chloroquine toxicity, one with hydroxychloroquine toxicity, and 25 with quinine toxicity. All three drugs were classified as non-dialyzable (not amenable to clinically significant removal by extracorporeal treatments). The available data do not support using extracorporeal treatments in addition to standard care for patients severely poisoned with either chloroquine or quinine (strong recommendation, very low quality of evidence). Although hydroxychloroquine was assessed as being non-dialyzable, the clinical evidence was not sufficient to support a formal recommendation regarding the use of extracorporeal treatments for this drug. Conclusions On the basis of our systematic review and analysis, the EXTRIP workgroup recommends against using extracorporeal methods to enhance elimination of these drugs in patients with severe chloroquine or quinine poisoning.
AB - Background Although chloroquine, hydroxychloroquine, and quinine are used for a range of medical conditions, recent research suggested a potential role in treating COVID-19. The resultant increase in prescribing was accompanied by an increase in adverse events, including severe toxicity and death. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup sought to determine the effect of and indications for extracorporeal treatments in cases of poisoning with these drugs. Methods We conducted systematic reviews of the literature, screened studies, extracted data, and summarized findings following published EXTRIP methods. Results A total of 44 studies (three in vitro studies, two animal studies, 28 patient reports or patient series, and 11 pharmacokinetic studies) met inclusion criteria regarding the effect of extracorporeal treatments. Toxicokinetic or pharmacokinetic analysis was available for 61 patients (13 chloroquine, three hydroxychloroquine, and 45 quinine). Clinical data were available for analysis from 38 patients, including 12 with chloroquine toxicity, one with hydroxychloroquine toxicity, and 25 with quinine toxicity. All three drugs were classified as non-dialyzable (not amenable to clinically significant removal by extracorporeal treatments). The available data do not support using extracorporeal treatments in addition to standard care for patients severely poisoned with either chloroquine or quinine (strong recommendation, very low quality of evidence). Although hydroxychloroquine was assessed as being non-dialyzable, the clinical evidence was not sufficient to support a formal recommendation regarding the use of extracorporeal treatments for this drug. Conclusions On the basis of our systematic review and analysis, the EXTRIP workgroup recommends against using extracorporeal methods to enhance elimination of these drugs in patients with severe chloroquine or quinine poisoning.
UR - http://www.scopus.com/inward/record.url?scp=85092274626&partnerID=8YFLogxK
U2 - 10.1681/ASN.2020050564
DO - 10.1681/ASN.2020050564
M3 - Article
C2 - 32963091
AN - SCOPUS:85092274626
SN - 1046-6673
VL - 31
SP - 2475
EP - 2489
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 10
ER -