ABSTRACT
Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0-27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0-10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0-50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.
ABSTRACT
Objetivo: Estudio cuantitativo: conocer la prevalencia de inadecuación del tratamiento para la osteoporosis en prevención primaria (OPP) en mujeres de 60-74 años. Estudio cualitativo: conocer los criterios diagnósticos y de tratamiento de la OPP y su variabilidad en médicos de atención primaria (AP) y especialistas. Material y método: Estudio cuantitativo: estudio observacional, transversal y retrospectivo. Población: mujeres de 60-74 años con tratamiento activo para la OPP (n = 424) en mayo del 2012. Se consideró inadecuación si presentaban ≤ 2 factores de riesgo con DXA realizada o con DXA T-score ≥ −2,4. Estudio cualitativo: técnica Delphi (15 ítems) y dos rondas de consulta. Periodo: marzo-abril del 2014. Población: médicos AP, reumatólogos y traumatólogos (n = 251). Muestreo aleatorio. Resultados: Estudio cuantitativo: grado de inadecuación del 63,4%. En el 43,2% no constaba diagnóstico de osteoporosis. En el 82,3% no constaban factores de riesgo. Tratamiento: 40,3% con bisfosfonatos y 47,9% con calcio + vitamina D. Estudio cualitativo: el 23% respondieron a la primera ronda y, de estos, el 67% a la segunda ronda. Los ítems con mayor acuerdo fueron valoración de factores de riesgo para el diagnóstico y bisfosfonatos como tratamiento. Los ítems con menor consenso fueron utilización del FRAX y densitometría y tratamiento solo con calcio + vitamina D. Conclusiones: El porcentaje de inadecuación es alto. El grado de registro en historia clínica es bajo. La metodología Delphi es útil para detectar discrepancias entre recomendaciones de guías de práctica clínica y resultados (AU)
Objective: Quantitative study: To assess the prevalence of inadequacy of treatment for osteoporosis in primary prevention (OPP) in women aged 60-74 years. Qualitative study: To evaluate the diagnostic and treatment criteria of the OPP and it's variability in primary care physicians (PC) and specialists. Material and methods: Quantitative study: observational, cross-sectional and retrospective study. Population: women aged 60 -74 years with active treatment for OPP (n = 424) in May 2012. Inadequacy if they had ≤ 2 risk factors with a DXA or DXA T-score ≥ −2.4. Qualitative study: Delphi technique (15items) and two rounds of consultation. Period: March-April 2014. Population: PC physicians, rheumatologists and orthopaedic surgeons (n = 251). Random sampling. Results: Quantitative study: degree of inadequacy is 63.4%. In 43.2% isnt mention a diagnosis of osteoporosis. In 82.3% there isnt mention of risk factors. Treatment: bisphosphonate 40.3% and calcium + vitamin D 47.9%. Qualitative study: 23% respond to the first round, and of these 67% the second round. Items with higher agreement were the important of the evaluation of risk factors for diagnosis and bisphosphonates for treatment. Items with fewer consensuses were using the FRAX and densitometry and treatment with only calcium + vitamin D. Conclusions: The percentage of inadequacy is high. The degree of registration in medical history is low. The Delphi method is useful for detecting discrepancies between recommendations of clinical practice guidelines and results (AU)
Subject(s)
Humans , Female , Middle Aged , Aged , Osteoporosis/drug therapy , Osteoporosis/prevention & control , Primary Health Care/statistics & numerical data , Medication Errors , Primary Prevention/trends , Osteoporotic Fractures , Cross-Sectional Studies , Retrospective Studies , Observational Study , Inappropriate Prescribing , Surveys and Questionnaires , Physicians, Primary Care , Risk Factors , Diphosphonates/administration & dosage , Vitamin DABSTRACT
OBJECTIVE: Quantitative study: To assess the prevalence of inadequacy of treatment for osteoporosis in primary prevention (OPP) in women aged 60-74years. Qualitative study: To evaluate the diagnostic and treatment criteria of the OPP and it's variability in primary care physicians (PC) and specialists. MATERIAL AND METHODS: Quantitative study: observational, cross-sectional and retrospective study. POPULATION: women aged 60-74years with active treatment for OPP (n=424) in May 2012. Inadequacy if they had ≤2 risk factors with a DXA or DXA T-score ≥-2.4. Qualitative study: Delphi technique (15items) and two rounds of consultation. PERIOD: March-April 2014. POPULATION: PC physicians, rheumatologists and orthopaedic surgeons (n=251). Random sampling. RESULTS: Quantitative study: degree of inadequacy is 63.4%. In 43.2% isn't mention a diagnosis of osteoporosis. In 82.3% there isn't mention of risk factors. TREATMENT: bisphosphonate 40.3% and calcium +vitaminD 47.9%. Qualitative study: 23% respond to the first round, and of these 67% the second round. Items with higher agreement were the important of the evaluation of risk factors for diagnosis and bisphosphonates for treatment. Items with fewer consensuses were using the FRAX and densitometry and treatment with only calcium +vitaminD. CONCLUSIONS: The percentage of inadequacy is high. The degree of registration in medical history is low. The Delphi method is useful for detecting discrepancies between recommendations of clinical practice guidelines and results.
