clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.37489/2588-0519-2020-S4-53-59clinvest-527Research ArticleАКТУАЛЬНЫЕ ОБЗОРЫACTUAL REVIEWИзменение роли монотерапии гидроксихлорохином и комбинированной терапии гидроксихлорохином в сочетании с азитромицином у пациентов с COVID-19Adjusting the role of hydroxychloroquine with or without azithromycin in patients with COVID-19https://orcid.org/0000-0003-0623-7263ОтделеновВ. А.OtdelenovV. A.

Отделенов Виталий Александрович – доцент кафедры клинической фармакологии и терапии. SPIN-код: 8357-5770

Москва

Otdelenov Vitaly A. – Associate Professor of the Department of Clinical Pharmacology and Therapy. SPIN code: 8357-5770

Moscow

https://orcid.org/0000-0002-6753-8572КиселёвЮ. Ю.KiselevYu. Yu.

Киселёв Юрий Юрьевич – PhD, доцент факультета наук о здоровье OsloMet

Осло

Kiselev Yuri Yu. – PhD, Associate Professor at the Faculty of Health Sciences OsloMet

Oslo

https://orcid.org/0000-0002-9307-4994МирзаевК. Б.MirzaevK. B.

Мирзаев Карин Бадавиевич – к. м. н., доцент кафедры клинической фармакологии и терапии. SPIN-код: 8308-7599

Москва

Mirzaev Karin B. – Candidate of Medical Sciences, Associate Professor of the Department of Clinical Pharmacology and Therapy. SPIN code: 8308-7599

Moscow

https://orcid.org/0000-0002-6636-3950МатвеевА. В.MatveevA. V.

Матвеев Александр Витальевич – к. м. н., доцент кафедры клинической фармакологии и терапии. SPIN-код: 8518-1320

Москва

Matveev Alexander V. – Candidate of Medical Sciences, Associate Professor of the Department of Clinical Pharmacology and Therapy. SPIN code: 8518-1320

Moscow

https://orcid.org/0000-0002-4496-3680СычёвД. А.SychevD. A.

Сычёв Дмитрий Алексеевич – д. м. н., профессор, член-корр. РАН, ректор, зав. кафедрой клинической фармакологии и терапии. SPIN-код: 4525-7556

Москва

Sychev Dmitry A. – Doctor of Medical Sciences, Professor, Corresponding Member RAS, Rector, Head. Department of Clinical Pharmacology and Therapy. SPIN code: 4525-7556

Moscow

dmitriy.alex.sychev@gmail.comФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuing Professional Education of the Ministry of Health of RussiaRussian FederationУниверситет Осло МетрополитенНорвегияOslo Metropolitan UniversityNorway20202810202004SФармаCOVID5359Copyright © Отделенов В.А., Киселёв Ю.Ю., Мирзаев К.Б., Матвеев А.В., Сычёв Д.А., 20202020Отделенов В.А., Киселёв Ю.Ю., Мирзаев К.Б., Матвеев А.В., Сычёв Д.А.Otdelenov V.A., Kiselev Y.Y., Mirzaev K.B., Matveev A.V., Sychev D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/527

Учитывая результаты последних исследований, необходимо рассматривать вопрос об отхождении от рутинного применения гидроксихлорохина в схемах лечения COVID-19, особенно в комбинации с азитромицином. Применение гидроксихлорохина, особенно в комбинации с азитромицином может быть ассоциировано с повышенным риском внутригоспитальной смертности, удлинения интервала QT при отсутствии убедительной доказанной эффективности в отношении клиренса вируса SARS-CoV-2 и исходов. Применение гидроксихлорохина, особенно в комбинации с азитромицином, может быть рассмотрено в отдельных случаях, при этом следует тщательно оценить соотношение пользы и риска, а также усилить контроль за безопасностью применения данных лекарственных препаратов. Безопасность применения гидроксихлорохина в амбулаторных условиях у больных с COVID-19 недостаточно изучена и сопряжена с рисками, связанными с трудностями обеспечения мониторинга интервала QT и уровня электролитов, поэтому не может рассматриваться в качестве терапии первой линии в амбулаторных условиях. Не рекомендуется амбулаторное применение гидроксихлорохина при COVID-19 без должного мониторинга безопасности (клинического, инструментального и лабораторного).

Taking recent publications into account, one should consider avoiding routine use of hydroxychloroquine, especially if combined with azithromycin, for COVID-19. Such treatment may be associated with the increased risk for hospital mortality and QT prolongation, while there is no documented effectiveness regarding SARS-CoV-2 clearance and outcomes. This treatment may be considered in individual cases, provided potential benefit and risks are carefully weighted, and safety monitoring is enhanced. Hydroxychloroquine safety in outpatients with COVID-19 is poorly studied and risks are increased by challenges in monitoring QT and electrolytes, hence hydroxychloroquine cannot be considered as first line treatment in outpatient settings. Such use of hydroxychloroquine is not recommended if clinical, instrumental, and laboratory monitoring are not in place.

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The authors declare that there are no conflicts of interest present.