The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

The aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected acco...

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Bibliographic Details
Published in:Scientific reports Vol. 11; no. 1; pp. 6589 - 13
Main Authors: Biguetti, Claudia Cristina, Junior, Joel Ferreira Santiago, Fiedler, Matthew William, Marrelli, Mauro Toledo, Brotto, Marco
Format: Journal Article
Language:English
Published: London Nature Publishing Group UK 23-03-2021
Nature Publishing Group
Nature Portfolio
Subjects:
692/308
692/699
Adult
Aged
Biopsy
Case reports
Chloroquine
Clinical trials
Creatine
Creatine kinase
Creatine Kinase - metabolism
Fructose-Bisphosphate Aldolase - metabolism
Humanities and Social Sciences
Humans
Hydroxychloroquine
Hydroxychloroquine - administration & dosage
Hydroxychloroquine - adverse effects
Hydroxychloroquine - toxicity
Inflammatory diseases
L-Lactate dehydrogenase
L-Lactate Dehydrogenase - metabolism
Lactic acid
Meta-analysis
Middle Aged
multidisciplinary
Muscle Weakness - epidemiology
Muscle Weakness - etiology
Muscle, Skeletal - drug effects
Muscle, Skeletal - metabolism
Muscle, Skeletal - pathology
Muscles
Myopathy
Observational studies
Observational Studies as Topic
Qualitative analysis
Quantitative analysis
Science
Science (multidisciplinary)
Skeletal muscle
Systematic review
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Description
Summary:The aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected according to the following inclusion criteria: English language; size of sample (> 5 patients), adult (> age of 18) patients, treated with CQ/HCQ for inflammatory diseases, and presenting and not presenting with toxic effects on skeletal muscles. We collected data published from 1990 to April 2020 using PubMed, Cochrane Library, EMBASE, and SciELO. Risk of bias for observational studies was assessed regarding the ROBIN-I scale. Studies with less than five patients (case reports) were selected for an additional qualitative analysis. We used the software Comprehensive Meta-Analysis at the confidence level of 0.05. We identified 23 studies for qualitative analysis (17 case-reports), and five studies were eligible for quantitative analysis. From case reports, 21 patients presented muscle weakness and confirmatory biopsy for CQ/HCQ induced myopathy. From observational studies, 37 patients out of 1,367 patients from five studies presented muscle weakness related to the use of CQ/HCQ, and 252 patients presented elevated levels of muscle enzymes (aldolase, creatine phosphokinase, and lactate dehydrogenase). Four studies presented data on 34 patients with confirmatory biopsy for drug-induced myopathy. No study presented randomized samples. The chronic use of CQ/HCQ may be a risk for drug-induced myopathy. There is substantiated need for proper randomized trials and controlled prospective studies needed to assess the clinical and subclinical stages of CQ/HCQ -induced muscle myopathy.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-021-86079-4