Hidroksiklorokin veya klorokinin COVID-19\u2019daki etkinli\u011fini kar\u015f\u0131la\u015ft\u0131ran \u015fu ana kadar yap\u0131lm\u0131\u015f, g\u00f6zlemsel toplam 10 \u00e7al\u0131\u015fman\u0131n 6\u2019s\u0131nda hidroksiklorokinin olumlu etkileri olabilece\u011fi bildirilirken, 4\u2019\u00fcnde (2\u2019si yay\u0131mlanm\u0131\u015f ve vaka say\u0131s\u0131 1000 \u00fczerinde olan) herhangi bir etkisinin olmad\u0131\u011f\u0131 bildirilmi\u015ftir (7-16). Bu g\u00f6zlemsel \u00e7al\u0131\u015fmalar\u0131n t\u00fcm\u00fcnde, elde edilmi\u015f sonu\u00e7larda, kar\u0131\u015ft\u0131r\u0131c\u0131 fakt\u00f6rlerin etkisinin s\u00f6z konusu olabilece\u011fi ve bu nedenle randomize kontroll\u00fc \u00e7al\u0131\u015fmalar\u0131n gereklili\u011fi vurgulanm\u0131\u015ft\u0131r.<\/p>\n
Bu konunun a\u00e7\u0131kl\u0131\u011fa kavu\u015fmas\u0131 i\u00e7in halen devam etmekte olan randomize kontroll\u00fc \u00e7al\u0131\u015fmalar\u0131n sonu\u00e7lar\u0131 beklenmektedir. Ancak bu s\u00fcre\u00e7te, hidroksiklorokinin tek ba\u015f\u0131na kullan\u0131m\u0131nda veya azitromisinle kombinasyonunda ortaya \u00e7\u0131kan istenmeyen etkiler konusunda baz\u0131 uyar\u0131lar ve \u00e7al\u0131\u015fmalar yay\u0131mlanm\u0131\u015ft\u0131r. COVID-19 salg\u0131n\u0131ndan \u00f6nce yap\u0131lm\u0131\u015f \u00e7al\u0131\u015fmalarda farkl\u0131 endikasyonlarda kullan\u0131ld\u0131klar\u0131nda hem hidroksiklorokinin, hem de azitromisinin, ayr\u0131 ayr\u0131 QT aral\u0131\u011f\u0131n\u0131n uzamas\u0131 riskini art\u0131rd\u0131\u011f\u0131, ila\u00e7la ili\u015fkili torsades de pointes\u2019e ve ani kardiyak \u00f6l\u00fcme yol a\u00e7abildi\u011fi g\u00f6sterilmi\u015ftir (17, 18). Ge\u00e7ti\u011fimiz aylar i\u00e7inde hem \u00fclkemizden, hem de di\u011fer \u00fclkelerden bu ajanlar\u0131n COVID-19 hastalar\u0131nda kullan\u0131ld\u0131\u011f\u0131nda kardiyotoksisite yaratabildi\u011fi, \u00f6zellikle azitromisin-hidroksiklorokin kombinasyonu yap\u0131lan gruplarda bu riskin daha y\u00fcksek oldu\u011fu bildirilmi\u015ftir (19-27).<\/p>\n
Sonu\u00e7 olarak elde edilen veriler, \u00f6zellikle erken d\u00f6nemde ba\u015flanan hidroksiklorokinin COVID-19 hastal\u0131\u011f\u0131n\u0131n tedavisindeki yerini halen tam olarak ortaya koyamam\u0131\u015ft\u0131r ve devam etmekte olan \u00e7ok say\u0131daki randomize kontroll\u00fc \u00e7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131n\u0131n k\u0131sa s\u00fcre i\u00e7inde a\u00e7\u0131klanmas\u0131 beklenmektedir. Ancak mevcut veriler, bu ajanlar\u0131n kardiyotoksik etkilerinin olabilece\u011fini, \u00f6zellikle azitromisinle veya ba\u015fka baz\u0131 ila\u00e7larla kombine kullan\u0131ld\u0131klar\u0131nda bu kardiyotoksik etkilerinin daha fazla oldu\u011funu d\u00fc\u015f\u00fcnd\u00fcrmektedir. Bu nedenlerle bu konuda yap\u0131lmakta olan randomize kontroll\u00fc ara\u015ft\u0131rmalar sonu\u00e7lan\u0131ncaya kadar, COVID-19 tedavisi amac\u0131yla\u00a0 hidroksiklorokin+azitromisin kombinasyonundan\u00a0 ka\u00e7\u0131n\u0131lmas\u0131,\u00a0 kardiyotoksisite a\u00e7\u0131s\u0131ndan risk fakt\u00f6rleri olan hastalarda (>65 ya\u015f, kad\u0131n cinsiyet, konjestif kalp yetmezli\u011fi veya akut myokard infarkt\u00fcs\u00fc gibi kalp hastal\u0131klar\u0131, kan potasyum seviyesinin <3.5 mEq\/l olmas\u0131, \u00a0di\u00fcretik kullan\u0131m\u0131, b\u00f6brek yetmezli\u011fi, QT aral\u0131\u011f\u0131n\u0131 uzatan ba\u015fka ila\u00e7 kullan\u0131m\u0131 ve sepsis varl\u0131\u011f\u0131) hidroksiklorokin kullan\u0131lmamas\u0131 en ak\u0131lc\u0131 yakla\u015f\u0131m olarak g\u00f6r\u00fcnmektedir. Bunun d\u0131\u015f\u0131nda kalan gruplarda COVID-19 tedavisinde hidroksiklorokinin, tercihen klinik \u00e7al\u0131\u015fmalar i\u00e7inde yer alacak \u015fekilde kullan\u0131lmas\u0131,\u00a0 bu ilac\u0131n ba\u015fland\u0131\u011f\u0131 hastalar\u0131n t\u00fcm\u00fcnde\u00a0 hem ba\u015flang\u0131\u00e7ta, hem de yat\u0131\u015f s\u00fcresi boyunca kardiyak riskler a\u00e7\u0131s\u0131ndan uygun \u015fekilde ve yak\u0131n izlem yap\u0131lmas\u0131 \u00f6nemlidir.<\/p>\n
Hidroksiklorokinin profilaktik olarak kullan\u0131lmamas\u0131 konusunda derne\u011fimizin 21 Mart 2020 tarihinde bildirdi\u011fi g\u00f6r\u00fc\u015f (https:\/\/www.klimik.org.tr\/?p=88760<\/a>), o tarihten \u00a0beri aksini d\u00fc\u015f\u00fcnd\u00fcrecek g\u00fc\u00e7l\u00fc kan\u0131t i\u00e7eren yay\u0131nlar olmamas\u0131 nedeniyle halen ge\u00e7erlidir.<\/p>\n KAYNAKLAR<\/strong><\/p>\n 1) Chen J. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19) Journal of Zhejiang University 2020. doi: 10.3785\/j.issn.1008- 9292.2020.03.03 )<\/p>\n 2) Chen Z, Hu J, Zhang Z, Jiang S, Han S et al. 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JAMA 2020 <\/em>. doi:10.1001\/jama.2020.8630<\/p>\n 14)\u00a0 Early\u00a0diagnosis\u00a0and\u00a0management\u00a0of\u00a0COVID-19\u00a0patients:\u00a0a\u00a0real-life\u00a0cohort study of 3,737 patients, Marseille, France. https:\/\/www.mediterranee-infection.com\/early-diagnosis-and-management-of-covid-19-patients-a-real-life-cohort-study-of-3737-patients-marseille-france\/<\/a>)<\/p>\n 15) Ip A, Berry DA, Hansen E, Goy AH, Pecora Al, Sinclaire BA, et a.\u00a0 Hydroxychloroquine and Tocilizumab Therapy in COVID-19 Patients \u2013 An Observational Study . doi: https:\/\/doi.org\/10.1101\/2020.05.21.20109207 medRxiv preprint<\/p>\n 16) Gu\u00e9rin V, L\u00e9vy P, Thomas JL, Lardenois T, Lacrosse P, Sarrazin E, et al. .Azithromycin and hydroxychloroquine accelerate recovery of outpatients with mild\/moderate COVID-19. Preprints 2020; doi:10.20944\/preprints202005.0486.v1<\/p>\n 17) Chen CY, Wang FL, Lin CC. 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Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive 21) Borba MGS, De Almeida Val F, Sampaio VS, Arau\u0301jo Alexandre MA, Melo GC et al. (2020). Chloroquine diphosphate in two different dosages as adjunctive therapy ofhospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study);https:\/\/www.medrxiv.org\/content\/10.1101\/2020.04.07.20056424v2 .<\/p>\n 22) Zengin R,\u00a0 Sar\u0131kaya ZT,\u00a0 Karadag\u0306 N, C\u0327uhadarog\u0306lu \u00c7, Ergo\u0308nu\u0308l \u00d6, Kocago\u0308z S. Adverse Cardiac Events Related to Hydroxychloroquine Prophylaxis and Treatment of COVID-19. IDCM 2020<\/p>\n 23) https:\/\/www.fda.gov\/emergency-preparedness-and-response\/mcm-legal-regulatory-and-policy-framework\/emergency-use-authorization#covidtherapeutics<\/a>\u00a0 <\/u><\/p>\n![\"\"](\"https:\/\/www.klimik.org.tr\/wp-content\/uploads\/2017\/04\/klimik-logo-png-629x234.png\"){kind=logo}
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\nfor Coronavirus Disease 2019 (COVID-19) JAMA Cardiol<\/em> 2020; doi:10.1001\/jamacardio.2020.1834<\/p>\n