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

Author(s)

Biguetti, Claudia Cristina ^{[1, 2]} ; Santiago Junior, Joel Ferreira ^[3] ; Fiedler, Matthew William ^[1] ; Marrelli, Mauro Toledo ^{[4, 1]} ; Brotto, Marco ^[1]

Affiliation

^[1] Univ Texas Arlington, Coll Nursing & Hlth Innovat, Bone Muscle Res Ctr, 655 W Mitchell St, Arlington, TX 76010 - USA

^[2] Univ Texas Dallas, Dept Bioengn, 800 W Campbell Rd, Richardson, TX 75080 - USA

^[3] Hlth Sci Ctr, Unisagrado Irma Arminda 10-50, Bauru, SP - Brazil

^[4] Univ Sao Paulo, Sch Publ Hlth, Dept Epidemiol, Ave Dr Arnaldo 715, BR-01246904 Sao Paulo, SP - Brazil

• Document type: Review article
• Source: SCIENTIFIC REPORTS; v. 11, n. 1 MAR 23 2021.
• Web of Science Citations: 0

Abstract

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. (AU)

• FAPESP's process: 15/20827-2 - Effect of bone quality and connection type of dental implants on stress distribution
• Grantee: Joel Ferreira Santiago Junior
• Support Opportunities: Regular Research Grants