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

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 sele...

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Autores principales:	Claudia Cristina Biguetti, Joel Ferreira Santiago Junior, Matthew William Fiedler, Mauro Toledo Marrelli, Marco Brotto
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/cba8bda858ef431a886e4273fbdb904a
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spelling	oai:doaj.org-article:cba8bda858ef431a886e4273fbdb904a2021-12-02T13:24:15ZThe toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis10.1038/s41598-021-86079-42045-2322https://doaj.org/article/cba8bda858ef431a886e4273fbdb904a2021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-86079-4https://doaj.org/toc/2045-2322Abstract 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.Claudia Cristina BiguettiJoel Ferreira Santiago JuniorMatthew William FiedlerMauro Toledo MarrelliMarco BrottoNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Claudia Cristina Biguetti Joel Ferreira Santiago Junior Matthew William Fiedler Mauro Toledo Marrelli Marco Brotto The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis
description	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.
format	article
author	Claudia Cristina Biguetti Joel Ferreira Santiago Junior Matthew William Fiedler Mauro Toledo Marrelli Marco Brotto
author_facet	Claudia Cristina Biguetti Joel Ferreira Santiago Junior Matthew William Fiedler Mauro Toledo Marrelli Marco Brotto
author_sort	Claudia Cristina Biguetti
title	The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis
title_short	The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis
title_full	The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis
title_fullStr	The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis
title_full_unstemmed	The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis
title_sort	toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/cba8bda858ef431a886e4273fbdb904a
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The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

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