New crown outbreak current, call for rheumatoid cornerstone drug hydroxychloroquine to carry out more evidence-based research!

For the safety of novel coronavirus pneumonia, a drug that is approved by the Department of rheumatism is developing the anti infection and anti-inflammatory research, which will add strength to the prevention and control of the new crown pneumonia. The novel coronavirus pneumonia is being treated byepidemic. In the afternoon of February 4, sun Yanrong, deputy director of the biological center of the Ministry of science and technology, said at the press conference of the National Health Commission that in addition to radcivir, other antiviral drugs, such as chloroquine phosphate, were found.therefore, chloroquine / hydroxychloroquine has attracted much attention as an anti rheumatic drug (dmrads) to improve the disease condition.01. Chloroquine / hydroxychloroquine: changes in the structure of compounds lead to drug changes. In 1951, antimalarial drugs appeared on the stage of history for the treatment of rheumatic diseases. After the development and application changes from adipine to chloroquine, and then to hydroxychloroquine (HCQ), they have been used till now.hydroxychloroquine and chloroquine belong to 4-aminoquinoline antimalarial drugs. Hydroxychloroquine is a new antimalarial drug developed on the basis of chloroquine in 1944. The difference between hydroxychloroquine and chloroquine is that one ethyl in chloroquine is replaced by one hydroxyethyl in hydroxychloroquine (Fig. 1). However, the side effects of chloroquine were similar to those of chloroquine.after more than half a century of evidence-based medicine, hydroxychloroquine stands out among antimalarial drugs, and its efficacy and safety have been fully recognized by national guidelines and gradually replaced chloroquine.Fig. 1. Structural differences between chloroquine and hydroxychloroquine compounds. 02. The use status of hydroxychloroquine in rheumatic diseases. In 1955, hydroxychloroquine was approved for marketing and widely used in rheumatic immune diseases.the advantages of hydroxychloroquine are good safety and low incidence of adverse reactions, which is conducive to improve patient compliance.■ course of anti rheumatic disease of hydroxychloroquine. In 1992, the British rheumatic society included hydroxychloroquine in the expert management guide for rheumatoid arthritis; in 1996, the first American rheumatic Association (ACR) guidelines on rheumatoid arthritis (RA) recommended hydroxychloroquine for the treatment of RA.in 1999, hydroxychloroquine was officially listed in China; in 2003, the first RA guideline in China included hydroxychloroquine as the drug of choice.up to now, there are still several guidelines to include hydroxychloroquine as the first-line treatment drug.■ hydroxychloroquine in the treatment of RA: it is recommended as the first line, and the combination of hydroxychloroquine is the preferred DMARDs for the treatment of RA.in 2015, the Asia Pacific Alliance Against Rheumatism (aplar) and ACR guidelines recommended methotrexate (MTX) as the first-line drug in the treatment of RA; when MTX is intolerable, other traditional dmrads such as hydroxychloroquine can also be used as the first-line drug; when the single drug has poor efficacy or has adverse prognostic factors, it can be treated with combined regimen.the optimal drugs of traditional DMARDs were MTX, hydroxychloroquine, sulfasalazine (SSZ) and leflunomide (LEF).the traditional DMARDs combination schemes include hydroxychloroquine + MTX, hydroxychloroquine + SSZ or MTX + SSZ.the traditional DMARD triple regimen is: hydroxychloroquine + MTX + SSZ.the above scheme has been unanimously recognized by aplar and ACR guidelines [3,4]. ■ hydroxychloroquine is used as a basic drug for SLE and LN. In addition, hydroxychloroquine is also recommended for systemic lupus erythematosus (SLE) and lupus nephritis (LN). in 2008, the European Union Against Rheumatism (eluar) guidelines for SLE pointed out that SLE patients without significant organ involvement could benefit from antimalarial treatment on the premise of no drug contraindication Ln guidelines recommend that hydroxychloroquine should be used as the basic drug for all SLE patients with nephritis if there is no relevant contraindication; EULAR also indicated in the 2012 ln guideline that hydroxychloroquine is recommended for all patients with lupus nephritis when there is no drug contraindication [6]. in China, the diagnosis and treatment guidelines of SLE in 2010 were clear, and hydroxychloroquine can be used to treat patients with mild SLE without obvious organ damage [7]. in 2014, China's expert consensus on the treatment of rheumatic diseases once again stated that hydroxychloroquine can be used as a basic drug for SLE patients, and can be used for a long time without contraindications [8]. ■ future trend of combined treatment. With the deepening understanding of the disease, RA treatment strategy began to evolve and become more active, and DMARDs combined scheme treatment can be started at the beginning [9]. there are also meta-analysis shows that the combination of biological and traditional DMARDs has better curative effect [10]. It is worth mentioning that the combination of traditional DMARDs (containing hydroxychloroquine) is still the guarantee of clinical benefits, more economic benefits, and more in line with China's national conditions [11-16]. hydroxychloroquine has a variety of mechanisms, including anti-inflammatory, immune regulation, anti infection, anti-tumor, metabolic regulation and anti thrombosis. the concern this time is due to chloroquine phosphate, which is also a 4-aminoquinoline antimalarial drug. According to sun Yanrong's statement in the press conference, the anti coronavirus effect of chloroquine phosphate has been confirmed in vitro [17]. but as Academician Wang Chen said, in order to get scientific conclusions, we must carry out strict clinical trials. Novel coronavirus pneumonia, a drug that has been approved in the safety field, is being given more support by in this special period. It is also necessary to carry out anti infection and anti-inflammatory research to provide new strength for the prevention and control of the new crown pneumonia. Bai Yansong talks with Academician Wang Chen. References: [1] d, et al al.Clin Drug Investig. 2018 Aug;38(8):653-671[3]Lau CS, et al; APLAR. Int J Rheum Dis. 2015 Sep;18(7):685-713.  [4]Singh JA, et al. Arthritis Rheumatol. 2016 Jan;68(1):1-26.[5]Hahn BH,et al.Arthritis Care Res (Hoboken) 2012 Jun;64(6):797-808[6]Bertsais GK, Et al.Rheum [7] guidelines for the diagnosis and treatment of systemic lupus erythematosus. Chinese Journal of Rheumatology, May 2010, Vol. 14. [8] National rheumatology data center and CStar expert consensus group. Chinese Journal of rheumatology. 2014,18 (3): 148-150. [9] ajeganova s, et al. Then adv musculoskelet dis. 2017 Oct; 9 (10): 249-262. [10] hazlewood GS, et al. Cochrane Database Syst Rev. 2016 Aug 29;(8):CD010227.[11]Zhao M, et al. Arthritis Rheumatol. 2017; 69 (suppl 10): ABSTRACT 546[12]Liang H, et al. RMD Open. 2019 Sep 23;5(2):e001013.[13]Chiu YM, et al. Int J Rheum Dis. 2014 Dec;17 Suppl 3:9-19.[14]Law ST,et al. 2019 Oct 17;150:104497. doi: 10.1016/j.phrs.2019.104497.[15]Goodman SM, Et al.Semin Arthritis Rheum. 2015; 44 (6): 627-32. [16] plantone D, et al. Clin drug investment. 2018; 38 (8): 653-71. [17] Martin J Vincent, et al. Virol J. 2005; 2:69 this information is for medical and scientific research reference only. Sanofi does not recommend using this product in any way inconsistent with the prescription information approved in your country,