{"id":89229,"date":"2020-03-31T22:37:11","date_gmt":"2020-03-31T22:37:11","guid":{"rendered":"https:\/\/raed.academy\/?p=89229"},"modified":"2020-04-10T10:28:58","modified_gmt":"2020-04-10T10:28:58","slug":"cloroquina-i-coronavirus-esperanca-o-miratge","status":"publish","type":"post","link":"https:\/\/raed.academy\/ca\/cloroquina-i-coronavirus-esperanca-o-miratge\/","title":{"rendered":"Cloroquina i coronavirus: esperan\u00e7a o miratge?"},"content":{"rendered":"

Ram\u00f3n Ricardo Vidal y Plana<\/strong><\/em><\/a>
\nDoctor en Ci\u00e8ncias Biol\u00f2giques i Farmacologia Aplicada, especialista en Biologia Molecular (Organitzaci\u00f3 Europea de Biologia Molecular-Universitat de Troms\u00f6) i a<\/em>cad\u00e8mic corresponent de la Reial Acad\u00e8mia Europea de Doctors-Barcelona 1914 (RAED)<\/em><\/p>\n

Si els esperan\u00e7adors resultats d’assajos cl\u00ednics actualment en curs confirmen l’efic\u00e0cia de la cloroquina contra el coronavirus, potser podr\u00e0 contribuir a combatre l’actual pand\u00e8mia de Covid-19 (SARS-CoV-2) amb un nou enfocament.<\/span><\/p>\n

Diferent de la quinina, d’origen natural, la cloroquina \u00e9s un compost qu\u00edmic de s\u00edntesi, del grup de les quatre aminoquinolines, descobert el juny de 1934 pel cient\u00edfic Johann Andertsag<\/strong>, doctor en qu\u00edmica per la Universitat T\u00e8cnica de Munic<\/strong>, durant les seves investigacions als laboratoris de l’empresa farmac\u00e8utica Bayer<\/strong>.<\/p>\n

La cloroquina va ser utilitzada durant la Segona Guerra Mundial per al tractament de la mal\u00e0ria. Fins avui, la seva efic\u00e0cia terap\u00e8utica ha estat reconeguda per a la prevenci\u00f3 i el tractament de la mal\u00e0ria (paludisme) i altres infeccions protozo\u00e0ries com la lambliasis, l’amebiasi extraintestinal, el distoma hep\u00e0tic, la leismaniosis i tamb\u00e9 la paragonimiasis (de par\u00e0sits trem\u00e8todes del g\u00e8nere Paragonimus amb larves que infecten certs cargols i crancs). Per les seves propietats antiinflamat\u00f2ries, la cloroquina tamb\u00e9 \u00e9s utilitzada per tractar pacients d’artritis reumatoide, espondiloartritis, lupus eritomat\u00f3s dif\u00fas i connectivopaties.<\/p>\n

En les seves diferents aplicacions, el mecanisme d’acci\u00f3 de la cloroquina \u00e9s diferent. La comercialitzaci\u00f3 de la cloroquina fosfat va ser oficialment autoritzada a Fran\u00e7a a partir del 1949. A partir del 1990 van ser descrits tamb\u00e9 efectes anti-virals, amb un mecanisme d’acci\u00f3 capa\u00e7 de modificar el pH dels \u00f2rgans intracel\u00b7lulars anomenats lisosomes. Per aquesta propietat, la cloroquina fosfat impedeix la infecci\u00f3 de les c\u00e8l\u00b7lules per certs virus.<\/p>\n

Hidroxicloroquina i coronavirus<\/h3>\n

\"\"El major defensor del protocol terap\u00e8utic basat en la cloroquina \u00e9s Didier Raoult<\/strong>, director de l’Hospital Universitari Mediterr\u00e0nia<\/strong> (IHU<\/strong>) de Marsella. A la fi del passat mes de febrer de 2020 va publicar un v\u00eddeo en qu\u00e8 presenta la cloroquina com una soluci\u00f3 terap\u00e8utica per combatre el Covid-19 (SARS-CoV-2). La seva orientaci\u00f3 es basa en la constataci\u00f3 que els malalts, quan comencen a presentar dificultats respirat\u00f2ries, o ingressen ja en reanimaci\u00f3, no posseeixen ja gaireb\u00e9 virus i freq\u00fcentment ni s’aconsegueix cultivar-los. Per aix\u00f2 sembla massa tard per tractar efica\u00e7ment amb productes antivirals.<\/span><\/p>\n

El ministre franc\u00e8s de Solidaritat i Salut, Olivier V\u00e9ran<\/strong>, ha declarat haver parlat diverses vegades amb Raoult. “M’ha informat de les seves observacions i dels seus assajos, que he transm\u00e8s a la Direcci\u00f3 General de la Sanitat<\/strong>, que els est\u00e0 estudiant. Sabem que hi ha investigacions interessants sobre un efecte in vitro per\u00f2 els resultats dels assajos sobre pacients estan encara per determinar”. Si b\u00e9 l’Organitzaci\u00f3 Mundial de la Salut<\/strong> recomana no promoure ter\u00e0pies amb una efic\u00e0cia i innocu\u00eftat que no han estat prou provades en assajos cl\u00ednics respectuosos dels rigorosos criteris de la farmacologia cl\u00ednica, V\u00e9ran ha autoritzat als hospitals francesos a poder prescriure cloroquina per al tractament del coronavirus si el metge responsable ho jutja \u00fatil, sense obligaci\u00f3 d’esperar els resultats dels assajos cl\u00ednics en curs.<\/p>\n

El decret del Govern de Fran\u00e7a<\/strong> (Diari Oficial<\/strong> del 26 de mar\u00e7 del 2020) precisa: “La hidroxicloroquina i l’associaci\u00f3 Lopinavir\/Ritonavir poden ser prescrits, subministrats i administrats sota la responsabilitat d’un metge als pacients infectats per la Covid-19, als establiments de salut que els preveuen, aix\u00ed com per a la continuaci\u00f3 del seu tractament si el seu estat ho permet i compta amb l’autoritzaci\u00f3 del prescriptor inicial al domicili”. Aquesta condici\u00f3 de fase avan\u00e7ada de la malaltia podria ser responsable d’un possible frac\u00e0s d’un vast assaig cl\u00ednic europeu, codificat amb el nom de “Discovery”<\/strong>, que va estudiar l’efic\u00e0cia de la cloroquina i d’altres f\u00e0rmacs, ja que preveu principalment estudiar malalts greus de Covid-19 (SARS-CoV-2).<\/p>\n

L’assaig est\u00e0 coordinat per Yazdan Yazdanpanah<\/strong>, director del servei de malalties infeccioses de l’Hospital AP-HP Bichat<\/strong> de Par\u00eds. Hi participen m\u00e9s de 3.200 pacients de Covid-19 amb s\u00edmptomes greus, de set pa\u00efsos (Fran\u00e7a, B\u00e8lgica, Pa\u00efsos Baixos, Luxemburg, Gran Bretanya, Alemanya i Espanya), dels quals 800 a Fran\u00e7a. Aquest assaig cl\u00ednic preveu estudiar diverses mol\u00e8cules que han demostrat una certa activitat en assajos in vitro, en laboratori, sobre la Covid-19 (SARS-CoV-2). Els pacients estan repartits a l’atzar en cinc grups, quatre dels quals rebran un dels quatre tractaments experimentals, entre ells un amb hidroxicloroquina, i els altres tres amb ter\u00e0pies antivirals, mentre que el cinqu\u00e8 grup rebr\u00e0 cures ja reconegudes, entre les quals l’oxigenoter\u00e0pia.<\/p>\n

Tot i que la cloroquina ve sent utilitzada en medicina per a altres aplicacions terap\u00e8utiques des de fa m\u00e9s de 70 anys, l’Acad\u00e8mia Francesa de Medicina<\/strong>, que ha constitu\u00eft un grup de treball sobre la Covid-19 (SARS-CoV-2), i l’Acad\u00e8mia Francesa de Ci\u00e8ncies<\/strong> han expressat la posici\u00f3 que “davant de la pand\u00e8mia de Covid-19, la r\u00e0pida progressi\u00f3 t\u00e9 com a conseq\u00fc\u00e8ncia una morbositat i una mortalitat elevades, no disposem fins avui de cap tractament m\u00e8dic efica\u00e7 per a aquesta infecci\u00f3”. Una de les dificultats dels assajos cl\u00ednics sobre pacients infectats per\u00f2 no en estat greu de salut \u00e9s la petita proporci\u00f3 de pacients destinats a agreujar-se.<\/span><\/p>\n

Un assaig cl\u00ednic multic\u00e8ntric realitzat a la Xina pels professors Jianjun Gao<\/strong>, Zhenxue Tian<\/strong> i Xu Yang<\/strong>, del departament de Farmacologia de la Universitat de Qingdao<\/strong> i de l’Hospital de Qingdao<\/strong>, a la prov\u00edncia de Shandong, a l’est de la Xina, estudi que va ser publicat el 19 de febrer de 2020, mostra que petites concentracions de cloroquina fosfat bloquegen in vitro la penetraci\u00f3 de la SARS-CoV-2 a les c\u00e8l\u00b7lules. Sobre aquesta base, un assaig cl\u00ednic dut a terme en deu hospitals xinesos, a Wuhan, Pequ\u00edn, Xangai i altres set localitats, sobre 100 pacients infectats de SARS-CoV-2 amb pneum\u00f2nia confirmada, va constatar l’efic\u00e0cia terap\u00e8utica de la cloroquina administrada durant sis dies a la dosi di\u00e0ria de 500 mg, molt inferior a la dosi t\u00f2xica, igual o superior a 2 grams.<\/p>\n

En un assaig cl\u00ednic no “randomitzat” realitzat a l’IHU de Marsella per Didier Raoult sobre 24 pacients tractats amb una dosi di\u00e0ria de 600 mg de hidroxicloroquina sulfat, la toler\u00e0ncia \u00e9s millor que la de cloroquina fosfat, amb una efic\u00e0cia equivalent, associada aquesta vegada a l’antibi\u00f2tic Azitromicina per prevenir eventuals infeccions bacterianes secund\u00e0ries, el 75% d’aquests pacients havien eliminat el virus (seropositivitat negativa) en menys d’una setmana, comparat amb el resultat de nom\u00e9s el 10% dels pacients que no havien rebut aquest tractament.<\/p>\n

Per a Raoult, el tractament amb hidroxicloroquina sulfat permet la curaci\u00f3 de la majoria de malalts en poc temps, eliminant el virus molt abans del final del seu cicle natural, que \u00e9s d’uns vint dies. Aix\u00f2 permetria evitar la degradaci\u00f3 fins a formes greus de la malaltia, que necessiten cures intensives, i que es verificarien nom\u00e9s si el virus persisteix per llarg temps en els pacients contaminats.<\/p>\n

\"Dr.

Dr. Ram\u00f3n Ricardo Vidal y Plana<\/p><\/div>\n

A Gran Bretanya s’ha iniciat un estudi comparatiu sobre 1.000 pacients, comparant en doble cec un grup tractat amb cloroquina fosfat, un grup tractat amb sulfat de hidroxicloroquina i un grup placebo. Segons els investigadors xinesos, un tractament diari de 500 mg de cloroquina durant uns deu dies hauria de ser suficient.<\/p>\n

Aquests avantatges, de ser confirmades, podrien indicar el cam\u00ed a seguir, pel que fa a la recerca d’una vacuna efica\u00e7 la disponibilitat no podria ser abans de diversos mesos.<\/p>\n

La cloroquina \u00e9s un producte relativament econ\u00f2mic, de f\u00e0cil fabricaci\u00f3, produ\u00eft per nombrosos laboratoris del m\u00f3n i distribu\u00eft des de fa decennis sota els noms comercials registrats per diferents grups farmac\u00e8utics de Resochin (cloroquina difosfat), Plaquenil (hidroxicloroquina sulfat), Axemal, Dolquine, Ilinol i Quensyl, entre d’altres.<\/p>\n

Tot i i ax\u00ed,<\/span> \u00e9s indispensable<\/span> evitar la temptaci\u00f3 de<\/span> l’automedicaci\u00f3,<\/span> ja que<\/span> l’Ag\u00e8ncia Nacional<\/strong><\/span> de Salut<\/span> i<\/span> de<\/span>l <\/span>Medicament<\/span><\/strong> de Fran\u00e7a<\/span> i l’ag\u00e8ncia<\/span> de la Regi\u00f3 de<\/span> Nouvelle<\/span> Aquitaine<\/span> han alertat<\/span> i<\/span> descrit<\/span> recentment<\/span> diversos casos<\/span> de pertorbacions<\/span> de<\/span>l <\/span>ritme<\/span> card\u00edac<\/span> i fins i tot<\/span> d’aturada card\u00edaca<\/span> que ha assolit<\/span> fins i tot<\/span> a provocar la mort<\/span> de certs<\/span> pacients<\/span> automedicats<\/span> amb<\/span> productes a base de<\/span> cloroquina<\/span> o<\/span> de<\/span> Plaquenil<\/span> (<\/span>hidroxicloroquina<\/span> sulfat<\/span>)<\/span>.<\/span><\/span><\/p>\n

\u00bf<\/span>Demostrar\u00e0<\/span> la cloroquina<\/span> ser una arma<\/span> efica\u00e7<\/span> per v\u00e8ncer<\/span> el flagell<\/span> pand\u00e8mic<\/span> de<\/span> Covid<\/span>–<\/span>19<\/span>?<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Ram\u00f3n Ricardo Vidal y Plana Doctor en Ci\u00e8ncias Biol\u00f2giques i Farmacologia Aplicada, especialista en Biologia Molecular (Organitzaci\u00f3 Europea de Biologia Molecular-Universitat de Troms\u00f6) i acad\u00e8mic corresponent de la Reial Acad\u00e8mia Europea de Doctors-Barcelona 1914 (RAED) Si els esperan\u00e7adors resultats d’assajos cl\u00ednics actualment en curs confirmen l’efic\u00e0cia de la cloroquina contra el coronavirus, potser podr\u00e0 contribuir […]<\/p>\n","protected":false},"author":12,"featured_media":89213,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[268,273],"tags":[],"class_list":["post-89229","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-coronavirus-des-del-coneixement","category-salut","et-has-post-format-content","et_post_format-et-post-format-standard"],"yoast_head":"\nCloroquina i coronavirus: esperan\u00e7a o miratge? - Reial Acad\u00e8mia Europea de Doctors<\/title>\n<meta name=\"description\" content=\"Si es confirma l'efic\u00e0cia de la cloroquina contra el coronavirus, potser podr\u00e0 contribuir a combatre l'actual pand\u00e8mia. 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