Hello e-druggers,
I have followed with interest the postings about chikungunya ("chicken
guinea") disease. As it spreads into larger areas, especially India,
e-druggers might be interested to know that there is an interesting
dialogue, mostly in French, about the possible use of chloroquine in the
treatment of the arthralgia associated with CHIK. Here are some items of
information and useful links:
1. A paper published in South Africa in 1984 concerning 10 cases of CHIK
showed some effect of CQ in treating the symptoms of arthritis.
Brighton SW. Chloroquine phosphate treatment of chronic Chikungunya
arthritis. An open pilot study. S Afr Med J 1984 Aug 11;66(6):217-8. This
paper is not available electronically; can anyone obtain a hard copy and
send it to me?
The abstract of the paper:
"Over 12% of patients who contract Chikungunya virus infection develop
chronic joint symptoms. These symptoms respond only partially to the
non-steroidal anti-inflammatory drugs. An open pilot study on the efficacy
of chloroquine phosphate was carried out and 10 patients completed 20 weeks
of therapy. Both the Ritchie articular index and morning stiffness improved
significantly. In the patient's assessment, 7 out of 10 considered their
conditions to have improved. On the basis of the doctor's assessment, 5 of
the 10 had improved. These results justify further controlled blind trials
of chloroquine in chronic Chikungunya arthritis."
2. From the University of malaya:
http://www.vadscorner.com/alphaviruses.html
Treatment
Supportive care with rest is indicated during the acute joint symptoms.
Movement and mild exercise tend to improve stiffness and morning arthralgia,
but heavy exercise may exacerbate rheumatic symptoms. In unresolved
arthritis refractory to aspirin and nonsteroidal antiinflammatory drugs,
chloroquine phosphate (250 mg/day) has given promising results.
3. From the French government (in French):
http://agmed.sante.gouv.fr/pdf/10/chicungu.pdf
"Dans le cadre de l'enquête mise en place pour identifier les molécules
actives contre le virus du Chikungunya, des essais ont été réalisés en laboratoire sur des cultures cellulaires in vitro et ont montré une activité antivirale de la chloroquine (Nivaquine®) sur ce virus. L'Agence française de sécurité sanitaire des produits de santé (Afssaps) relève qu'il s'agit de tests préliminaires et qu'à ce stade, aucune donnée d'efficacité et de sécurité n'est disponible chez l'homme.
Dans ce contexte, l'Agence rappelle les indications et les conditions d'un
bon usage de la Nivaquine®. La Nivaquine® est indiquée principalement dans le traitement préventif et curatif du paludisme. Elle aussi utilisée dans le traitement des symptômes de la polyarthrite rhumatoïde et dans le traitement du lupus. L'utilisation de ce médicament nécessite une prescription médicale."
Rough translation:
In the context of the search for molecules with activity against the
chikungunya virus, lab tests on cell cultures in vitro have shown that
chloroquine (NivaquineR) has some antiviral activity against this virus.
The Fench agency of health and medicines safety (AFSSAPS) points out that
this involves preliminary tests and that at this stage, no information on
the efficacy or safety in humans is available. In this context, the Agency
reiterates the conditions of proper usage of Nivaquine (CQ ). Nivaquine/
CQ is indicated primarily for the prevention and treatment of malaria. It
is also used in the symptoms of rheumatoid polyarthritis and of lupus. The
use of this medication requires a prescription". (the rest of the statement
reminds users of the need to avoid over dosage etc.)
4. Finally, the wikipedia on CHIK is growing rapidly and provides
interesting material: http://en.wikipedia.org/wiki/Chikungunya_virus
The entry for CHIK does not currently discuss the possible use of CQ for
CHIK, however.
Best wishes,
Susan Foster, PhD
Director of Public Policy and Education
Alliance for the Prudent Use of Antibiotics
susan.foster@tufts.edu
www.apua.org