1/6 Two proposed interventions from Li Taisheng, the director of ID dept. of Peking Union Medical College Hospital; he works on the frontline for #SARSCoV2 and SARSCov1
🔸1. "Give IV immunoglobulin as soon as possible. Firstly, IVIG can boost the body's immune response;"
2/6 "more importantly, IVIG can interrupt the inflammatory process. If this stage is missed, a large dose of glucocorticoids could be given later but it would cause a decline in the patient's immune system and induce various complications."
3/6 "According to the clinical effects, if IVIG could be given on around day 7 after symptoms onset, or as soon as the biological indicators deteriorated, most likely it would help prevent the patients' condition worsening."
🔸Baseline QT intervals: ~435
🔸11% of patients QT increased to >500ms
🔸Creatinine and renal function are significantly important factors for QT prolongations.
🔹The QT intervals were increasing daily, which seems to be related to the elevating blood concentrations of HCQ
1/7 France has done the first pharmacokinetic (PK) study of HCQ for ICU patients of #COVID19, a fantastic job for dosage optimization.
🔸13 patients, average weight=82.7 kg
🔸46% pts BMI>30
🔸12 on mechanical ventilators
🔸1 on ECMO
🔸30.7% with medium/severe renal dysfunction
2/7 🔸2 pts had QT prolongations (>500ms ), but not related to HCQ levels.
🔸 Regimen D: 200mgX3/day for 7 days;
PK simulation shows HCQ reached the therapeutic level of 1mg/L on day 2.5 but exceeds 2mg/L (risk of ocular toxicity) on day 5
3/7 🔺In this D regimen, the average HCQ dose is ~7.5 mg/kg/day, which is above the well established safe upper limit: 6.5 mg/kg/day; meanwhile, the HCQ blood concentration exceeds the upper safe level: 2mg/L.