A randomized controlled trial of chloroquine for the treatment of dengue in Vietnamese adults.
BACKGROUND
There is currently no licensed antiviral drug for treatment of dengue. Chloroquine (CQ) inhibits the replication of dengue virus (DENV) in vitro.


RESULTS
A double-blind, randomized, placebo-controlled trial of CQ in 307 adults hospitalized for suspected DENV infection was conducted at the Hospital for Tropical Diseases (Ho Chi Minh City, Vietnam) between May 2007 and July 2008. Patients with illness histories of 72 hours or less were randomized to a 3-day course of CQ (n = 153) or placebo (n = 154). Laboratory-confirmation of DENV infection was made in 257 (84%) patients. The primary endpoints were time to resolution of DENV viraemia and time to resolution of DENV NS1 antigenaemia. In patients treated with CQ there was a trend toward a longer duration of DENV viraemia (hazard ratio (HR) = 0.80, 95% CI 0.62-1.05), but we did not find any difference for the time to resolution of NS1 antigenaemia (HR = 1.07, 95% CI 0.76-1.51). Interestingly, CQ was associated with a significant reduction in fever clearance time in the intention-to-treat population (HR = 1.37, 95% CI 1.08-1.74) but not in the per-protocol population. There was also a trend towards a lower incidence of dengue hemorrhagic fever (odds ratio = 0.60, PP 95% CI 0.34-1.04) in patients treated with CQ. Differences in levels of T cell activation or pro- or anti-inflammatory plasma cytokine concentrations between CQ- and placebo-treated patients did not explain the trend towards less dengue hemorrhagic fever in the CQ arm. CQ was associated with significantly more adverse events, primarily vomiting.


CONCLUSIONS
CQ does not reduce the durations of viraemia and NS1 antigenaemia in dengue patients. Further trials, with appropriate endpoints, would be required to determine if CQ treatment has any clinical benefit in dengue.


BACKGROUND
Current Controlled Trials number ISRCTN38002730.
Tricou
Vianney
V
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
Minh
Nguyet Nguyen
NN
Van
Toi Pham
TP
Lee
Sue J
SJ
Farrar
Jeremy
J
Wills
Bridget
B
Tran
Hien Tinh
HT
Simmons
Cameron P
CP
D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use*; D003715:Dengue / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010919:Placebos / Q000008:administration & dosage; D013997:Time Factors; D014744:Vietnam; D019562:Viral Load; D014766:Viremia; D055815:Young Adult
D000956:Antigens, Viral; D000998:Antiviral Agents; D010919:Placebos; D002738:Chloroquine