ABSTRACT
Rituximab (RTX), a chimeric monoclonal anti-CD20 antibody has become part of the standard therapy for patients with CD20-expressing B-cell lymphoma and rheumatoid arthritis. After encouraging results with open studies in systemic lupus erythematosus (SLE), RTX has not shown its effectiveness in randomized controlled trials. However, its efficacy has been validated in renal, hematological, and neuropsychiatric disorders. Understanding the history of RTX in SLE would be instructive in the hydroxychloroquine (HCQ) saga in COVID-19. Three steps would be necessary and sufficient before definitively closing the debate: 1) determine the effective and safe dose of HCQ, as well as the minimum duration of treatment in COVID-19; 2) define the profile of patients in whom HCQ would be more likely to be effective (especially in asymptomatic patients and/or at the onset of the first signs of the disease) and 3) conduct one or more multicentre RCT to evaluate the efficacy and safety of HCQ in COVID-19 in SSA.
Subject(s)
COVID-19 Drug Treatment , Hydroxychloroquine/therapeutic use , Immunologic Factors/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Rituximab/therapeutic use , HumansABSTRACT
Confirmation of COVID-19 infection is still challenging in Cameroon due to lack of sufficient RT-PCR tests and screening capacity. International organizations as well as philanthropic donators initially provided these tests. Due to limited kits availability, mass screening is currently a luxury that the country cannot afford. This impacts on estimates of disease prevalence, on the understanding of its burden and delays the implementation of targeted preventive measures. Besides RT-PCR, chest CT-scan could be a useful tool for screening purposes. However, its sensitivity and cost make its integration in management algorithms difficult. We discuss below the challenges and potential solutions that could ease the diagnosis of COVID-19 infection in Cameroon.