If some people want to generalize the antimalarial chloroquine as a treatment against the covid-19 pandemic, health authorities, including the WHO, call for caution. Update on the state of current knowledge on this substance.

If some people want to generalize the antimalarial chloroquine as a treatment against the covid-19 pandemic, health authorities, including the WHO, call for caution. Update on the state of current knowledge on this substance.

(.) – Chloroquine is known by several trade names, depending on the countries and the laboratories that manufacture them: Nivaquine or Resochin for example. There is a derivative, better tolerated hydroxychloroquine, known in France as Plaquénil, for joint diseases of inflammatory origin, such as rheumatoid arthritis.

The side effects are numerous: nausea, vomiting, rashes but also ophthalmological attacks, cardiac, neurological disorders …

With dozens of officially registered infections, the Grand Duchy has chosen to take drastic measures to limit the spread of covid-19. Measures that impact the daily lives of 614,000 residents and 200,000 cross-border residents of the country.

An overdose can be particularly dangerous and doctors strongly advise against consuming it without medical advice. “These two drugs are said to be” with a narrow therapeutic margin “, which means that the effective dose and the toxic dose are relatively close,” warns the French Pharmacy Society.

What do we know about its effects on the coronavirus?

Several laboratories that manufacture chloroquine drugs have announced donations to health authorities in several countries and / or the increase or resumption of their production.

In mid-February, Chinese researchers claimed to have had positive results with clinical trials involving a hundred covid-19 patients in ten hospitals. Despite the reduced number of patients and the lack of details on the methodology and results of the Chinese trials, Didier Raoult, director of the Hospital-University Institute (IHU) Mediterranean infection and recognized specialist in infectious diseases, relayed these results in France . Professor Raoult is also a member of the scientific committee placed with the government.

Atypical and nonconformist, he defends chloroquine tooth and nail as a treatment, in the press and in videos very shared on the internet.

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It has attracted numerous criticisms from other scientists, who call for taking this path with caution, in the absence of clinical studies done according to strict methodological protocols and published in a prestigious scientific journal with independent reading committee.

In addition to a series of trials conducted in China (chloroquine alone or in combination with other molecules), teams of Pr Raoult are testing chloroquine on patients at the IHU, positive trials according to the team, which has published results involving twenty patients.

Reported for the first time by the WHO on December 31, 2019, the 2019-nCoV virus has spread throughout the world in a few weeks. China, the center of the epidemic, is particularly affected.

They received Plaquenil and some, depending on their symptoms, the antibiotic azythromicine. “Despite the small sample size, our study shows that treatment with hydroxychloroquine is significantly associated with a decrease / disappearance of viral load (…) and its effects are reinforced by azithromycin” , according to the study co-signed by Pr Raoult.

Invoking the Hippocratic oath of doctors, his team announced Sunday its intention to now administer “all infected patients” hydroxychloroquine + azithromycin to the sick. Treatment is also provided in particular at the Nice University Hospital with the consent of families, according to Mayor Christian Estrosi, himself treated with chloroquine.

For its part, the AP-HP (Parisian public hospitals) has noted a high demand for hydroxychloroquine from hospital pharmacies since Friday.

Why is it controversial?

At European level, a clinical trial dubbed Discovery has been launched in several countries to test experimental treatments, including hydroxychloroquine, a trial which “will include at least 800 French patients suffering from severe forms of COVID-19” according to Inserm .

In the United States, the FDA, which oversees the marketing of drugs, announced “an extensive clinical trial” while recalling that its role was to ensure that the products were safe and effective.

On the one hand, those who call for caution and to wait for large clinical trials conducted according to strict scientific orthodoxy to validate or not treatment with chloroquine; on the other, those who want to speed up the process and administer it very broadly in the name of the health emergency.

In France, several elected officials are mounting the pressure to rapidly generalize the use of chloroquine. As for Donald Trump, he has praised its merits on several occasions.

Hence the very firm recall of the World Health Organization (WHO) on Monday, which “condemns the use of drugs without proof of their effectiveness”, warning against “false hopes”, in a barely allusion veiled at the publication of the IHU.

The WHO points in particular to the reduced nature of the number of patients and the fact that it is “non-randomized”, that is to say that the patient groups (those who receive treatment and those who do not receive it) have not been defined by lot. Nor is it “double-blind,” a method that keeps doctors and patients unaware of who is receiving treatment.

In France, the Minister of Health Olivier Véran said Monday that he was preparing to authorize treatment with hydroxychloroquine but only for severe forms and in a hospital setting “on the collegial decision of doctors” and promised an order on the subject.

“In the absence of any convincing data”, it is however excluded to prescribe it in the general population or for non-severe cases.

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