For the past two months, Professor Jean-Louis Montastruc, head of the Center for Pharmacovigilance and Drug Information at the Toulouse University Hospital, has warned of the dangers of using chloroquine for Covid-19 patients. When the WHO decides to suspend clinical trials as a precaution, the pharmacologist, member of the National Academy of Medicine, decrypts the study published on May 22 in “The Lancet” which shows the ineffectiveness of the molecule and its dangers, especially on the heart rate.
What do we learn from the study in The Lancet on chloroquine?
This study is not a clinical trial but a large-scale pharmacoepidemiological study involving several thousand patients. It has been very well done because it includes adjustments: taking into account age, sex, weight, other treatments makes it possible to compare patients and give a convincing argument. In this case, this study shows that there is no efficacy of chloroquine against Covid-19 and that there is an excess mortality thereafter, due to the cardiac adverse effects of the molecule.
This last point is not a surprise, we know that quinidine derivatives can cause heart rhythm disturbances. In this study, the patients who took chloroquine had it within 48 hours after the first symptoms, so we cannot say that taking it too late is the cause of its ineffectiveness – thesis defended by Pr Didier Raoult.
As a pharmacologist, are you relieved by the publication of these conclusions?
Yes because it’s been two months and two weeks that I say it as well as the whole French pharmacological community. We have been heard too little. These findings are a relief, they are in the interest of our patients. Chloroquine may remain as an example of a drug whose effectiveness has been evaluated outside of clinical trials.
What should be next?
Cardiac adverse effects, excess mortality with chloroquine are very strong arguments. I hope that the High Council of Public Health will ban the use of chloroquine for Covid-19 (lupus and rheumatoid arthritis are not concerned, in these diseases, the balance of benefits / risks tips in favor of chloroquine) .
“It is questionable to put a risk to the patients who would take it, even within the framework of a clinical trial”
Will this study close the debate on whether or not to use chloroquine in Covid-19 cases?
I hope so. As a precaution and safety principle, chloroquine should no longer be used to treat Covid-19 patients.
Do you still need a clinical trial to conclude?
It is ethically questionable to put patients at risk even in clinical trials. And then there was so much turmoil around chloroquine that patients wanted to enter clinical trials provided they were in the group that would take chloroquine or hydroxychloroquine … Doctors also prescribed preventively and for those around them! However, it is unreasonable to prescribe an untested and dangerous drug.
Read also :
Coronavirus: WHO suspends clinical trials with hydroxychloroquine “as a precaution”
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