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Coronavirus: 9 things to know about chloroquine

In depth
This article is part of the dossier: Corona Chronicles: 23-27 March

By Clarisse Juompan-Yakam
Posted on Thursday, 26 March 2020 16:05

In Nantong, China, employees of a pharmaceutical industry are busy producing chloroquine on February 27, 2020. © Xu Congjun/Utuku/ROPI-REA

There is renewed interest in chloroquine now that a number of doctors have asserted that it has beneficial effects on COVID-19 patients. However, the scientific community is still divided over such claims.

Here is what your need to now about chloroquine.

Blockbuster drug

A blockbuster drug for many years now for the prevention and treatment of malaria, chloroquine is also used in rheumatology and dermatology. A product of German, American and French pharmaceutical industry research conducted in the 1930s and 1940s, the drug became available in France in 1949. It was marketed alone under the name Nivaquine and in combination with proguanil hydrochloride under the name Savarine.

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What is hydroxychloroquine?

Hydroxychloroquine is a molecule derived from chloroquine. It is used to treat conditions such as rheumatoid arthritis and certain forms of lupus, but is not indicated as an antimalarial drug in France. Marketed under the name Plaquenil, it has an anti-inflammatory effect which Nivaquine does not.

Fast acting

Rapidly absorbed, chloroquine is distributed to all tissues in the body and can thus treat any infected organs, whether the liver or the lungs. It does not act directly on the virus, but rather on “sick” cells by reducing their infectious capacity.

A lethal weapon?

For Professor Didier Raoult, Director of the Méditerranée Infection Foundation at the Marseille University Hospital Centre in southern France, chloroquine has the potential to be a miracle cure against COVID-19. He administered it on 16 March 2020 to patients admitted to his department, at a dose of 600 mg of hydroxychloroquine per day, in combination with azithromycin (a macrolide antibiotic).

According to his results, six days later, only a quarter of patients still carried the virus, compared to 90% for patients who did not receive the same treatment. On 23 March, French Minister of Health Olivier Véran approved the use of chloroquine in hospitals to treat patients with the most severe forms of coronavirus.

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Controversies

Professor Raoult’s critics are concerned that the molecule has been tested on too few patients for his observations to be conclusive and that he did not follow the scientific protocol typically used in clinical trials to eliminate the risk of bias in the interpretation of results. Most scientists think that more time is needed before the treatment can be determined to be safe and effective.

These are not the only concerns, as chloroquine reportedly causes a number of side effects and is behind quite a few incidences of heart attacks. Known as Discovery, a trial coordinated by the French National Institute of Health and Medical Research (Institut national de la santé et de la recherche médicale – INSERM) is underway and aims to evaluate the effectiveness of four drugs, including chloroquine, on more than 300 European patients.

Trump card: cheap

On 24 March, Morocco also decided to introduce chloroquine (Nivaquine) and hydroxychloroquine (Plaquenil) as a treatment for patients with confirmed COVID-19 infections. If the studies currently being conducted end up confirming its efficacy, Africa will have a clear advantage in the fight against the coronavirus due to the country’s extensive familiarity with chloroquine, a drug that is frequently used, well known and, above all, inexpensive: a box of 20 tablets of Nivaquine 100 mg costs €3.16 and a box of 30 tablets of Plaquenil 200 mg costs €5.19.

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Obsolescence

Although it was one of the most widely prescribed antimalarial drugs up until the 1980s, chloroquine is less and less recommended today because of the development of resistant strains, first in Asia and later in Africa and the Americas. It has become obsolete, with artemisinin-based treatments now favoured.

Toxic

In Africa, chloroquine has always had the reputation – wrongly, according to its advocates – of being especially toxic. It is true that it was often used in suicides in the 1970s. In addition, it has known toxic effects on the retina, particularly when it is taken long term.

To eat Ndolé or not eat Ndolé?

Contrary to an idea circulating on social media, eating Ndolé does not cure coronavirus. Although Vernonia amygdalina – the scientific name for the leafy vegetable – is indeed used in many traditional remedies, has certain therapeutic qualities and is as bitter as Nivaquine, it does not contain the same molecules as the drug.

The same can be said for kinkeliba, a plant known for its diuretic and anti-inflammatory properties, which has neither a curative effect on malaria nor viruses of any kind, and can even be dangerous.

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