Covid-19: The Prescribe medical journal unfavorable to the use of chloroquine


SCEPTICISM – The independent journal Prescrire, having analyzed the results of certain clinical trials of chloroquine to combat Covid-19, has just made negative conclusions about its use, in particular because of the risks of cardiac effects.

Prescribing chloroquine to patients who test positive for the new coronavirus continues to be debated. For the prevention or treatment of infection, with or without the antibiotic azithromycin, on patients who are not very symptomatic or severe … Hydroxychloroquine, a less toxic derivative of chloroquine, is currently being tested with all sauces against Covid -19. What to think about it? Hope or skepticism in the face of the miracle remedy praised for so many weeks by Professor Raoult and described as “heavenly gift” by Donald Trump?

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The independent review Prescribe, whose work has been the benchmark for many years in the area of ​​drug efficacy analysis, favors the second option, which has just negative conclusions about the use of chloroquine for the treatment of Covid-19. As detailed The Parisian, Prescribe first analyzed a clinical trial conducted in Shanghai, China, on 150 patients, with a “good level of evidence”, the results of which were made public on April 14. Half of the patients were taking hydroxychloroquine and “there was no demonstrated antiviral effect in these patients”, writes Prescribe. In contrast, the only patient whose state of health worsened was in the hydroxychloroquine group.

Another series of trials followed, including one in four hospitals in Île-de-France which compared the evolution of 181 patients affected by Covid-19 with pulmonary involvement justifying oxygen therapy: 84 had started receiving hydroxychloroquine (600 mg per day) within the first 48 hours of their hospitalization, and 97 had not received it during this period (control group). Although there was no “statistically significant difference” in the improvement of patients’ health, more cardiac side effects appeared in the group taking hydroxychloroquine, and 9, 5% of them had to stop this treatment for this reason.

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Always according to Prescribe, the adverse reaction profiles of hydroxychloroquine and azithromycin suggest that their combination increases the risk of serious heart rhythm disorders, a hypothesis supported by “more and more clinical data”, writes the review. In particular that of a team in New York having studied the electrocardiographic data of a series of 84 patients hospitalized for a covid-19 and treated by the association hydroxychloroquine + azithromycin. “Under treatment, a prolongation of the QT interval of the electrocardiogram exceeding 500 milliseconds was found in 11% of patients, a threshold at which the risk of cardiac arrhythmia and torsade de pointes is particularly high”.

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Serious cardiac side effects

The conclusions of Prescribe are very unfavorable to the combination of these two treatments, based on the results of different clinical trials, recalling the results of the Nice regional pharmacovigilance center survey, under the authority of the French Medicines Agency (ANSM), relating more specifically to cardiovascular adverse reactions reported in treatment with covid-19: “53 cases of cardiac adverse effects were thus analyzed, including 43 cases reported with hydroxychloroquine, alone or in combination (in particular with azithromycin): 7 cases of sudden death (including 3 successfully resuscitated), ten disorders of the electrocardiographic rhythm or cardiac symptoms of the syncope type, and disorders of the conduction including lengthening of the QT interval, favorable evolution after cessation of treatment. The ANSM concluded that, given the importance of underreporting in a context of high activity by hospital care teams, these cases identified ‘constitute an important signal’ “.

So, according to the review, two conclusions on April 15, 2020: “we do not yet know any treatment that reduces the risk of progression to a serious Covid-19” and “exposing patients to hydroxychloroquine and azithromycin increases the risk of effects serious cardiac adverse events “.

Dozens of studies and clinical trials are currently underway around the world, just for hydroxychloroquine. Internationally as in France, the molecule divides. Doctors from the Geneva University Hospitals (HUG) signed this Friday, April 17 a detailed summary unfortunately not showing any major beneficial effect of the molecule at this stage.

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