Coronavirus: "For severe cases, it is for the caregivers to judge if chloroquine is the most suitable treatment"

Presented as the miracle treatment against coronavirus, should we rush to chloroquine? This molecule, marketed by the Sanofi laboratory under the name of Plaquenil, is experiencing a sudden revival of notoriety because it is part, among other drugs, of the treatments under study to fight against the pandemic.

Professor Didier Raoult, director of the Institut hospitalo-universitaire (IHU) Méditerranée Infection de Marseille (Bouches-du-Rhône), recommends generalizing its use to treat Covid-19 after a clinical trial on only 25 patients. Media outlets that have generated a real rush towards the molecule in pharmacies, while many scientists claim that these results should be confirmed first.

>> Read also: Chloroquine, an old drug for the new coronavirus?

"Currently, there is a high demand for this drug in pharmacies. We are also witnessing an increase in prescriptions for it," confirms Philippe Besset, president of the Federation of Pharmaceutical Unions of France (FSPF), contacted by France. 24.

For Nivaquine (a drug based on chloroquine), the wholesaler-distributor OCP noted "a strong increase in requests from pharmacists. Since the end of February, they have multiplied by 30". This date "corresponds to the appearance of the first cases of Covid-19 in Europe and the growing media coverage around clinical trials based on chloroquine", adds the company.

Non-authorization prescriptions

Hydroxychloroquine, a derivative of chloroquine, is used in particular for the treatment of lupus, an autoimmune disease, as well as other chronic pathologies, in particular inflammatory diseases.

"It is a listed medication, that is to say that it requires a prescription to be dispensed", explains Carine Wolf-Thal, president of the order of Pharmacists, interviewed by France 24. "This measure dates from January 2020. In theory, it is prescribed only for the indications listed on its marketing authorization (MA), that is to say diseases such as lupus or polyarthritis. "

"Prescribers can always make prescriptions outside this marketing authorization", continues Carine Wolf-Thal. "But whether it is in the case of the coronavirus or as a general rule, this prescription is always done under their responsibility and must be indicated on the prescription. These are the kinds of prescriptions that we have seen flowering in recent times. "

Towards a shortage of Chloroquine ?

The massive diversion of this drug raises fears of a shortage for chronic patients who really need it.

"Plaquénil is the basic treatment for our disease", explains Johanna Clouscard, president of the Lupus France association, interviewed by franceinfo. His two tablets a day allow him to avoid skin damage and joint pain caused by this chronic autoimmune disease. His association reports several field trips where patients complain of a treatment that is now untraceable.

"Today, there are no more stocks in pharmacies," confirms the president of the FSPF, Philippe Besset.

Today a patient asked me again for #Chloroquine. I can never say it enough: we (almost) do not have it, we do not give this medicine as a prevention and there are patients who REALLY need it. Let us await the results of the experiment. #coronavirus pic.twitter.com/bB67jOjnHi

For Carine Wolf-Thal, "there is no shortage of chloroquine. Pharmacies cannot order massive stocks. They are limited by wholesalers precisely to avoid a shortage."

And the sector is organized for chronic patients. The Sanofi laboratory has in particular set up a special number for pharmacists to obtain the drug for those who really need it, explains the president of the Order of Pharmacists.

"We have to show our feet now," explains Philippe Besset. "You must contact the laboratories directly and present a prescription dated January or February demonstrating that the patient does have a chronic disease."

In front of the debates caused by chloroquine, the Minister of Health, Olivier Véran, announced on Monday March 23 a decree to "supervise" its use.

"With this decree, chloroquine derivatives can only be used in the context of a trial or in a hospital environment. The drug will be reserved for those who need it and who have prescriptions in accordance with marketing authorizations. ", concludes Carine Wolf-Thal.

Dangerous self-medication

According to the French Pharmacy Society, the two drugs have a narrow therapeutic margin, which means that the effective dose and the toxic dose are relatively close. The two specialists interviewed by France 24 warn against any self-medication against the coronavirus.

"The instructions for hydroxychloroquine and the Medicines Agency list the common side effects. They range from partial loss of visual acuity, to nausea and digestive disorders. More rarely and especially more serious, they can cause heart failure. ", explains Philippe Besset.

Beyond the possible toxicity of the treatment, the other risk is to settle on a treatment which is not the most adapted to the virus.

"It seems like chloroquine is the drug that will save us all. Yet there are other treatments, including antivirals or retrovirals," says Carine Wolf-Thal.

"If the patient has a mild form - which represents 85% of cases -, paracetamol is sufficient. No need to expose yourself to the risks and side effects of chloroquine. For severe or severe cases, it is It is up to caregivers to judge if chloroquine is the most appropriate treatment depending on the patient's condition and health problems, says the president of the order of pharmacists. We must trust hospital staff and research teams ".

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