There is no evidence that chloroquine is effective in preventing or treating Covid-19, warns Unicamp researcher

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The medical and scientific communities are emphatic: there is no proof of the effectiveness of the use of chloroquine and hydroxychloroquine in cases of Covid-19, the disease caused by the new coronavirus (SARS-Cov-2). Recent studies demonstrate, on the contrary, the lack of safety in clinical routine with medications. Cardiac arrhythmia, one of the most common side effects, is potentially fatal, according to researchers warning.

After analyzing recent research regarding routine treatment with chloroquine and hydroxychloroquine (a compound analogous to chloroquine), the professor at the Unicamp Chemistry Institute, Luiz Carlos Dias, indicates that “the results of clinical trials in humans for SARS-CoV-2 , at different stages of the infection, are not favorable.” The studies that show some benefit, he says, were carried out in a non-randomized manner, without placebos and without double-blinding, research procedures that are adopted to provide more certainty in the results regarding the clinical effectiveness of the medicine. 

The teacher, who works on the development of drugs for neglected diseases, including malaria, one of the illnesses for which chloroquine is used in Brazil, notes that, due to the adverse effects, even in the case of malaria, where there is proof of effectiveness, the medication is administered only with a strict patient monitoring. Therefore, for him, the best alternative for controlling the new coronavirus pandemic, at the moment, is social isolation.

audio description: montage of two color photographs by professor Luiz Carlos Dias
Chloroquine and azithromycin, a combination suggested by the Ministry of Health, combines two medications that can cause cardiac arrhythmia, says professor Luiz Carlos

Expansion of use

Even recognizing that there are no guarantees of positive results, the Ministry of Health, in a protocol published this Wednesday (20), recommended expanding the use of chloroquine for mild cases of the disease in Brazil. In the Ministry of Health's recommendation, determined by President Jair Bolsonaro, it is indicated that the medicine be administered together with azithromycin, an antibiotic. Azithromycin, as well as chloroquine and hydroxychloroquine, can also cause cardiac arrhythmia. “You combine two medications that cause cardiac arrhythmia, which can be fatal”, warns Luiz Carlos.

The decision contradicts the Guidelines for the Pharmacological Treatment of Covid-19, released by Medical Societies the day before. In the publication, jointly signed by the Brazilian Association of Intensive Care Medicine, the Brazilian Society of Infectious Diseases and the Brazilian Society of Pneumology and Phthisiology, doctors point out the low or very low level of evidence in routine treatment of the disease with chloroquine or hydroxychloroquine and recommend that they not be used, either alone or in combination with azithromycin.

The World Health Organization (WHO), through its emergencies director, Michel Ryan, spoke out after the Brazilian government's decision stating that “neither chloroquine nor hydroxychloroquine have been effective in the treatment of Covid-19 or in prophylaxis against disease infection. In fact, it's the opposite." The National Council of Health Secretaries (CONASS) also released note highlighting that the Ministry of Health's decision had no technical participation nor tripartite agreement, that is, it was not a common agreement between the federation, states and municipalities.

audio description: color photograph of professor Luiz Carlos Dias inside the laboratory
"There are no scientific studies published on its use at the beginning of the disease or on safe dosage", says the researcher

No scientific evidence

The recommendations for the use of chloroquine in mild cases, for Luiz Carlos, are nothing more than personal opinions. The teacher, who in 2016 showed that there was no proof of the effectiveness of phosphoethalamine, popularly called the "cancer pill" against cancer cells, recommends that any decision about chloroquine and hydroxychloroquine be based on scientific evidence. “There are no scientific studies published on its use at the beginning of the disease or on safe dosage. We need more studies and investigations to confirm whether there really is efficiency in the onset of the disease, as there are only personal reports from doctors, but this needs to be proven in a clinical trial, following scientific rigor, with control, or the results could be disastrous for the population. ”, says the teacher.

In addition to there being no evidence of effectiveness with patients who present mild symptoms, he points out that studies carried out with critically ill patients admitted to the Intensive Care Unit (ICU), also indicate that the combination, as well as the individual administration of the medications, is not positive. “Several trials carried out and published in reputable medical journals and clinical trials carried out in several countries have already shown that the combination of hydroxychloroquine and azithromycin or chloroquine and azimithromycin, or chloroquine and hydroxychloroquine alone, have no benefit for ICU patients”.

There are at least seven clinical trials, one of them in Brazil, which were interrupted due to the death of patients due to cardiac arrhythmia. “Certainly a greater number of studies are needed. There is no miracle medicine in the case of Covid-19, science needs time and scientists are working to develop a vaccine and find a medicine that reduces hospital stays by increasing bed turnover in ICUs”.

For Luiz Carlos, It is necessary to understand that there is danger in propagating an unvalidated medicine as a possible solution. He also warns that chloroquine and hydroxychloroquine, under no circumstances, can be used as prevention. “People cannot believe that there is a cure and leave isolation, take to the streets, believing that if they become infected they will be cured by these medicines. Those who are defending the use of chloroquine are distorting all the results published in reputable international journals and clinging to personal reports or studies that are considered flawed and without authorization from the National Research Ethics Council”, he states.

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audio description: colorful montage with images of medicine cards and microscope

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