Little known to the general public, chloroquine is now at the heart of scientific and political debates. This antimalarial drug, and especially its derivative hydroxychloroquine, raises hope in the fight against the new coronavirus, while a hypothetical vaccine is inevitably waiting. But its effectiveness is still far from being proven, its generalization divides the scientific community.
So, yes or no, does hydroxychloroquine have an impact on patients with Covid-19 disease? To settle the debate, many countries are launching clinical trials or prescribing treatments based on hydroxychloroquine, usually in hospitals. Who are those who bet everything on this potential remedy? Who is developing the most studies on the subject?
To respond, we relied on an American reference site, ClinicalTrials.gov, which lists clinical trials - in progress, completed, not started - worldwide. Note that the data is not exhaustive since, for example, the studies of the very media professor Didier Raoult do not appear there.
Twenty countries, around fifty studies
In total, out of 388 clinical trials linked to Covid-19, 53 are launched, or will soon be launched. A study is completed, it is a Chinese investigation published on March 3. The latter did not note any particular efficacy of hydroxychloroquine.
According to data recorded by ClinicalTrials, 20 countries are in the running, most in Europe or Asia. An international trial has also been undertaken.
It is in the United States that the largest number of clinical trials on chloroquine or its derivatives take place. No wonder the first world power, President Donald Trump, very enthusiastic about this drug, having mentioned about this molecule a "gift from God".
Out of 80 studies launched or about to be launched in the country, 16 are interested in the use of this molecule. The United States has also allowed doctors to donate chloroquine in hospitals and "appropriately, when a clinical trial is not available or not feasible."
In China, 2% of clinical trials devoted to chloroquine
Next are Canada, Brazil and France, which each have four clinical trials of chloroquine or its derivatives. Spain and South Korea have three trials, while China, the country where the virus was born, has two. However, the Chinese have launched the most comprehensive clinical trials in the fight against SARS-CoV-2.
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If we compare, for each country, the share of studies devoted to chloroquine with that of the other clinical trials set up, we note that some States rely solely on this drug. This is the case of South Korea (100%): out of its three clinical trials, all are devoted to chloroquine.
In China, the first country in terms of number of clinical studies to fight against the coronavirus, 2% of the trials are interested in this potential treatment. In the United States, the ratio is 20%. For France, third in number of trials, it is almost 10%.
Angers University Hospital coordinates a study
In France, among the four trials registered on the ClinicalTrials website, one is part of the European study Discovery. This large-scale project, coordinated by Inserm and launched on March 22 in seven countries, aims to test four potential treatments, including hydroxychloroquine. "For the first results and the first trends, nothing will be available before at least the end of the month," warned on April 8, infectious disease specialist Florence Ader, who is piloting this trial.
Other studies have been launched to evaluate hydroxychloroquine in France, in particular by the CHU d'Angers, in collaboration with 36 other French hospitals. Its name: Hycovid. It will concern 1,300 patients.
For its part, the CHU de Saint-Etienne will try to demonstrate whether the use of hydroxychloroquine, but also of the lopinavir / ritonavir combination, could reduce the incidence of infections linked to the new coronavirus in exposed caregivers.
Finally, in Lyon, at the Léon Bérard Center, a clinical trial will be carried out on 273 patients. It aims to compare three treatments, including a chloroquine analog, in cancer patients with Covid-19.
Two petitions in France
In addition, the research institute of Professor Didier Raoult, in Marseille, put online this Friday the summary of a new study touting the merits of hydroxychloroquine (which it recommends in combination with an antibiotic). A number of scientists point out to the infectiologist the absence in his study of a control group (patients who are given a placebo) and do not validate his conclusion for this reason.
For the moment, in France, hydroxychloroquine is authorized in hospitals only, and only for severe cases. Two petitions with more than 300,000 signatures each ask to authorize a broader prescription of this drug, without waiting for the validation of the studies in progress.
And in Africa?
According to data listed on the ClinicalTrials website, no African country has yet registered a clinical study devoted to the use of chloroquine, a drug that is however well known to the inhabitants of sub-Saharan Africa. This treatment and its derivatives have in fact been used for years to treat malaria on the continent.
The situation could change: the World Health Organization (WHO) has been coordinating since the end of March an international clinical study supposed to test several treatments, including hydroxychloroquine, and "twenty-six African countries have expressed their interest," Franceinfo told Michel Yao, WHO emergency operations manager in Africa.
“None of them has started the test ( Editor's note: on April 3 ). The delays are due to validation processes by the ethics committees and to the fact that they do not have enough hospitalized patients. "