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Composition analysis of falsified chloroquine phosphate samples seized during the COVID-19 pandemic

Tchounga et al., Journal of Pharmaceutical and Biomedical Analysis, doi:10.1016/j.jpba.2020.113761
Nov 2020  
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Analysis of fake CQ tablets finding:
- no CQ in six samples, substituted with metronidazole (at sub-therapeutic levels) or paracetamol.
- trace levels of paracetamol and chloramphenicol in four and two samples respectively.
- CQ levels too low in two samples.
7 meta analyses show significant improvements with hydroxychloroquine for mortality Landsteiner de Sampaio Amêndola, Risch, Risch (B), Stricker, hospitalization Landsteiner de Sampaio Amêndola, recovery Prodromos, combined death/hospitalization/cases Ladapo, and cases García-Albéniz.
Currently there are 38 HCQ for COVID-19 early treatment studies, showing 76% lower mortality [60‑86%], 67% lower ventilation [-710‑99%], 31% lower ICU admission [1‑53%], and 41% lower hospitalization [28‑51%].
Tchounga et al., 12 Nov 2020, peer-reviewed, 7 authors.
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Composition analysis of falsified chloroquine phosphate samples seized during the COVID-19 pandemic
C A Waffo Tchounga, P Y Sacre, P Ciza, R Ngono, E Ziemons, Ph H Hubert, R D Marini
Journal of Pharmaceutical and Biomedical Analysis, doi:10.1016/j.jpba.2020.113761
The proliferation of falsified medicines can cause serious public health issues, particularly in the context of a global pandemic such as the actual COVID-19 pandemic. Our study involved eight chloroquine phosphate medicines seized in Cameroon, Democratic Republic of Congo and Niger during March and May 2020. These suspect samples were first analyzed in a screening phase using field tools such as handheld Raman spectroscopy (TruScan) and then in a confirmation phase using laboratory tools such as hyperspectral Raman imaging and High Performance Liquid Chromatography (HPLC). The results confirmed the falsified nature of the samples, highlighting the presence of metronidazole at low dose in four samples (16.6, 15.2, 15.2 and 14.5 mg/tab), too low levels of chloroquine in two samples (2.4 and 20.2 mg/tab), and substitution of chloroquine phosphate by paracetamol in one sample (255.7 mg/tab). The results also confirmed that four samples had been adulterated with paracetamol in trace amounts and two of them presented traces of chloramphenicol.
In the frame of the COVID-19 pandemic, the need for specific products (allegedly treating the disease) may increase rapidly at a global scale. This constitute an opportunity for criminal groups and unscrupulous sellers to sell substandard and falsified medicines. In this context, the application of rapid, easy-to-use techniques such as Raman spectroscopy should make it possible to combat efficiently the resurgence of poor-quality medicines. However, handheld devices are not sensitive enough to detect trace level contaminants or low-dosed active ingredients. Therefore, hyperspectral imaging may help in this context providing also a "signature" of the product composition possibly allowing the grouping of falsification cases. CRediT authorship contribution statement Declaration of Competing Interest The authors report no declarations of interest. Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi: 113761.
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