Legal aid won for malaria drug case

BMJ 1996; 313 doi: (Published 14 September 1996) Cite this as: BMJ 1996;313:643

A firm of solicitors has won legal aid to research a possible claim against Hoffmann-La Roche, makers of the antimalarial drug mefloquine (Lariam), by more than 500 people who claim to have suffered side effects, including panic attacks, depression, and fits.

Lawrence Tucketts of Bristol has won the contract to investigate the strength of the case, a process which usually takes at least a year. The Legal Aid Board will then decide whether the chances of success and the likely compensation warrant the cost of full funding.

Most potential litigants have come forward since fears about the drug were first aired last year on BBC TV's Watchdog programme. Lawyers estimate that the numbers joining the action, if it goes ahead, could be as high as 750.

Mefloquine, the newest and strongest antimalarial, has been increasingly prescribed by general practitioners since it was licensed in Britain, in 1990, because it was believed to offer the greatest protection against malaria, which kills some 20 British travellers a year. The drug is even more widely used in the US and some European countries.

But a new joint study by the London School of Hygiene and Tropical Medicine and Medical Advisory Services for Travellers Abroad (the MASTA study) has found a significantly higher rate of neuropsychiatric side effects from mefloquine than from chloroquine plus proguanil. The research, published in the BMJ on 31 August, found that 0.7% of travellers taking mefloquine suffered temporarily disabling neuropsychiatric effects compared with 0.09% of those taking the alternative combination.

Gordon Cook, consultant physician at the Hospital for Tropical Diseases and University College Hospital, London, first raised concerns about the drug in a letter to the BMJ. He said: “I have never prescribed it for prophylaxis, though my colleagues are still prescribing it. There is no doubt that it is a bit more effective, but if people won't take it, it makes it counterproductive. There's no doubt that the majority of people can tolerate it, but there is a subset of Homo sapiens who can't tolerate it.”

Dr Stuart Dollow, senior medical adviser to Roche Products Ltd, Hoffmann-La Roche's UK arm, said the findings of the MASTA study were comparable to the results of earlier studies. He said the authors acknowledged that their study was too small to detect rare side effects such as the 1:10 000 risk of adverse effects serious enough to warrant admission to hospital found by a much larger study.

“Disabling” side effects—defined as those bad enough to prevent a traveller temporarily carrying out day to day activities—was a new classification, he added. “We agree with the authors' conclusion that mefloquine is appropriate only where the risk both of malaria and of chloroquine resistance is high. This study does not change the overall risk-benefit profile of Lariam.—CLARE DYER, legal correspondent, BMJ

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