{"id":39453,"date":"2020-12-09T07:27:26","date_gmt":"2020-12-09T07:27:26","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=39453"},"modified":"2021-01-10T01:34:12","modified_gmt":"2021-01-10T01:34:12","slug":"hydroxychloroquine-fails-to-prevent-covid-19-or-sars-cov-2-transmission-when-used-as-pep","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/39453","title":{"rendered":"Hydroxychloroquine fails to prevent COVID-19 or SARS-CoV-2 transmission when used as PEP"},"content":{"rendered":"
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<\/strong>Simon Collins, HIV i-Base<\/span><\/b><\/p>\n<\/div>\n

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Results from a large randomised open-label phase 3 study reported hydroxychloroquine (HCQ) had no impact as prophylaxis against COVID-19 and didn’t reduce symptoms in participants who did become infected.<\/span><\/strong><\/p>\n<\/div>\n

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The Barcelona PEP study was run in three regions in Catalonia, and reported in 24 November edition of NEJM. [1]<\/span><\/p>\n<\/div>\n

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Between 17 March and 28 April 2020 the study enrolled 2314 adults in who had been in contact with 672 index case patients with confirmed COVID-19. Participants were randomised to open label HCQ (n=1116) or standard of care (n=1198) (based on hand hygiene, face masks, social distancing, and isolation of case patients and contacts).<\/span><\/p>\n<\/div>\n

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Contact risk was defined as being within two metres for >15 minutes to 7 days before enrollment and who were at high risk (a health care worker, a household contact, a nursing-home worker, or a nursing-home resident). Participants connected to the same index case were randomised together as a group.<\/span><\/p>\n<\/div>\n

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The primary endpoint of incidence of symptomatic COVID-19 confirmed by PCR was similar in both groups: 5.7% vs 6.2%, respectively (risk ratio: 0.86 [95% CI: 0.52 to 1.42]). There were also no differences in SARS-CoV-2 transmission: 18.7% vs 17.8%, respectively.<\/span><\/p>\n<\/div>\n

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However, side effects were significantly higher (56.1% vs 5.9%) although these were not related to higher rates of discontinuations from the study.<\/span><\/p>\n<\/div>\n

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comment<\/span><\/h3>\n<\/div>\n
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This finding support those from other RCTs.<\/span><\/strong><\/p>\n<\/div>\n

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A randomised study in 821 participants that also found no benefits from hydroxychoroquine used as post exposure prophylaxis (PEP) for COVID-19 after moderate or high risk of exposure, although fewer index cases had PCR-confirmed infection. [3]<\/span><\/strong><\/p>\n<\/div>\n

Another randomised, double-blind, placebo-controlled clinical study of HCQ as PEP in 132 health workers also found no benefit in preventing infection, but with higher side effects reported in the HCQ arm. [4]<\/strong><\/p>\n<\/div>\n

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And as this issue of HTB was being compiled, a multicentre US randomised controlled study also reported no benefit of HCQ as PEP (400 mg\/day for 3 days followed by 200 mg\/day for 11 days) at preventing SARS-CoV-2 infection by day 14. [5] This study had been presented as a late breaker abstract at IDWeek in October 2020.<\/strong><\/p>\n

Other large well-publicised studies have reported that HCQ also has no benefit as treatment from COVID-19 in moderate or advanced infection. [6, 7, 8]<\/span><\/strong><\/p>\n<\/div>\n

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With definitive studies now finding no benefit before infection or in moderate (hospitalised infection) it is difficult to believe that a new study planned in 13 African countries – the ANTICOV study – is likely to find any benefit hydroxychoroquine in early confirmed infection. [9]<\/span><\/strong><\/p>\n<\/div>\n

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References<\/span><\/p>\n<\/div>\n

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  1. Mitj\u00e0 et al. A cluster-randomized trial of hydroxychloroquine for prevention of Covid-19. NEJM. DOI: 10.1056\/NEJMoa2021801. (24 November 2020).
    \n<\/span>https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2021801<\/a><\/li>\n
  2. ClinicalTrials.gov<\/a>.\u00a0Treatment of non-severe confirmed cases of COVID-19 and chemoprophylaxis of their contacts as prevention strategy: a cluster randomized clinical trial (PEP CoV-2 Study).\u00a0NCT04304053.
    \n    https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2021801?query=RP<\/a><\/li>\n
  3. Boulware DR\u00a0et al. A randomized trial of hydroxychloroquine as postexposure prophylaxis for Covid-19. N Engl J Med\u00a02020;383:517-525. (6 August 2020).
    \n    https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2016638<\/a><\/li>\n
  4. Abella BS\u00a0et al. Efficacy and safety of hydroxychloroquine vs placebo for pre-exposure SARS-CoV-2 prophylaxis among health care workers: a randomized clinical trial. JAMA Intern Med. DOI:10.1001\/jamainternmed.2020.6319. (30 September 2020).
    \n    https:\/\/jamanetwork.com\/article.aspx?doi=10.1001\/jamainternmed.2020.6319<\/a><\/li>\n
  5. Barnabas RV et al. Hydroxychloroquine as postexposure prophylaxis to prevent severe acute respiratory syndrome coronavirus 2 infection. Annals of Internal Medicine. DOI:\u00a010.7326\/M20-6519. (8 December 2020).
    \n    https:\/\/www.acpjournals.org\/doi\/full\/10.7326\/M20-6519<\/a><\/li>\n
  6. UK RECOVERY study stops hydroxychloroquine (HCQ) for COVID-19: more than 1100 deaths question ethics and safety overall. HTB (26 June 2020).
    \n    https:\/\/i-base.info\/htb\/38188<\/a><\/li>\n
  7. UK RECOVERY study stops hydroxychloroquine (HCQ) for COVID-19: more than 1100 deaths question ethics and safety overall. HTB (26 June 2020).
    \n    https:\/\/i-base.info\/htb\/38188<\/a><\/li>\n
  8. No survival benefit from remdesivir hydroxychloroquine lopinavir\/r or interferon-\u03b21a in moderate and severe COVID-19: interim results from the WHO SOLIDARITY study. HTB (11 November 2020).
    \n    https:\/\/i-base.info\/htb\/39223<\/a><\/li>\n
  9. International COVID-19 study launches in Africa but with drugs that have little chance of working (ANTICOV). HTB (25 November 2020).
    \n    https:\/\/i-base.info\/htb\/39419<\/a><\/li>\n<\/ol>\n

    This article was first posted on 30 November 2020.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Results from a large randomised open-label phase 3 study reported hydroxychloroquine (HCQ) had no impact as prophylaxis against COVID-19 and didn’t reduce symptoms in participants who did become infected. The Barcelona PEP study was run in …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[283,289,278],"tags":[],"class_list":["post-39453","post","type-post","status-publish","format-standard","hentry","category-covid-19-investigational-drugs","category-covid-19-transmission","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/39453","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=39453"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/39453\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=39453"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=39453"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=39453"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}