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Efficacy and safety of hydroxychloroquine in healthcare professionals with mild SARS-CoV-2 infection: prospective, non-randomized trial

Agusti et al., Enfermedades Infecciosas y Microbiología Clínica, doi:10.1016/j.eimc.2020.10.023
Dec 2020  
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Progression 68% Improvement Relative Risk Time to viral- 32% no CI HCQ for COVID-19  Agusti et al.  EARLY TREATMENT Is early treatment with HCQ beneficial for COVID-19? Prospective study of 142 patients in Spain Lower progression with HCQ (not stat. sig., p=0.21) c19hcq.org Agusti et al., Enfermedades Infecciosa.., Dec 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 419 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 112 treatments. c19hcq.org
Small trial of low dose HCQ for healthcare workers with mild SARS-CoV-2 showing 68% lower progression to pneumonia, p = 0.21, and faster, but not statistically significant viral clearance. There were no ICU admissions or deaths. Prospective non-randomized study. The figures and supplementary data are not currently available in the pre-proof edition.
risk of progression, 68.4% lower, RR 0.32, p = 0.21, treatment 2 of 87 (2.3%), control 4 of 55 (7.3%), NNT 20, pneumonia.
time to viral-, 31.8% lower, relative time 0.68, treatment 87, control 55.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Agusti et al., 9 Dec 2020, prospective, Spain, peer-reviewed, median age 37.0, 13 authors, average treatment delay 5.0 days, dosage 400mg bid day 1, 200mg bid days 2-5.
This PaperHCQAll
Efficacy and safety of hydroxychloroquine in healthcare professionals with mild SARS-CoV-2 infection: Prospective, non-randomized trial
Antonia Agusti, Elena Guillen, Alfonso Ayora, Andres Anton, Cristina Aguilera, Xavier Vidal, Cristina Andres, Manuel Alonso, Meritxell Espuga, Juliana Esperalba, Mª Queralt Gorgas, Benito Almirante, Esteban Ribera
Enfermedades Infecciosas y Microbiología Clínica, doi:10.1016/j.eimc.2020.10.023
Objectives: To assess the efficacy and safety of hydroxychloroquine (HCQ) compared with no treatment in healthcare workers with mild SARS-CoV-2 infection. Methods: Prospective, non-randomized study. All health professionals with confirmed COVID-19 between April 7 and May 6, 2020, non-requiring initial hospitalization were asked to participate. Patients who accepted treatment were given HCQ for five days (loading dose of 400 mg q12 h the first day followed by200 mg q12 h). Control group included patients with contraindications for HCQ or who rejected treatment. Study outcomes were negative conversion and viral dynamics of SARS-CoV-2, symptoms duration and disease progression. Result: Overall, 142 patients were enrolled: 87 in treatment group and 55 in control group. The median age was 37 years and 75% were female, with few comorbidities. There were no significant differences in time to negative conversion of PCR between both groups. The only significant difference in the probability of negative conversion of PCR was observed at day 21 (18.7%, 95%CI 2.0-35.4). The decrease of SARS-CoV-2 viral load during follow-up was similar in both groups. A non significant reduction in duration of some symptoms in HCQ group was observed. Two patients with HCQ and 4 without treatment developed pneumonia. No patients required admission to the Intensive Care Unit or died. About 50% of patients presented mild side effects of HCQ, mainly diarrhea. Conclusions: Our study failed to show a substantial benefit of HCQ in viral dynamics and in resolution of clinical symptoms in health care workers with mild COVID-19.
Ethics The study was conducted according to international ethical recommendations. In accordance with the national directives in relation to post-authorization studies, the study was approved by the Ethics Committee of Clinical Investigation of the Vall d'Hebron University Hospital (Institutional Review Board -03/04/2020) and registered on the European Union electronic Register of Post-Authorization Studies (EU PAS Register Number EUPAS34570). This trial had no financial support. Laboratorios Rubió contributed to the study with the required doses of hydroxychloroquine (Dolquine). Laboratorios Rubió had no role in study design, data collection and interpretation, or the decision to submit the work for publication. Conflict of interest All authors declare no conflict of interest. Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.eimc.2020.10.023.
References
Arshad, Kilgore, Chaudhry, Jacobsen, Wang et al., Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19, Int J Infect Dis
Bessière, Roccia, Delinière, Charrière, Chevalier et al., Assessment of QT Intervals in a case series of patients with Coronavirus Disease 2019 (COVID-19) infection treated with hydroxychloroquine alone or in combination with azithromycin in an Intensive Care Unit, JAMA Cardiol
Cipriani, Zorzi, Ceccato, Capone, Parolin et al., Arrhythmic profile and 24-hour QT interval variability in COVID-19 patients treated with hydroxychloroquine and azithromycin, Int J Cardiol
Ferner, Aronson, Chloroquine and hydroxychloroquine in covid-19, BMJ, doi:10.1136/bmj.m1432
Gautret, Lagier, Parola, Hoang, Meddeb et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents
Geleris, Sun, Platt, Zucker, Baldwin et al., Observational study of hydroxychloroquine in hospitalized patients with covid-19, N Engl J Med
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Mahévas, Tran, Roumier, Chabrol, Paule et al., Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data, BMJ
Mercuro, Yen, Shim, Maher, Mccoy et al., Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19), JAMA Cardiol
Mitjà, Corbacho-Monné, Ubals, Tebe, Ñafiel et al., Hydroxychloroquine for early treatment of adults with mild Covid-19: a randomizedcontrolled trial, Clin Infect Dis, doi:10.1093/cid/ciaa1009,ciaa1009
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Rosenberg, Dufort, Udo, Wilberschied, Kumar et al., Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State, JAMA
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