Hydroxychloroquine as Postexposure Prophylaxis to Prevent Severe Acute Respiratory Syndrome Coronavirus 2 Infection
MBChB, MSc, DPhil Ruanne V Barnabas, ScD Elizabeth R Brown, PhD Anna Bershteyn, MD Helen C Stankiewicz Karita, MD, MPH Christine Johnston, PhD, MPH Lorna E Thorpe, MD Angelica Kottkamp, MD, MPH Kathleen M Neuzil, MD, MPH Miriam K Laufer, MD Meagan Deming, PhD Michael K Paasche-Orlow, MD Patricia J Kissinger, PhD, MPH Alfred Luk, MD Kristopher Paolino, MD Raphael J Landovitz, MD, MSc Risa Hoffman, MD Torin T Schaafsma, MS Meighan L Krows, BA Katherine K Thomas, MS Susan Morrison, MD, MPH Harald S Haugen, MS Lara Kidoguchi, MPH Mark Wener, MD Alexander L Greninger, PhD, MS, MPhil Meei-Li Huang, PhD Keith R Jerome, MD, PhD; Anna Wald, MD, MPH Connie Celum, MD, MPH Helen Y Chu, MD, MPH Jared M Baeten
Annals of Internal Medicine, doi:10.7326/m20-6519
Background: Effective prevention against coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently limited to nonpharmaceutical strategies. Laboratory and observational data suggested that hydroxychloroquine had biological activity against SARS-CoV-2, potentially permitting its use for prevention.
Objective: To test hydroxychloroquine as postexposure prophylaxis for SARS-CoV-2 infection. Design: Household-randomized, double-blind, controlled trial of hydroxychloroquine postexposure prophylaxis. (ClinicalTrials .gov: NCT04328961) Setting: National U.S. multicenter study. Participants: Close contacts recently exposed (<96 hours) to persons with diagnosed SARS-CoV-2 infection. Intervention: Hydroxychloroquine (400 mg/d for 3 days followed by 200 mg/d for 11 days) or ascorbic acid (500 mg/d followed by 250 mg/d) as a placebo-equivalent control. Measurements: Participants self-collected mid-turbinate swabs daily (days 1 to 14) for SARS-CoV-2 polymerase chain reaction (PCR) testing. The primary outcome was PCRconfirmed incident SARS-CoV-2 infection among persons who were SARS-CoV-2 negative at enrollment.
Results: Between March and August 2020, 671 households were randomly assigned: 337 (407 participants) to the hydroxychloroquine group and 334 (422 participants) to the control group. Retention at day 14 was 91%, and 10 724 of 11 606 (92%) expected swabs were tested. Among the 689 (89%) participants who were SARS-CoV-2 negative at baseline, there was no difference between the hydroxychloroquine and control groups in SARS-CoV-2 acquisition by day 14 (53 versus 45 events; adjusted hazard ratio, 1.10 [95% CI, 0.73 to 1.66]; P > 0.20). The frequency of participants experiencing adverse events was higher in the hydroxychloroquine group than the control group (66 [16.2%] versus 46 [10.9%], respectively; P = 0.026).
Limitation: The delay between exposure, and then baseline testing and the first dose of hydroxychloroquine or ascorbic acid, was a median of 2 days.
Conclusion: This rigorous randomized controlled trial among persons with recent exposure excluded a clinically meaningful effect of hydroxychloroquine as postexposure prophylaxis to prevent SARS-CoV-2 infection.
Corresponding Author: Ruanne V. Barnabas
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