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Pre exposure Hydroxychloroquine use is associated with reduced COVID19 risk in healthcare workers

Bhattacharya et al., medRxix, doi:10.1101/2020.06.09.20116806
Jun 2020  
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Case 81% Improvement Relative Risk HCQ for COVID-19  Bhattacharya et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 106 patients in India Fewer cases with HCQ (p=0.001) Bhattacharya et al., medRxix, June 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 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments.
HCQ reduced cases from 38% to 7%. 106 people. No serious adverse effects.
risk of case, 80.7% lower, RR 0.19, p = 0.001, treatment 4 of 54 (7.4%), control 20 of 52 (38.5%), NNT 3.2.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Bhattacharya et al., 9 Jun 2020, retrospective, India, preprint, 7 authors.
This PaperHCQAll
The beneficial role of N-acetylcysteine as an adjunctive drug in treatment of COVID-19 patients in a tertiary care hospital in India: an observational study
Raja Bhattacharya, Maitry Mondal, Subhendu Bikash Naiya, Lamsaka Lyngdoh, Dr Rishav Mukherjee, Prabhat K Singh
International Journal of Research in Medical Sciences, doi:10.18203/2320-6012.ijrms20204010
Background: N-acetyl cysteine, a mucolytic agent, demonstrates free radical scavenging and anti-inflammatory properties, and prevents endothelial dysfunction by inhibition of NF-KB and formation of no adducts. This has a potential role to tackle cytokine storms, endothelial dysfunction and prothrombotic state observed in COVID-19 manifestations like ARDS and Multi organ dysfunction. Methods: Institution based descriptive cross sectional study, 164 patients from laboratory confirmed RT PCR positive COVID-19 patients, in the study period from 27 th May 2020 to 10 th August 2020, were assessed, in medical college Kolkata, a dedicated COVID-19 care facility. Results: It was observed that moderate-severe patients who received N-acetyl cysteine along with standard therapy had average hospital stay duration of 12 days, higher rate of discharge, average duration of oxygen therapy of 8 days, less number of deaths and reduced transfer to critical care facilities. Conclusions: N-acetyl cysteine can be considered as an adjunctive therapy with standard protocol driven care, due to its beneficial anti-inflammatory and free radical scavenging properties.
Aldini, Altomare, Baron, Vistoli, Carini et al., N-Acetylcysteine as an antioxidant and disulphide breaking agent: the reasons why, Free radical res
Andrews, Prasad, Quyyumi, N acetyl cysteine improves coronary and peripheral vascular function, J Am Coll Cardiol
Bhattacharya, Mondal, Naiya, Lyngdoh, Mukherjee et al., The beneficial role of N-acetylcysteine as an adjunctive drug in treatment of COVID-19 patients in a tertiary care hospital in India: an observational study, Int J Res Med Sci
Bikdeli, Madhavan, Jimenez, Church, Dreyfus et al., COVID-19 and thrombotic or thromboembolic disease:implications for prevention, antithrombotic therapy, and followup, JACC
Carsana, Sonzogni, Nasr, Rossi, Pellegrinelli et al., Pulmonary postmortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study, The Lancet Infectious disease
Ellul, Benjamin, Singh, Lant, Michael et al., Neurological associations of COVID-19, Lancet Neurol
Flora, Grassi, Carati, Attenuation of influenza-like symptomatology and improvement of cell mediated immunity with long term N acetyl cysteine treatment, Eur respirJ
Goodman, Brunton, Chabner, Knollmann, Goodman & Gilman's pharmacological basis of therapeutics
Hagiwara, Ishii, Kitamura, Aerosolized administration of N-acetylcysteine attenuates lung fibrosis induced by bleomycin in mice, Am J Respir Crit Care Med
Hurst, Shaw, Lemaistre, Laboratory and clinical evaluation of the mucolytic properties of acetyl-cysteine, Am Rev Respir Dis
Jang, Kim, Lee, Kim, Moon et al., The tyrosine phosphatase, SHP-1, is involved in bronchial mucin production during oxidative stress, Biochem Biophys Res Commun
Mata, Sarrion, Armengot, Carda, Martinez, Respiratory syncytial virus inhibits cilia genesis in differentiated normal human bronchial epithelial cells: effectiveness of N acetyl cysteine, PLOS ONE
Miller, Rivero, Ziad, Smith, Elamin, Influence of nebulized unfractionated heparin and Nacetylcysteine in acute lung injury after smoke inhalation injury, J Burn Care Res
Mp, N-acetylcysteine as a potential treatment for COVID-19, Future Microbiol
Nishikawa, Kanki, Ogawa, Differential effects of N acetyl cysteine on nitroglycerin and nicorandil induced vasodilation in human coronary circulation, J Cardiovasc Pharmacol
Prescott, Donovan, Jarvie, Proudfoot, The Disposition And Kinetics of Intravenous N acetylcysteine in patients with Paracetamol overdose, Eur J chin pharmacol
Sagristá, García, De Madariaga, Mora, Antioxidant and pro-oxidant effect of the thiolic com-pounds N-acetyl-L-cysteine and glutathione against free radical-induced lipid peroxidation, Free Radic Res
Soltan -Sharifi, Mojtahedzadeh, Najafi, Rouini, Khajavi et al., Improvement by N acetyl cysteine of acute respiratory distress syndrome through increasing intracellular glutathione, and extracellular thiol molecules and antioxidant power: evidence for underlying toxicological mechanisms, Hum Exp Toxicol
Stamler, Slivika, Biological chemistry of thiols in the vasculature and in vascular related disease, Nur Rev
Wu, Wu, Liu, Yang, The SARS-CoV-2 outbreak: What we know, Int J Infect Dis
Zhou, Fu, Zheng, Wnag, Zhao et al., Pathogenic T cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients, Natl Sci Rev
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HCWs who had voluntarily taken hydroxychloroquine (HCQ) prior to exposure were ' 'considered one cohort while those who had not were considered to be another. All participants ' 'with a verifiable contact history were tested for COVID-19 by rtPCR. The two cohorts were ' 'comparable in terms of age, gender, comorbidities and exposure. The primary outcome was ' 'incidence rates of rtPCR positive COVID-19 infection amongst HCQ users and non ' 'users.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>106 healthcare ' 'workers were examined in this cohort study of whom 54 were HCQ users and rest were not. The ' 'comparative analysis of incidence of infection between the two groups demonstrated that ' 'voluntary HCQ usage was associated with lesser likelihood of developing SARS-CoV-2 infection, ' 'compared to those who were not on it, X2=14.59, p&lt;0.001. None of the HCQ users noted any ' 'serious adverse ' 'effects.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This study ' 'demonstrated that voluntary HCQ consumption as pre-exposure prophylaxis by HCWs is associated ' 'with a statistically significant reduction in risk of SARS-CoV-2. 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