de la Iglesia: Hydroxicloroquine for pre-exposure prophyylaxis for SARS-CoV-2 [HCQ]

Hydroxicloroquine for pre-exposure prophyylaxis for SARS-CoV-2

de la Iglesia et al., medRxiv, doi:10.1101/2020.08.31.20185314 (Preprint)

de la Iglesia et al., Hydroxicloroquine for pre-exposure prophyylaxis for SARS-CoV-2, medRxiv, doi:10.1101/2020.08.31.20185314 (Preprint)

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Analysis of autoimmune disease patients on HCQ, compared to a control group from the general population (matched on age and sex, but not adjusted for autoimmune disease), showing non-significant differences between groups.

Other research shows that the risk of COVID-19 for systemic autoimmune disease patients is much higher overall, Ferri et al. show OR 4.42, p<0.001 [Ferri], which is the observed real-world risk, taking into account factors such as these patients potentially being more careful to avoid exposure.

If we adjust for the different baseline risk, the mortality result becomes RR 0.35, p=0.23, suggesting a substantial benefit for HCQ treatment (as shown in other studies). This study is excluded in the after exclusion results of meta analysis: not fully adjusting for the different baseline risk of systemic autoimmune patients.

1. Ferri at al., Clinical Rheumatology, doi:0.1007/s10067-020-05334-7, COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series, https://link.springer.com/article/10.1007/s10067-020-05334-7.

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risk of hospitalization, 50.0% higher, RR 1.50, p = 1.00, treatment 3 of 687 (0.4%), control 2 of 688 (0.3%).

risk of case, 42.6% higher, RR 1.43, p = 0.15, treatment 42 of 648 (6.5%), control 30 of 660 (4.5%), suspected COVID-19.

risk of case, 7.8% lower, RR 0.92, p = 0.84, treatment 12 of 678 (1.8%), control 13 of 677 (1.9%), NNT 665, confirmed COVID-19.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

de la Iglesia et al., 2 Sep 2020, retrospective, database analysis, Spain, preprint, 17 authors.

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Abstract: medRxiv preprint doi: https://doi.org/10.1101/2020.08.31.20185314; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . HYDROXICLOROQUINE FOR PRE-EXPOSURE PROPHYLAXIS FOR SARS-CoV-2 AUTHORS: 1. Jaime López de la Iglesia 1 2. Naiara Cubelos Fernández2 3. Roi Naveiro Flores 3 4 4. Marina Montoro Gómez 5. Francisco Javier González de Haro4 6. María Ajenjo González5 5 7. Estefanía Tobal Vicente 8. María Lamuedra Gil de Gómez4 9. María Teresa Nuevo Guisado4 10.Isabel Torio Gómez 4 11.Ana Peñalver Andrada4 12.Nuria Martínez Cao4 13.Paula González Figaredo 4 14.Carlos Robles García4 15.Lidia Anastasia Alvarado Machón5 5 16.Ángeles Lafont Alcalde 17.José Cesáreo Naveiro Rilo6 Affiliations: 1 Doctor en Medicina Familiar y Comunitaria. Jefe de estudios de la Unidad Docente Multidisciplinar de Atención Familiar y Comunitaria de GAP León (España). 2 Licenciada en Medicina. GAP León (España). 3 Instituto de Ciencias Matemáticas. Estadística e investigación operativa. Consejo Superior de Investigación Científica (ICMAT-CSIC). 4 Graduado en Medicina. GAP León (España). 5 Doctora en Medicina. GAP León (España). 6 Doctor en Salud Pública y Medicina Preventiva. Unidad Docente de Medicina Familiar y Comunitaria de León (España). Contact: Naiara Cubelos Fernández. Mail: n.cubelos.fernandez@gmail.com -1NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.08.31.20185314; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . Tlf: +34 666813552 ABSTRACT SARS-CoV-2 infection has a high transmission level. At the present time there is not a specific treatment approved but it is known that, in vitro, chloroquine and hydroxychloroquine can inhibit the coronavirus. Objective: verifying if patients with autoimmune diseases that are on treatment with HCQ have less incidence and severity on COVID-19. Material and methods: this is a retrospective cohort study. The exposed cohort was formed by individuals with autoimmune diseases with HCQ treatment. The control cohort was randomly selected using the Health Card database. To deal with confounding variables and evaluate the effect of HCQ on the incidence and severity of SARS-CoV-2 infection, propensity score matching was used. Risk difference and paired percentage difference between exposed and non-exposed groups was estimated. Results: 919 individuals formed the exposed cohort and 1351 the control cohort. After matching, there were 690 patients on each group. During the time of the study, in the exposed group there were 42 (6.1%) individuals with suspected COVID-19, 12(1.7%) with confirmed COVID-19 and 3(0.4%) were hospitalized. In the control group there were 30(4.3%) individuals with suspected COVID-19, 13(1.9%) with confirmed COVID-19 and 2(0.3%) were hospitalized. The risk difference between each cohort was: 0.017(-0.05-0.04) for suspected COVID-19; -0.014(-0.015-0.012) for confirmed COVID-19 and..

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