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0 0.5 1 1.5 2+ Hospitalization -50% Improvement Relative Risk Case -43% Case (b) 8% HCQ for COVID-19  de la Iglesia et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 1,375 patients in Spain More cases with HCQ (not stat. sig., p=0.15) de la Iglesia et al., medRxiv, September 2020 Favors HCQ Favors control

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

de la Iglesia et al., medRxiv, doi:10.1101/2020.08.31.20185314
Sep 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 421 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
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.
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.
This PaperHCQAll
Hydroxicloroquine for Pre-Exposure Prophylaxis for SARS-COV-2
Jaime López De La Iglesia, Naiara Cubelos Fernández, Roi Naveiro Flores, Marina Montoro Gómez, Francisco Javier González De Haro, María Ajenjo González, Estefanía Tobal Vicente, María Lamuedra Gil De Gómez, María Teresa Nuevo Guisado, Isabel Torio Gómez, Ana Peñalver Andrada, Nuria Martínez Cao, Paula González Figaredo, Carlos Robles García, Lidia Anastasia Alvarado Machón, Ángeles Lafont Alcalde, José Cesáreo Naveiro Rilo
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 0.001(-0.007-0.007) for hospitalized patients. There were not significant differences. Conclusion: there is no difference neither on the incidence nor on the severity of COVID-19 between patients with autoimmune diseases with HCQ treatment and patients that do not take HCQ.
Ajenjo, None
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Anastasia, Machón, None
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Lamuedra, De, None
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Martínez, None
Mathian, Mahevas, Rohmer, Roumier, Cohen-Aubart et al., Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine, Ann Rheum Dis, doi:10.1136/annrheumdis-2020-217566
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Montoro, None
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Peñalver, None
Robles, None
Roi, Flores, None
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