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0 0.5 1 1.5 2+ Symp. case 44% Improvement Relative Risk Case, PCR+ 50% Case 41% HCQ for COVID-19  Dhibar et al.  Prophylaxis Is post-exposure prophylaxis with HCQ beneficial for COVID-19? Prospective study of 317 patients in India Fewer cases with HCQ (p=0.041) Dhibar et al., Int. J. Antimicrobial A.., Nov 2020 Favors HCQ Favors control

Post Exposure Prophylaxis with Hydroxychloroquine (HCQ) for the Prevention of COVID-19, a Myth or a Reality? The PEP-CQ Study

Dhibar et al., International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106224, NCT04408456
Nov 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.
Low dose prospective PEP study with 132 HCQ patients and 185 control patients, showing significantly lower COVID-19 cases with treatment. There were no serious adverse events. HCQ 800mg on day one followed by 400mg once weekly for 3 weeks.
risk of symptomatic case, 43.9% lower, RR 0.56, p = 0.21, treatment 6 of 132 (4.5%), control 15 of 185 (8.1%), NNT 28, adjusted per study.
risk of case, 50.0% lower, RR 0.50, p = 0.04, treatment 10 of 132 (7.6%), control 28 of 185 (15.1%), NNT 13, adjusted per study, PCR+.
risk of case, 41.0% lower, RR 0.59, p = 0.03, treatment 14 of 132 (10.6%), control 36 of 185 (19.5%), NNT 11, adjusted per study.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Dhibar et al., 6 Nov 2020, prospective, India, peer-reviewed, 13 authors, trial NCT04408456 (history).
This PaperHCQAll
Post-exposure prophylaxis with hydroxychloroquine for the prevention of COVID-19, a myth or a reality? The PEP-CQ Study
Deba Prasad Dhibar, Navneet Arora, Arpit Kakkar, Neeraj Singla, Ritin Mohindra, Vikas Suri, Ashish Bhalla, Navneet Sharma, Mini P Singh, Ajay Prakash, Lakshmi Pvm, Bikash Medhi
International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106224
Many drugs have been tried for the treatment/prevention of COVID-19 with limited success. Direct household contacts of COVID-19 patients are at highest risk for SARS-CoV-2 infection. Hydroxychloroquine (HCQ) has been tried against COVID-19 owing to its in vitro virucidal action against SARS-CoV-2, but the role of HCQ as post-exposure prophylaxis (PEP) remains inconclusive. In this open-label, controlled clinical trial, asymptomatic individuals who had direct contact with laboratory-confirmed COVID-19 cases or had undertaken international travel in the last 2 weeks were offered HCQ prophylaxis and assigned to PEP ( n = 132) or control ( n = 185) group. The PEP group received HCQ 800 mg on Day 1 followed by 400 mg once weekly for 3 weeks. Both groups undertook home quarantine for 2 weeks along with social distancing and personal hygiene. Over 4-week follow-up, 50/317 participants (15.8%) had new-onset COVID-19. The incidence of COVID-19 was significantly ( P = 0.033) lower in the PEP (14/132; 10.6%) compared to the control (36/185; 19.5%) group (total absolute risk reduction, -8.9% points). The NNT to prevent the occurrence of 1 COVID-19 case was 12. Overall relative risk was 0.59 (95% CI 0.33-1.05). Compliance was good. The most common adverse event was epigastric discomfort with burning sensation (three participants), with no serious adverse events. PEP with HCQ has the potential for the prevention of COVID-19 in at-risk individuals. Until definitive therapy is available, continuing PEP with HCQ may be considered in suitable at-risk individuals. Further randomised clinical trials with larger samples are required for better evaluation of HCQ as PEP for COVID-19 prevention.
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Catteau, Dauby, Montourcy, Bottieau, Hautekiet et al., Belgian Collaborative Group on COVID-19 Hospital Surveillance. Low-dose hydroxychloroquine therapy and mortality in hospitalized patients with COVID-19: a nationwide observational study of 8075 participants, Int J Antimicrob Agents, doi:10.1016/j.ijantimicag.2020.106144
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