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No benefit of hydroxychloroquine on SARS-CoV-2 viral load reduction in non-critical hospitalized patients with COVID-19

Faíco-Filho et al., Braz J Microbiol, doi:10.1007/s42770-020-00395-x (date from preprint)

Jun 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 422 studies, recognized in 42 countries.

Lower risk for mortality, hospitalization, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,000+ studies for 60+ treatments. c19hcq.org

Viral load comparison for 34 HCQ and 32 control patients hospitalized with moderate COVID-19. All patients recovered limiting the room for beneficial effects.

While not achieving statistical significance, results show faster recovery with HCQ. The greatest benefit is seen mid-recovery as expected for an effective treatment:

Δt7-12: 81% improvement with HCQ
Δt<7: 24% improvement with HCQ

For Δt>12, everyone has recovered so there is no room for improvement. Since the HCQ group started slightly higher the improvement is slightly less. Most participants have also dropped out by this test, with only 6 HCQ and 9 control remaining (also suggesting HCQ patients recovered faster).

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Δt7-12 ΔCt improvement, 80.8% lower, RR 0.19, p = 0.40, treatment 34, control 32, mid-recovery, relative median Ct improvement, Figure 2.

Δt<7 ΔCt improvement, 24.0% lower, RR 0.76, p = 0.36, treatment 34, control 32, relative median Ct improvement, Figure 2.

Δt>12 ΔCt improvement, 15.0% higher, RR 1.15, p = 0.52, treatment 34, control 32, relative median Ct improvement, Figure 2.

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

Faíco-Filho et al., 21 Jun 2020, prospective, Brazil, peer-reviewed, median age 58.0, 6 authors.

This Paper HCQ All

No benefit of hydroxychloroquine on SARS-CoV-2 viral load reduction in non-critical hospitalized patients with COVID-19

Klinger Soares Faíco-Filho, Danielle Dias Conte, Luciano Kleber De Souza Luna, Joseane Mayara Almeida Carvalho, Ana Helena Sitta Perosa, Nancy Bellei

Brazilian Journal of Microbiology, doi:10.1007/s42770-020-00395-x

Background Some studies have shown that hydroxychloroquine (HCQ) is an effective drug in reducing the in vitro replication of SARS-CoV-2. However, the in vivo effect of HCQ still unclear. Objectives This study aims to evaluate viral load clearance in patients with COVID-19 who underwent HCQ treatment in comparison with a control group that did not receive the drug. Study design This prospective study comprised consecutive viral load measurements in patients with COVID-19 hospitalized with a moderate illness. Patients received 400 mg of HCQ every 12 h for 10 days according to the medical decision. Nasal swab samples were collected from patients during early, intermediary, and final clinical stage of COVID-19. Results A total of 155 samples were collected from 66 patients with COVID-19 (60% female), with a median age of 58 years. The viral load between studied groups, assumed as a semiquantitative measure of cycle threshold (Ct) values, presented no significant difference within the three consecutive measures (ΔCt) (p > 0.05). We also analyzed the ΔCt viral load at different intervals of sample collection (Δt < 7; 7-12; and > 12 days) without significant differences at any ΔCt (p > 0.05). Conclusion In this study, we did not observe any change in viral load reduction in vivo with the use of HCQ.

References

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Cdc, CDC 2019-Novel Coronavirus (2019-nCoV) Realtime RT-PCR diagnostic panel

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Who, Coronavirus disease 2019 (COVID-19)

Xu, Han, Li, Sun, Wang et al., Effective treatment of severe COVID-19 patients with tocilizumab, Proc Natl Acad Sci

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Late treatment
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