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Hydroxychloroquine pre-exposure prophylaxis for COVID-19 among healthcare workers: Initial experience from India

Kadnur et al., Journal of Family Medicine and Primary Care, doi:10.4103/jfmpc.jfmpc_1177_21
Jul 2020  
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Case 62% Improvement Relative Risk HCQ for COVID-19  Kadnur et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Prospective study of 358 patients in India (April - June 2020) Fewer cases with HCQ (p=0.01) Kadnur et al., J. Family Medicine and .., Jul 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.
4,400+ studies for 79 treatments.
Prophylaxis study with 334 low-risk healthcare workers in India, showing significantly lower risk of cases with treatment. Symptomatic patients received PCR results, but only some asymptomatic patients did, so there may have been additional asymptomatic cases. There were no severe adverse events.
risk of case, 62.3% lower, RR 0.38, p = 0.01, treatment 10 of 258 (3.9%), control 15 of 100 (15.0%), NNT 9.0, odds ratio converted to relative risk, multivariate logistic regression.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Kadnur et al., 22 Jul 2020, prospective, India, peer-reviewed, mean age 31.2, 16 authors, study period 23 April, 2020 - 11 June, 2020. Contact:
This PaperHCQAll
Hydroxychloroquine pre-exposure prophylaxis for COVID-19 among healthcare workers: Initial experience from India
Dr Manish Soneja, Harshith B Kadnur, Anivita Aggarwal, Komal Singh, Ankit Mittal, Neeraj Nischal, Praveen Tirlangi, Adilrashid Khan, Devashish Desai, Ankesh Gupta, Arvind Kumar, Pankaj Jorwal, Ashutosh Biswas, Ravindramohan Pandey, Naveet Wig, Randeep Guleria
Journal of Family Medicine and Primary Care, doi:10.4103/jfmpc.jfmpc_1177_21
Background: Hydroxychloroquine (HCQ) had generated considerable interest for coronavirus disease 2019 (COVID-19) prophylaxis. We conducted a prospective observational study at a tertiary care hospital in India, with dedicated COVID-19 care facilities. Objectives: Primary objective was incidence of adverse effects, secondary objective being efficacy in preventing COVID-19. Methods: Healthcare workers were recruited and grouped based on voluntary HCQ prophylaxis as per national guidelines. Side effects in HCQ group were graded in accordance with national cancer institute-common terminology criteria for adverse events (NCI-CTCAE) version 5.0. At 3-7-week follow-up, groups were compared for COVID-19 exposure, symptoms development and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR results. Results: Among 358 participants recruited, 216 (60.3%) were males and mean age was 31.2 ± 6.6 years. Chemoprophylaxis was initiated by 258 (72%) participants. After loading dose, 7 (2.7%) reported grade 2 and 1 (0.4%) grade 3 adverse effects. Discontinuation of HCQ due to side effects was reported in 11 (4.3%) participants. Electrocardiogram was done by 50 (19.4%) participants on HCQ; no abnormalities were noted. A total of 106 (41%) among those taking and 63 (63%) among those not taking HCQ were tested for SARS-CoV-2 due to influenza-like illness or significant exposure. Among all participants, 25 (6.9%, 95% confidence interval [CI] 4.3-9.6) developed COVID-19 during the study period. In the group taking HCQ, 10 (3.9%) tested positive compared to 15 (15%) in the group not taking HCQ (P < 0.001). Odds ratio with HCQ intake was 0.34 (95% CI 0.13-0.83, P = 0.01) and the number needed to treat was 12. Conclusion: HCQ is safe at the recommended dose for pre-exposure prophylaxis of COVID-19.
Conflicts of interest There are no conflicts of interest.
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