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Antimalarials are not Effective as Pre-Exposure Prophylaxis for COVID-19: A Retrospective Matched Control Study

Klebanov et al., Journal of Drugs in Dermatology, doi:10.36849/jdd.6593
Jul 2023  
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Mortality 31% Improvement Relative Risk Case -6% HCQ for COVID-19  Klebanov et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 62,069 patients in the USA Study underpowered for serious outcomes Klebanov et al., J. Drugs in Dermatology, Jul 2023 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.
4,300+ studies for 75 treatments.
Retrospective 3,074 patients with antimalarial prescriptions and 58,955 matched controls, showing no significant differences with antimalarial prophylaxis for PCR+ cases (99% HCQ). Authors provide only PCR+ and mortality outcomes, and do not provide intermediate clinical outcomes that may show a statistically significant benefit. Authors do not adjust for the very different baseline risk for systemic autoimmune disease patients. 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<0.0011 (for symptomatic disease).
Although the 31% lower mortality is not statistically significant, it is consistent with the significant 26% lower mortality [22‑30%] from meta analysis of the 249 mortality results to date.
risk of death, 30.6% lower, RR 0.69, p = 0.80, treatment 3 of 3,074 (0.1%), control 83 of 58,995 (0.1%), NNT 2320.
risk of case, 5.9% higher, RR 1.06, p = 0.70, treatment 51 of 3,074 (1.7%), control 973 of 58,995 (1.6%), odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Klebanov et al., 1 Jul 2023, retrospective, USA, peer-reviewed, 10 authors. Contact:,
This PaperHCQAll
Antimalarials are not Effective as Pre-Exposure Prophylaxis for COVID-19: A Retrospective Matched Control Study
MD Nikokai Klebanov, MD MBA Vartan Pahalyants, MD Jordan T Said, William. S Murphy, MD Nicholas Theodosakis, MA Joseph Scarry, Stacey Duey, DDS Monina Klevens, MD Evelyn Lilly, MD Yevgeniy R Semenov
Journal of Drugs in Dermatology, doi:10.36849/jdd.6593
exposure impact on SARS-CoV-2 risk is of great importance to the practicing dermatologist. We investigated the efficacy of antimalarial drugs as pre-exposure SARS-CoV-2 prophylaxis in a US tertiary-care center. MATERIALS AND METHODS We included all adult patients with at least one prescription for chloroquine, hydroxychloroquine, or quinacrine from July 1, 2019 to February 29, 2020 (limiting prescriptions to those started before the pandemic onset) in the MassGeneral Brigham Enterprise Data Warehouse and Research Patient Data Registry. We exactmatched antimalarial-treated study patients with controls on age, sex, race, and Charleston Comorbidity Index. Additional collected variables included zip codes (used to estimate income using 2010 US Census), and medical history using ICD-9/ICD-10
Boulware, Pullen, Bangdiwala, Pastick, Lofgren et al., A randomized trial of hydroxychloroquine as postexposure prophylaxis for Covid-19, N Engl J Med
Carafoli, Chloroquine and hydroxychloroquine in the prophylaxis and therapy of COVID-19 infection
Favalli, Agape, Caporali, Incidence and clinical course of COVID-19 in patients with connective tissue diseases: A descriptive observational analysis, J Rheumatol
Hooijberg, Boekel, Vogelzang, Leeuw, Boers et al., Patients with rheumatic diseases adhere to COVID-19 isolation measures more strictly than the general population, Lancet Rheumatol
Kuderer, Choueiri, Shah, Shyr, Rubinstein et al., Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study, Lancet
Robinson, Gyawali, Evans, COVID-19 and cancer: do we really know what we think we know?, Nat Rev Clin Oncol
Sanders, Monogue, Jodlowski, Cutrell, Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review, JAMA -J Am Med Assoc
Schreiber, Sciascia, Bruce, Giles, Cuadrado et al., Hydroxychloroquine in patients with rheumatic diseases during the COVID-19 pandemic: a letter to clinicians, Lancet Rheumatol
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