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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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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.

4,100+ studies for 60+ treatments. c19hcq.org

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<0.001 Ferri (for symptomatic disease).

Although the 31% lower mortality is not statistically significant, it is consistent with the significant 25% lower mortality [20‑29%] from meta analysis of the 250 mortality results to date.

1. Ferri et al., COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series, Clinical Rheumatology, doi:0.1007/s10067-020-05334-7.springer.com, doi.org.

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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: sales@jddonline.com, support@jddonline.com.

This Paper HCQ All

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

References

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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