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0 0.5 1 1.5 2+ Mortality 60% Improvement Relative Risk Ventilation -71% ARDS -33% Case -476% HCQ for COVID-19  Perrella et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 26,325 patients in Italy More cases with HCQ (p=0.0000022) Perrella et al., Viruses, October 2021 Favors HCQ Favors control

Pre-Exposure Prophylaxis with Hydroxychloroquine Does Not Prevent COVID-19 nor Virus Related Venous Thromboembolism

Perrella et al., Viruses, doi:10.3390/v13102052
Oct 2021  
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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.
Retrospective 8,811 HCQ users and 17,514 control patients, showing higher risk of COVID-19 for HCQ users. There were 12 cases for the 8,811 HCQ patients. There is no count for the control group that produces the reported unadjusted OR 4.96. The closest is 5 cases for the 17,514 patients, or 0.02%.
Authors note that the period studied, Mar 8 - Apr 28, 2020, corresponds to an epidemic outbreak in the region studied, Campania. Signorelli et al. show a prevalence of 0.53% as of April 7, 2020, suggesting that the control group chosen in this study may not accurately represent the prevalence of COVID-19 at the time.
Authors do not adjust for the very different baseline risk for patients on HCQ, often 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.
risk of death, 60.0% lower, RR 0.40, p = 1.00, treatment 0 of 12 (0.0%), control 1 of 24 (4.2%), NNT 24, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of mechanical ventilation, 71.4% higher, RR 1.71, p = 0.28, treatment 6 of 12 (50.0%), control 7 of 24 (29.2%).
risk of ARDS, 33.3% higher, RR 1.33, p = 0.70, treatment 4 of 12 (33.3%), control 6 of 24 (25.0%).
risk of case, 476.4% higher, RR 5.76, p < 0.001, treatment 12 of 8,811 (0.1%), control 24 of 17,514 (0.1%), adjusted per study, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Perrella et al., 13 Oct 2021, retrospective, Italy, peer-reviewed, 6 authors. Contact: (corresponding author),,,,,
This PaperHCQAll
Pre-Exposure Prophylaxis with Hydroxychloroquine Does Not Prevent COVID-19 nor Virus Related Venous Thromboembolism
Alessandro Perrella, Valentina Orlando, Ugo Trama, Francesca F Bernardi, Enrica Menditto, Enrico Coscioni
Viruses, doi:10.3390/v13102052
Different and several public health strategies have been planned to reduce transmission of pandemic due to SARS-CoV-2 since it started. None drugs have been confirmed as able to prevent viral transmission. Hydroxychloroquine with its immunomodulatory properties has been proposed as potential anti-viral drug in particular for prevention once viral exposure has been happen or in first phases of infection. Furthermore, in several immunological systemic disease hydroxychloroquine was able to reduce the number of thrombotic complications. So, because COVID-19 was associated to immunological imbalance and to thrombotic complications, we retrospectively analyzed the rate of infection in those patients being under treatment with this drug during COVID-19 epidemic outbreak from 8 March until 28 April in particular comparing those with pre-exposure to this treatment and those that were not taking this medication before SARS-CoV-2 viral infections.
Conflicts of Interest: The authors declare no conflict of interest.
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Desai, Field, Grant, Mccormack, Recent advances in pre-exposure prophylaxis for HIV, BMJ, doi:10.1136/bmj.j5011
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Perrella, Carannante, Berretta, Rinaldi, Maturo et al., Novel Coronavirus 2019 (SARS-CoV-2): A global emergency that needs new approaches?, Eur. Rev. Med. Pharmacol
Perrella, Esposito, Amato, Santaniello, Antifungal prophylaxis with liposomal amphotericin B and caspofungin in high-risk patients after liver transplantation: Impact on fungal infections and immune system, Infect. Dis, doi:10.3109/23744235.2015.1100322
Perrella, Esposito, Pisaniello, D'alessio, Perrella et al., Role of liposomal Amphotericin B prophylaxis after liver transplantation compared with fluconazole for high-risk patients. Impact on infections and mortality within one year, Transplant. Proc, doi:10.1016/j.transproceed.2012.06.013
Perrella, Lanza, Santaniello, Pisaniello, Dicostanzo et al., Telbivudin as prophylaxis for hepatitis B virus recurrence after liver transplantation: A case series in single-center experience, Transplant. Proc, doi:10.1016/j.transproceed.2012.06.019
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Zhou, Chen, Chen, Advances in COVID-19: The Virus, the Pathogenesis, and Evidence-Based Control and Therapeutic Strategies, Front. Med, doi:10.1007/s11684-020-0773-x
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