Hydroxychloroquine as pre-exposure prophylaxis for COVID-19 in healthcare workers: a randomized trial

DOI record: { "DOI": "10.1093/cid/ciaa1571", "ISSN": [ "1058-4838", "1537-6591" ], "URL": "http://dx.doi.org/10.1093/cid/ciaa1571", "abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly emerging virus causing the ongoing coronavirus disease 2019 (COVID-19) pandemic with no known effective prophylaxis. We investigated whether hydroxychloroquine could prevent SARS-CoV-2 in healthcare workers at high risk of exposure.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>We conducted a randomized, double-blind, placebo-controlled clinical trial of healthcare workers with ongoing exposure to persons with SARS-CoV-2, including those working in emergency departments, intensive care units, COVID-19 hospital wards, and first responders. Participants across the United States and in the Canadian province of Manitoba were randomized to hydroxychloroquine loading dose then 400 mg once or twice weekly for 12 weeks. The primary endpoint was confirmed or probable COVID-19–compatible illness. We measured hydroxychloroquine whole-blood concentrations.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>We enrolled 1483 healthcare workers, of whom 79% reported performing aerosol-generating procedures. The incidence of COVID-19 (laboratory-confirmed or symptomatic compatible illness) was 0.27 events/person-year with once-weekly and 0.28 events/person-year with twice-weekly hydroxychloroquine compared with 0.38 events/person-year with placebo. For once-weekly hydroxychloroquine prophylaxis, the hazard ratio was .72 (95% CI, .44–1.16; P = .18) and for twice-weekly was .74 (95% CI, .46–1.19; P = .22) compared with placebo. Median hydroxychloroquine concentrations in whole blood were 98 ng/mL (IQR, 82–120) with once-weekly and 200 ng/mL (IQR, 159–258) with twice-weekly dosing. Hydroxychloroquine concentrations did not differ between participants who developed COVID-19–compatible illness (154 ng/mL) versus participants without COVID-19 (133 ng/mL; P = .08).</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>Pre-exposure prophylaxis with hydroxychloroquine once or twice weekly did not significantly reduce laboratory-confirmed COVID-19 or COVID-19–compatible illness among healthcare workers.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Clinical Trials Registration</jats:title>\n <jats:p>Clinicaltrials.gov NCT04328467.</jats:p>\n </jats:sec>", "author": [ { "ORCID": "http://orcid.org/0000-0001-5531-0231", "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "authenticated-orcid": false, "family": "Rajasingham", "given": "Radha", "sequence": "first" }, { "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "family": "Bangdiwala", "given": "Ananta S", "sequence": "additional" }, { "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "family": "Nicol", "given": "Melanie R", "sequence": "additional" }, { "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "family": "Skipper", "given": "Caleb P", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-1306-1713", "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "authenticated-orcid": false, "family": "Pastick", "given": "Katelyn A", "sequence": "additional" }, { "affiliation": [ { "name": "Vanderbilt University Medical Center, Nashville, Tennessee, USA" } ], "family": "Axelrod", "given": "Margaret L", "sequence": "additional" }, { "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "family": "Pullen", "given": "Matthew F", "sequence": "additional" }, { "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "family": "Nascene", "given": "Alanna A", "sequence": "additional" }, { "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "family": "Williams", "given": "Darlisha A", "sequence": "additional" }, { "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "family": "Engen", "given": "Nicole W", "sequence": "additional" }, { "affiliation": [ { "name": "University of Minnesota, Minneapolis, Minnesota, USA" } ], "family": "Okafor", "given": "Elizabeth C", "sequence": "additional" }, { "affiliation": [ { "name": "Vanderbilt University Medical Center, Nashville, Tennessee, USA" } ], "family": "Rini", "given": "Brian I", "sequence": "additional" }, { "affiliation": [ { "name": "Vanderbilt University Medical Center, Nashville, Tennessee, USA" } ], "family": "Mayer", "given": "Ingrid A", "sequence": "additional" }, { "affiliation": [ { "name": "Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada" } ], "family": "McDonald", "given": "Emily G", "sequence": "additional" }, { "affiliation": [ { "name": "Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada" } ], "family": "Lee", "given": "Todd C", "sequence": "additional" }, { "affiliation": [ { "name": "Oregon Health and Science University, Portland, Oregon, USA" } ], "family": "Li", "given": "Peter", "sequence": "additional" }, { "affiliation": [ { "name": "Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada" } ], "family": "MacKenzie", "given": "Lauren J", "sequence": "additional" }, { "affiliation": [ { "name": "Vanderbilt University Medical Center, Nashville, Tennessee, USA" } ], "family": "Balko", "given": "Justin M", "sequence": "additional" }, { "affiliation": [ { 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