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0 0.5 1 1.5 2+ Case 11% Improvement Relative Risk HCQ for COVID-19  Rao et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Prospective study of 1,294 patients in India No significant difference in cases Rao et al., Expert Review of Anti-infe.., Dec 2021 Favors HCQ Favors control

Hydroxychloroquine as pre-exposure prophylaxis against COVID-19 infection among healthcare workers: a prospective cohort study

Rao et al., Expert Review of Anti-infective Therapy, doi:10.1080/14787210.2022.2015326
Dec 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 422 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.
4,100+ studies for 60+ treatments.
Prospective PrEP study with low risk healthcare workers in India showing RR=0.89 [0.53-1.52]. There were no significant adverse effects. Only mean age and gender distribution are provided for baseline characteristics, no severity information is provided, and no adjustments were made. Authors analyze HCQ use for <8 vs. ≥8 weeks, noting a lack of statistical significance, but not providing the results.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with minimal group details.
risk of case, 11.0% lower, RR 0.89, p = 0.68, treatment 16 of 273 (5.9%), control 67 of 1,021 (6.6%), NNT 143.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Rao et al., 4 Dec 2021, prospective, India, peer-reviewed, 8 authors.
This PaperHCQAll
Hydroxychloroquine as pre-exposure prophylaxis against COVID-19 infection among healthcare workers: a prospective cohort study
Akshay Rao, Sundar Kumar Veluswamy, Banashankari Gunjiganur Shankarappa, Rithika Manjunatha Reddy, Nethravathi Umesh, Lissy John, Lysamma Mathew, Naresh Shetty
Expert Review of Anti-infective Therapy, doi:10.1080/14787210.2022.2015326
Background: Hydroxychloroquine had attracted significant attention in the initial phases of the COVID-19 pandemic but current recommendations do not support its use. However, the evidence against its use as pre-exposure prophylaxis have been of low to moderate quality and have been limited by high risk of bias. Methods: Following institutional ethics committee approval, healthcare workers (n = 1294) completing their first week-long COVID in-patient duty, subsequent institutional quarantine and RT-PCR testing for COVID-19 infection were included for this prospective cohort study. Demographic data, hydroxychloroquine usage and related adverse effects were captured through a 'Caring for the Caregivers' surveillance system. A chi-Square test of independence was used to determine the effect of hydroxychloroquine prophylaxis. Results: Among the 1294 participants (age: 31 ± 7 years, 61% women), 273 (21.1%) healthcare workers used hydroxychloroquine prophylaxis as per Indian Council of Medical Research recommendations and 83/1294 (6.4%) tested positive after their duty. There was no significant difference in COVID-19 incidence between those on hydroxychloroquine prophylaxis and those not on it (5.9% vs 6.6%, χ 2 = 0.177, p = 0.675; RR = 0.89, 95% CI -0.53 to 1.52). There were no significant adverse effects to hydroxychloroquine usage. Conclusion: This study demonstrated no benefit of hydroxychloroquine prophylaxis and provides quality evidence against its use in COVID-19 prevention.
Declaration of interest The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Reviewer disclosures Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. Author contributions Concept and design: The study was conceived by N Shetty, A Rao and S Kumar Veluswamy. B Gunjiganur Shankarappa, L John and L Mathew contributed towards the design of the study. Data collection: A Rao, S Kumar Veluswamy. L John, L Mathew, N Umesh and R Manjunatha Reddy contributed towards data collection. Analysis: A Rao and S Kumar Veluswamy analysed the data. Writing: A Rao and S Kumar Veluswamy together wrote the first draft and all authors critically reviewed the manuscript and contributed towards the writing. Approval: All authors read and approved the final version of the manuscript for submission ORCID Akshay Rao Sundar Kumar Veluswamy
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