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0 0.5 1 1.5 2+ Case 23% Improvement Relative Risk Case (b) -43% HCQ for COVID-19  Revollo et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? PSM retrospective 487 patients in Spain Fewer cases with HCQ (not stat. sig., p=0.52) Revollo et al., J. Antimicrobial Chemo.., Nov 2020 Favors HCQ Favors control

Hydroxychloroquine pre-exposure prophylaxis for COVID-19 in healthcare workers

Revollo et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkaa477
Nov 2020  
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Retrospective PrEP analysis with 69 healthcare workers on PrEP HCQ, and 418 control.
Authors report PCR and IgG results, with no baseline results for either. Authors note they "identified 69 HCWs receiving HCQ" while providing no information as to why or when they started HCQ.
No conclusions can be drawn from this study because many workers may have been positive before starting HCQ. Only 14% of workers chose to use HCQ and they may have been motivated to do so because they had an infection.
Authors perform several different adjustments, finding very different results. No information on death, hospitalization, symptoms, or severity is provided. Details on timing of serology and baseline serology status is not provided. Potential bias due to self-selection for risk.
25% of infections were detected before 7 days, indicating that they actually happened earlier (PCR false positive is very high initially). It is likely that many infections were before HCQ could reach therapeutic levels.
Although the 23% fewer cases is not statistically significant, it is consistent with the significant 29% fewer cases [21‑36%] from meta analysis of the 78 cases results to date.
risk of case, 23.0% lower, RR 0.77, p = 0.52, treatment 16 of 69 (23.2%), control 65 of 418 (15.6%), adjusted per study, PSM, risk of PCR+.
risk of case, 43.0% higher, RR 1.43, p = 0.42, treatment 17 of 60 (28.3%), control 62 of 404 (15.3%), adjusted per study, PSM, risk of IgG+.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Revollo et al., 21 Nov 2020, retrospective, propensity score matching, Spain, peer-reviewed, 16 authors.
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Abstract: JAC Research letters 8 Humeniuk R, Mathias A, Cao H et al. Safety, tolerability, and pharmacokinetics of remdesivir, an antiviral for treatment of COVID-19, in healthy subjects. Clin Transl Sci 2020; 13: 896–906. 9 FDA. Fact Sheet for Healthcare Providers Emergency Use Authorization (EUA) of VekluryV (Remdesivir). 2020. 10 Tempestilli M, Caputi P, Avataneo V et al. Pharmacokinetics of remdesivir and GS-441524 in two critically ill patients who recovered from COVID-19. J Antimicrob Chemother 2020; 75: 2977–80. R J Antimicrob Chemother 2021; 76: 827–829 doi:10.1093/jac/dkaa477 Advance Access publication 21 November 2020 Hydroxychloroquine pre-exposure prophylaxis for COVID-19 in healthcare workers ~ afiel2, Boris Revollo1, Cristian Tebe2, Judith Pen 3 1,4 Ignacio Blanco , Nuria Perez-Alvarez , Ruth Lopez5, Laura Rodriguez6, Josep Ferrer7, Pilar Ricart8, Enrique Moret9, Cristina Tural7, Anna Carreres10,  Videla1,11, Joan Matllo5, Sebastia 1,12,13 and Josep M. Llibre1* Bonaventura Clotet 1 Division of Infectious Diseases and FLS Foundation for Fighting AIDS, Infectious Diseases and Promoting Health and Science, University Hospital Germans Trias, Badalona, Spain; 2Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL)/University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain; 3  de la Salut, Metropolitana Nord Laboratory, Institut Catala Badalona, Spain; 4Statistics and Operations Research Department, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain; 5Occupational Risk Prevention Unit, University Hospital Germans Trias, Badalona, Spain; 6Pulmonary Medicine, University Hospital Germans Trias, Badalona, Spain; 7 Internal Medicine Department, University Hospital Germans Trias, Badalona, Spain; 8Intensive Care Unit Division, University Hospital Germans Trias, Badalona, Spain; 9Anaesthesiology Department, University Hospital Germans Trias, Badalona, Spain; 10 Emergency Department, University Hospital Germans Trias, Badalona, Spain; 11Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)/University of Barcelona, *Corresponding author. E-mail: Sir, Healthcare workers (HCWs) are a high-risk population for SARSCoV-2 infection and account for at least 11% of reported cases.1,2 We performed an observational cross-sectional case-control study to evaluate the efficacy of hydroxychloroquine pre-exposure prophylaxis (PrEP) among hospital HCWs. All HCWs (of all categories) who worked in the COVID-19 frontline wards of University Hospital Germans Trias (Badalona, Spain) were invited to participate. There was no protocol in the institution recommending hydroxychloroquine PrEP. The dose used by HCWs was 400 mg twice daily on the first day and 200 mg twice daily for an additional 4 days, with a maintenance dosing of 200 mg weekly thereafter. HCWs were classified as having high-risk occupational exposure if they worked in hospital-based COVID-19 wards, moderate-risk occupational exposure if they had direct contact with admitted patients, but not in COVID-19 wards, and low-risk occupational exposure if they had occasional contact with hospitalized patients. Reverse real-time PCR was performed for nasopharyngeal swabs of all HCWs with symptoms or suspicion of COVID-19. A screening of SARS-CoV-2 serology of all hospital HCWs was performed when the epidemic reached its end (late May 2020). The study..
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