tetano
Editor, Senior Moderator
Ann Intern Med
. 2020 Dec 8.
doi: 10.7326/M20-6519. Online ahead of print.
Hydroxychloroquine as Postexposure Prophylaxis to Prevent Severe Acute Respiratory Syndrome Coronavirus 2 Infection : A Randomized Trial
Ruanne V Barnabas[SUP] 1 [/SUP], Elizabeth R Brown[SUP] 1 [/SUP], Anna Bershteyn[SUP] 2 [/SUP], Helen C Stankiewicz Karita[SUP] 3 [/SUP], Christine Johnston[SUP] 1 [/SUP], Lorna E Thorpe[SUP] 2 [/SUP], Angelica Kottkamp[SUP] 2 [/SUP], Kathleen M Neuzil[SUP] 4 [/SUP], Miriam K Laufer[SUP] 4 [/SUP], Meagan Deming[SUP] 4 [/SUP], Michael K Paasche-Orlow[SUP] 5 [/SUP], Patricia J Kissinger[SUP] 6 [/SUP], Alfred Luk[SUP] 7 [/SUP], Kristopher Paolino[SUP] 8 [/SUP], Raphael J Landovitz[SUP] 9 [/SUP], Risa Hoffman[SUP] 9 [/SUP], Torin T Schaafsma[SUP] 3 [/SUP], Meighan L Krows[SUP] 3 [/SUP], Katherine K Thomas[SUP] 3 [/SUP], Susan Morrison[SUP] 3 [/SUP], Harald S Haugen[SUP] 3 [/SUP], Lara Kidoguchi[SUP] 3 [/SUP], Mark Wener[SUP] 3 [/SUP], Alexander L Greninger[SUP] 1 [/SUP], Meei-Li Huang[SUP] 10 [/SUP], Keith R Jerome[SUP] 1 [/SUP], Anna Wald[SUP] 1 [/SUP], Connie Celum[SUP] 3 [/SUP], Helen Y Chu[SUP] 3 [/SUP], Jared M Baeten[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Effective prevention against coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently limited to nonpharmaceutical strategies. Laboratory and observational data suggested that hydroxychloroquine had biological activity against SARS-CoV-2, potentially permitting its use for prevention.
Objective: To test hydroxychloroquine as postexposure prophylaxis for SARS-CoV-2 infection.
Design: Household-randomized, double-blind, controlled trial of hydroxychloroquine postexposure prophylaxis. (ClinicalTrials.gov: NCT04328961).
Setting: National U.S. multicenter study.
Participants: Close contacts recently exposed (<96 hours) to persons with diagnosed SARS-CoV-2 infection.
Intervention: Hydroxychloroquine (400 mg/d for 3 days followed by 200 mg/d for 11 days) or ascorbic acid (500 mg/d followed by 250 mg/d) as a placebo-equivalent control.
Measurements: Participants self-collected mid-turbinate swabs daily (days 1 to 14) for SARS-CoV-2 polymerase chain reaction (PCR) testing. The primary outcome was PCR-confirmed incident SARS-CoV-2 infection among persons who were SARS-CoV-2 negative at enrollment.
Results: Between March and August 2020, 671 households were randomly assigned: 337 (407 participants) to the hydroxychloroquine group and 334 (422 participants) to the control group. Retention at day 14 was 91%, and 10 724 of 11 606 (92%) expected swabs were tested. Among the 689 (89%) participants who were SARS-CoV-2 negative at baseline, there was no difference between the hydroxychloroquine and control groups in SARS-CoV-2 acquisition by day 14 (53 versus 45 events; adjusted hazard ratio, 1.10 [95% CI, 0.73 to 1.66]; P > 0.20). The frequency of participants experiencing adverse events was higher in the hydroxychloroquine group than the control group (66 [16.2%] versus 46 [10.9%], respectively; P = 0.026).
Limitation: The delay between exposure, and then baseline testing and the first dose of hydroxychloroquine or ascorbic acid, was a median of 2 days.
Conclusion: This rigorous randomized controlled trial among persons with recent exposure excluded a clinically meaningful effect of hydroxychloroquine as postexposure prophylaxis to prevent SARS-CoV-2 infection.
Primary funding source: Bill & Melinda Gates Foundation.
. 2020 Dec 8.
doi: 10.7326/M20-6519. Online ahead of print.
Hydroxychloroquine as Postexposure Prophylaxis to Prevent Severe Acute Respiratory Syndrome Coronavirus 2 Infection : A Randomized Trial
Ruanne V Barnabas[SUP] 1 [/SUP], Elizabeth R Brown[SUP] 1 [/SUP], Anna Bershteyn[SUP] 2 [/SUP], Helen C Stankiewicz Karita[SUP] 3 [/SUP], Christine Johnston[SUP] 1 [/SUP], Lorna E Thorpe[SUP] 2 [/SUP], Angelica Kottkamp[SUP] 2 [/SUP], Kathleen M Neuzil[SUP] 4 [/SUP], Miriam K Laufer[SUP] 4 [/SUP], Meagan Deming[SUP] 4 [/SUP], Michael K Paasche-Orlow[SUP] 5 [/SUP], Patricia J Kissinger[SUP] 6 [/SUP], Alfred Luk[SUP] 7 [/SUP], Kristopher Paolino[SUP] 8 [/SUP], Raphael J Landovitz[SUP] 9 [/SUP], Risa Hoffman[SUP] 9 [/SUP], Torin T Schaafsma[SUP] 3 [/SUP], Meighan L Krows[SUP] 3 [/SUP], Katherine K Thomas[SUP] 3 [/SUP], Susan Morrison[SUP] 3 [/SUP], Harald S Haugen[SUP] 3 [/SUP], Lara Kidoguchi[SUP] 3 [/SUP], Mark Wener[SUP] 3 [/SUP], Alexander L Greninger[SUP] 1 [/SUP], Meei-Li Huang[SUP] 10 [/SUP], Keith R Jerome[SUP] 1 [/SUP], Anna Wald[SUP] 1 [/SUP], Connie Celum[SUP] 3 [/SUP], Helen Y Chu[SUP] 3 [/SUP], Jared M Baeten[SUP] 3 [/SUP]
Affiliations
- PMID: 33284679
- DOI: 10.7326/M20-6519
Abstract
Background: Effective prevention against coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently limited to nonpharmaceutical strategies. Laboratory and observational data suggested that hydroxychloroquine had biological activity against SARS-CoV-2, potentially permitting its use for prevention.
Objective: To test hydroxychloroquine as postexposure prophylaxis for SARS-CoV-2 infection.
Design: Household-randomized, double-blind, controlled trial of hydroxychloroquine postexposure prophylaxis. (ClinicalTrials.gov: NCT04328961).
Setting: National U.S. multicenter study.
Participants: Close contacts recently exposed (<96 hours) to persons with diagnosed SARS-CoV-2 infection.
Intervention: Hydroxychloroquine (400 mg/d for 3 days followed by 200 mg/d for 11 days) or ascorbic acid (500 mg/d followed by 250 mg/d) as a placebo-equivalent control.
Measurements: Participants self-collected mid-turbinate swabs daily (days 1 to 14) for SARS-CoV-2 polymerase chain reaction (PCR) testing. The primary outcome was PCR-confirmed incident SARS-CoV-2 infection among persons who were SARS-CoV-2 negative at enrollment.
Results: Between March and August 2020, 671 households were randomly assigned: 337 (407 participants) to the hydroxychloroquine group and 334 (422 participants) to the control group. Retention at day 14 was 91%, and 10 724 of 11 606 (92%) expected swabs were tested. Among the 689 (89%) participants who were SARS-CoV-2 negative at baseline, there was no difference between the hydroxychloroquine and control groups in SARS-CoV-2 acquisition by day 14 (53 versus 45 events; adjusted hazard ratio, 1.10 [95% CI, 0.73 to 1.66]; P > 0.20). The frequency of participants experiencing adverse events was higher in the hydroxychloroquine group than the control group (66 [16.2%] versus 46 [10.9%], respectively; P = 0.026).
Limitation: The delay between exposure, and then baseline testing and the first dose of hydroxychloroquine or ascorbic acid, was a median of 2 days.
Conclusion: This rigorous randomized controlled trial among persons with recent exposure excluded a clinically meaningful effect of hydroxychloroquine as postexposure prophylaxis to prevent SARS-CoV-2 infection.
Primary funding source: Bill & Melinda Gates Foundation.