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Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Workers from India: A Meta-Analysis

Stricker et al., Journal of Infection and Public Health, doi:10.1016/j.jiph.2021.08.001

Aug 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.

Lower risk for mortality, hospitalization, recovery, cases, and viral clearance.

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. c19hcq.org

Meta analysis of 11 HCQ PrEP studies in India covering 7,616 healthcare workers, showing significantly lower cases with treatment.

7 meta analyses show significant improvements with hydroxychloroquine for mortality Landsteiner de Sampaio Amêndola, Risch, Risch (B), Stricker, hospitalization Landsteiner de Sampaio Amêndola, recovery Prodromos, combined death/hospitalization/cases Ladapo, and cases García-Albéniz.

Currently there are 106 HCQ for COVID-19 pre-exposure prophylaxis studies, showing 30% lower mortality [14‑43%] and 28% fewer cases [20‑35%].

1. García-Albéniz et al., Systematic review and meta-analysis of randomized trials of hydroxychloroquine for the prevention of COVID-19, European Journal of Epidemiology, doi:10.1007/s10654-022-00891-4.springer.com, doi.org.

2. Ladapo et al., Randomized Controlled Trials of Early Ambulatory Hydroxychloroquine in the Prevention of COVID-19 Infection, Hospitalization, and Death: Meta-Analysis, medRxiv, doi:10.1101/2020.09.30.20204693.medrxiv.org, doi.org.

3. Landsteiner de Sampaio Amêndola et al., COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis, Journal of Clinical Medicine, doi:10.3390/jcm11226865.mdpi.com, doi.org.

4. Prodromos et al., Hydroxychloroquine is effective, and consistently so used early, for Covid-19: A systematic review, New Microbes and New Infections, doi:10.1016/j.nmni.2020.100776.sciencedirect.com, doi.org.

5. Risch, H., Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis, American Journal of Epidemiology, kwaa093, 27 May 2020, doi:10.1093/aje/kwaa093.oup.com, doi.org.

6. Risch (B), H., Response to: “Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients” and “Re: Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis”, American Journal of Epidemiology, July 20, 2020, doi:10.1093/aje/kwaa152.oup.com, doi.org.

7. Stricker et al., Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Workers from India: A Meta-Analysis, Journal of Infection and Public Health, doi:10.1016/j.jiph.2021.08.001.sciencedirect.com, doi.org.

Important missing comments or errors? Let us know.

risk of death, 75.0% lower, RR 0.25, p < 0.001, treatment 1,273, control 4,127, >=6 doses.

risk of death, 44.0% lower, RR 0.56, p = 0.004, treatment 3,489, control 4,127, any number of doses.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Stricker et al., 5 Aug 2021, peer-reviewed, 2 authors.

This Paper HCQ All

Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Workers from India: A Meta-Analysis

MD Raphael B Stricker, Melissa C Fesler

Journal of Infection and Public Health, doi:10.1016/j.jiph.2021.08.001

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Conflicts of Interest and Funding The authors have no conflicts of interest to declare. There was no funding for the study.

References

Badyal, Chandy, Chugh, Hydroxychloroquine for SARS CoV2 prophylaxis in healthcare workers -A multicentric cohort study assessing effectiveness and safety, J Assoc Physicians India

Behera, Patro, Singh, Chandanshive, Pradhan, Role of ivermectin in the prevention of SARS-CoV-2 infection among healthcare workers in India: A matched case-control study, PLoS ONE, doi:10.1371/journal.pone.0247163

Bhattacharya, Chowdhury, Mukherjee, Pre exposure hydroxychloroquine use is associated with reduced COVID19 risk in healthcare workers, MedRxiv, doi:10.1101/2020.06.09.2011680640

Chatterjee, Anand, Singh, Healthcare workers and SARS-CoV-2 infection in India: a case-control investigation in the time of COVID-19, Indian J Med Res, doi:10.4103/ijmr.IJMR_2234_2039

Datta, Ghosal, Sinha, No role of HCQ in COVID-19 prophylaxis: A survey amongst Indian doctors, J Vaccines Vaccin

Dev, Meena, Gupta, Gupta, Sankar, Risk factors and frequency of COVID-19 among healthcare workers at a tertiary care centre in India: a case-control study, Trans Royal Soc Trop Med Hyg, doi:10.1093/trstmh/trab047

Goenka, Afzalpurkar, Goenka, Seroprevalence of COVID-19 amongst health care workers in a tertiary care hospital of a metropolitan city from India, J Assoc Physicians India

Haynes, Corey, Fernandes, Prospects for a safe COVID-19 vaccine, Sci Transl Med, doi:https://doi.org.10.1126/scitranslmed.abe0948

J O U R N A L P R E, -p r o o f, doi:10.1371/journal.pone.0247163

Kadnur, Aggarwal, Soneja, Hydroxychloroquine pre-exposure prophylaxis for COVID-19 among healthcare workers: Initial experience from India, Lancet Preprints, doi:10.2139/ssrn.3622350

Khurana, Kaushal, Gupta, Verma, Sharma et al., Prevalence and clinical correlates of COVID-19 outbreak among health care workers in a tertiary level hospital in Delhi, Am J Infect Dis, doi:10.3844/ajidsp.2021.107.119

Lofgren, Nicol, Bangdiwala, Safety of hydroxychloroquine among outpatient clinical trial participants for COVID-19, Open Forum Infect Dis

Mathai, Behera, Hande, Hydroxychloroquine as pre-exposure prophylaxis against COVID-19 in health-care workers: A single-center experience, J Mar Med Soc, doi:10.4103/jmms.jmms_115_20

Mutambudzi, Niedwiedz, Macdonald, Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants, Occup Environ Med, doi:https://doi.org.10.1136/oemed-2020-106731

Sogut, Can, Guven, Safety and efficacy of hydroxychloroquine in 152 outpatients with confirmed COVID-19: A pilot observational study, Am J Emerg Med

Stricker, Fesler, Flattening the risk: Pre-exposure prophylaxis for COVID-19, Infect Drug Resist

Yadav, Pate, Shankarkumar, Sero-survey for health-care workers provides corroborative evidence for the effectiveness of Hydroxychloroquine prophylaxis against J o u r n a l P r e -p r o o f COVID-19 infection, J Epidemiol Global Health, doi:https://doi.org.10.1136/oemed-2020-106731

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