Hydroxychloroquine for Pre-Exposure Prophylaxis for Sars-Cov-2
Keywords:
Hydroxychloroquine, Pre-exposure prophylaxis, COVID-19, SARS-CoV-2Abstract
SARS-CoV-2 infection has a high transmission level. At the present time there is not a specific treatment approved but it is
known that, in vitro, chloroquine and hydroxychloroquine can inhibit the coronavirus. Objective: verifying if patients with autoimmune diseases that are on treatment with HCQ have less incidence and severity on COVID-19. Material and methods: this is a retrospective cohort study. The exposed cohort was formed by individuals with autoimmune diseases with HCQ treatment. The control cohort was randomly selected using the Health Card database. To deal with confound ing variables and evaluate the effect of HCQ on the incidence and severity of SARS-CoV-2 infection, propensity score matching was used. Risk difference and paired percentage difference between exposed and non-exposed groups was estimated.Results: 919 individuals formed the exposed cohort and 1351 the control cohort. After matching, there were 690 patients on each group. During the time of the study, in the exposed group there were 42 (6.1%) individuals with suspected COVID-19, 12(1.7%) with confirmed COVID-19 and 3(0.4%) were hospitalized. In the control group there were 30(4.3%) individuals with suspected COVID-19, 13(1.9%) with confirmed COVID-19 and 2(0.3%) were hospitalized. The risk difference between each co hort was: 0.017(-0.05-0.04) for suspected COVID-19; -0.014(-0.015-0.012) for confirmed COVID-19 and 0.001(-0.007-0.007) for hospitalized patients. There were not significant differences. Conclusion: there is no difference neither on the incidence nor on the severity of COVID-19 between patients with autoim mune diseases with HCQ treatment and patients that do not take HCQ. Strengths and limitations of this study Strenghts: Ii provides evidence on pre-exposure prophylaxis of HCQ against COVID-19 for which there is still no evidence in clinical trials. The study on the pre-exposure prophylaxis of HCQ was carried out during the period of maximum circulation of SARS-COV-2 in Spain. Therefore, both cohorts had a high probability of exposure to the virus, which increases the power of the study. The dose of HCQ taken by most of the study subjects (400 mg per day) is similar to that used in several clinical trials that are underway as pre- and post-exposure prophylaxis of COVID-19. Limitations: The population of the exposed group suffers entirely from rheumatic diseases. This condition could act as a con founding factor, making it difficult to generalize the results to the entire population. Propensity score matching resulted in a reduction in sample size. Of the 900 initial couples, only 690 survive. Given the shortage of diagnostic tests during the study period, many of the possible COVID-19s were left unconfirmed, limiting the power of the study.
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