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Hydroxychloroquine did not prevent the development of COVID-19 within 4 days of potential exposure. In a randomized, double-blind study, the percentage of people who developed the disease after taking hydroxychloroquine was only two points less than people taking placebo, which was not statistically significant. Job published In the magazine The New England Journal of Medicine.
Hydroxychloroquine has activity in vitro for SARS-CoV and SARS-CoV-2. Presumably he violates terminal glycosylation of angiotensin-converting enzyme receptor 2, which is the site of binding of the virus to the cell, and also reduces the acidity in the endolysosome, preventing the spread of the virus in the cell.
Small studies showedthat the use of hydroxychloroquine can reduce or even eliminate the risk of developing disease upon contact with a carrier of the virus. The Russian Ministry of Health even included drug in the list of recommended for the prevention of COVID-19. However, whether a short-term high dose of hydroxychloroquine can actually prevent disease after close contact with an infected person remains unknown.
David R. Boulware of the University of Minnesota and his colleagues studied 821 people who had household or professional contact with a person infected with COVID-19 at a distance of less than 1.8 meters for more than 10 minutes. If the subject had neither a protective mask nor goggles on his face during contact, he fell into the group of high risk of infection (87.6 percent of the subjects). People with masks and without glasses were at low risk. Individuals with symptoms of COVID-19 or PCR-proven SARS-CoV-2 infection were excluded from this study, but were separately studied as part of the treatment of early infection.
The dosage regimen of hydroxychloroquine was 800 milligrams (4 tablets) once, then 600 milligrams (3 tablets) after 6-8 hours, then 600 milligrams (3 tablets) daily for 4 days for a general course of 5 days (19 tablets in total). If participants had gastrointestinal distress, they were advised to divide the daily dose into two or three doses. Placebo tablets, which were similar in appearance to hydroxychloroquine tablets, were administered at a similar dosage to the control group. The drugs were delivered to the subjects at home, and the researchers monitored their condition via the Internet – people had to send a report on their condition.
Total adherence to the experimental intervention varied across study groups: 75.4 percent of participants in the hydroxychloroquine group (312 out of 414) and 82.6 percent in the placebo group (336 out of 407) took all 19 prescribed tablets for 5 days (P = 0.01). The most common reasons for discontinuing prescribed hydroxychloroquine or placebo were side effects (17 participants in the hydroxychloroquine group and 8 in the placebo group) – nausea, loose stools, and abdominal discomfort.
107 participants (13 percent) developed COVID-19 within 14 days (either confirmed by PCR or the person developed the most common symptoms). The incidence of new diseases did not differ significantly between those who received hydroxychloroquine (49 of 414 – 11.8 percent) and those who received a placebo (58 of 407 – 14.3 percent) (p = 0.35). The absolute difference was −2.4 percentage points (95 percent confidence interval: −7.0 to 2.2). There was no significant difference in efficacy depending on the time of initiation of post-exposure prophylaxis.
–Cumulative incidence of COVID-19 diseases. Vertical bars represent 95 percent confidence intervals.
D.R. Boulware et al. / The New England Journal of Medicine, 2020
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– On average, people had four COVID-19 symptoms (interquartile range of two to five). The most common symptoms were cough (44.9 percent of 107 affected participants), fever (34.6 percent), shortness of breath (18.7 percent), weakness (49.5 percent), sore throat (40.2 percent). muscle pain (37.4 percent) and loss of smell (23.4 percent). Among participants who had symptoms on day 14, the mean symptom score (on a scale of 0 to 10, where high scores indicate greater severity) was 2.8 (interquartile range 1.6-5.0) for those who received hydroxychloroquine, and 2.7 (interquartile range 1.4-4.8) in those who received placebo (P = 0.34).
Due to the lack of diagnostic testing in the United States, the vast majority of participants, including health care workers, were diagnosed on the basis of a combination of symptoms, which is a limitation of the present study. Overall, however, it has not demonstrated a significant benefit of hydroxychloroquine as a post-exposure prophylaxis for COVID-19.
You can read about why the malaria drug has become a stumbling block in the treatment of coronavirus infection in our large material. “Wheel of misfortune”.
Vyacheslav Gomenyuk
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