Sharing experience: Hydroxychloroquine in preexposure prophylaxis against COVID-19

Sir,

Hydroxychloroquine (HCQ), use is well-known to treat or prevent malaria and is approved by Food and Drug Administration. It is also approved for the treatment of autoimmune disorders like rheumatoid arthritis, chronic discoid lupus erythematosus, and systemic lupus erythematosus. In early 2020, during the outbreak of pandemic with severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2) infection, the advisory released by the Indian Council of Medical Research (ICMR) and Ministry of Health and Family Welfare which constituted the National Task Force, Government of India, recommended the use of HCQ, against SARS–CoV-2 infection for prophylaxis and treatment to reduce the morbidity and mortality. Although, an established century-old antimalarial drug the advisory from ICMR was based on its proposed in-vitro anti-Covid activity. In this context, HCQ was distributed to Health Care Workers (HCWs) free of cost considering their high risk of exposure to COVID-19.[1]

The HCWs of all categories of our hospital included–doctors, nursing, and paramedical staff including support staff, who volunteered and consented were subjected to routine general clinical examination by physicians for known contraindications to HCQ. They were then distributed a single, course of HCQs free of cost as a prophylactic measure against COVID-19 by our hospital.

Subsequently, a retrospective survey was carried out using questionnaire on the mobile phone WhatsApp platform among HCWs who had collected the HCQ tablets. The primary objective of this quick retrospective survey was to assess the extent of compliance to HCQ and adverse events (AEs) if any to HCQ. This was felt important since it is reported that HCQ has a wide range of adverse reactions.[2,3] The questionnaire was designed to capture the level of compliance to HCQs as well as the pattern, extent, and severity of AEs through responses to ten-item questionnaires. These responses were analyzed descriptively to assess the level of compliance and profile of AEs to HCQ.

The survey forms were sent through WhatsApp to 245 HCWs of which 170 (69.38%) responded of which 56.47% had completed the single course of HCQs. There were 49/51 self–reported AEs which were mild to moderate and 2/51 (1.17%) were severe which resolved after discontinuation of HCQ along with appropriate pharmacological treatment, but none were hospitalized. This report is being submitted to add evidence to the existing AE profile observed among non-Covid otherwise healthy subjects who had received HCQ for COVID-19 prophylaxis.

The present survey showed the extent of nonadherence to HCQ prophylaxis among healthy HCWs was close to 50% and was influenced by factors such as mild–severe AEs. While mild AEs were found to be self-limiting the moderately severe cardiac event in one necessitated discontinuation of HCQ. Further, a severe dermatological AE in another subject warranted discontinuation along with pharmacological intervention. However, there was no mortality and none required hospitalization. Therefore, it may be suggested that careful monitoring should be a part of routine management of patients with SARS–CoV-2 infection receiving HCQ either for prophylaxis or treatment in a resource-limited country like India. Further, the studies in more number of subjects, over a longer duration of treatment may help in considering HCQ as a cheaper option for the prophylaxis and/or treatment of SARS–CoV-2 infection.

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Conflicts of interest

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