key: cord-0700426-aczzoafs
authors: Vastarella, Maria; Patrì, Angela; Annunziata, Maria Carmela; Cantelli, Mariateresa; Nappa, Paola; Tasso, Marco; Costa, Luisa; Caso, Francesco; Fabbrocini, Gabriella
title: Can hydroxychloroquine be useful in the prevention of COVID-19? An Italian survey in dermatological and rheumatological patients already under treatment.
date: 2020-05-01
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.04.136
sha: 7d4bd6443d117279ab3e36fc21ae24df60e110a6
doc_id: 700426
cord_uid: aczzoafs

nan

March 11th, 2020. To date, there is an urgent need for effective drugs against SARS-CoV-2. 24 Chloroquine(CQ) and hydroxychloroquine (HCQ) have been shown to inhibit SARS-CoV-2 in vitro, and 25 HCQ seems more effective than chloroquine. 1-2 26 The aim of our research would be the evaluation of HCQ preventive effects on SARS-CoV-2 infection 27 acquisition. We conducted an observational retrospective study through a telephone survey among patients in 28 treatment with HCQ for chronic dermatological or rheumatological diseases, referring to the Dermatologic 29 and Rheumatologic Clinics of the University of Naples Federico II, Italy. The survey and its results are 30 displayed in Table 1 , Table 2 and Table 3 . We reviewed a total of 66 subjects, 30 Dermatologic patients (8 31 males and 22 females, median age of 55.5 years, medium duration of HCQ treatment of 14.2 months, range 32 3-36 months) and 35 Rheumatologic patients (5 males and 30 females, median age of 46.1 years, medium 33 duration of HCQ treatment of 50.1 months, range 2-240 months). Overall, 65 (98.4%) of the 66 patients in 34 treatment with HCQ had not developed fever, sore throat, fatigue, cough or dyspnoea in the previous two 35 months. One patient had reported a temperature of 37.2 C° for only one day, without any other associated 36 symptoms. Mostly, the treatment was well tolerated without related adverse events; only two patients 37 described a brief episode of visual impairment. These patients were suggested to have an examination of the 38 ocular fundus, beyond the regular six-month ophthalmic follow-up already performed. 39 HCQ has immunomodulatory properties and an attractive adverse effect profile 2 . It could contribute to the 40 suppression of the cytokine release syndrome responsible for the progression of COVID-19 to severe clinical 41 forms through several mechanisms including i) reduction of T cell activation and differentiation; ii) 42 decreased production of cytokines by T cells and B cells (e.g. IL-1, IL-6 and TNF); iii) attenuation of pro-43 inflammatory signaling pathways activation. Interestingly, HCQ and CQ inhibit receptor binding and 44 membrane fusion, two critical steps required for cell entry by coronaviruses. 3 However, HCQ offers 45 advantages compared with CQ: better clinical safety profile, possible higher daily dose and fewer 46 pharmacological interactions. 1, 2, 4 In our study, no patient already in treatment with HCQ has developed symptoms suggestive for SARS-CoV-2 infection, although Italy is currently the third most infected country 48 in the world. Limitations of our study are the low sample size and the absence of exposure to established 49 cases of COVID-19 in the interviewed subjects.

Further studies on larger samples are needed to assess the possible protective effect of HCQ on SARS-CoV-51 2 infection. We recommend extending such kind of survey to all patients actually in treatment with HCQ, 52 possibly stratifying them according to residency, posology, other ongoing systemic treatments, comorbidities 53 and starting prospective observational study for a more extended period (4-6 months). The in vivo 54 demonstration of prophylactic efficacy of HCQ could be a revolutionary result to prevent the transmission of 55 the virus, until the development of a vaccine. 56

Tables 69 Table 1 -Questions asked in the telephone survey and dermatologic patients' answers. 70 The aim of our research would be the evaluation of HCQ preventive effects on SARS-CoV-2 infection 115 acquisition. We conducted an observational retrospective study through a telephone survey among patients in 116 treatment with HCQ for chronic dermatological or rheumatological diseases, referring to the Dermatologic 117 and Rheumatologic Clinics of the University of Naples Federico II, Italy. The survey and its results are 118 displayed in Table 1, Table 2 and Table 3 Table 1 -Questions asked in the telephone survey and dermatologic patients' answers. 159 Table 2 -Questions asked in the telephone survey and rheumatologic patients' answers. 160 

Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in 59 inhibiting SARS-CoV-2 infection in vitro

Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus

COVID-19: a recommendation to examine the effect of hydroxychloroquine in 64 preventing infection and progression

Hydroxychloroquine and ivermectin: a synergistic combination for COVID-19 66 chemoprophylaxis and/or treatment?

Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in 147 inhibiting SARS-CoV-2 infection in vitro

Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus

COVID-19: a recommendation to examine the effect of hydroxychloroquine in 152 preventing infection and progression

Hydroxychloroquine and ivermectin: a synergistic combination for COVID-19 154 chemoprophylaxis and/or treatment?