Musca Serban C
Université Rennes 2, Campus Villejean, Place du Recteur Henri Le Moal, CS 24307, Rennes Cedex, France.
Front Med (Lausanne). 2020 Aug 13;7:490. doi: 10.3389/fmed.2020.00490. eCollection 2020.
No vaccine against infection by SARS-CoV-2 yet exists. Treatment by hydroxychloroquine (HCQ) medication, among others, has been proposed. However, prophylactic HCQ medication has been little evaluated. We propose to use data from patients with rheumatic diseases (RA, SLR) who have been chronically taking HCQ medication since before the COVID-19 outbreak (hereafter: HCQpa), in order to evaluate the potential of HCQ for preventing infection with SARS-CoV-2. This can be achieved with relative ease by considering whether COVID-19 prevalence is significantly lower in HCQpa than in the general population (i.e., all people that are not HCQpa). Even if COVID-19 prevalence is truly significantly lower in HCQpa, some HCQpa may still present with COVID-19 (lower prevalence does not mean a prevalence of zero). However, given a value for COVID-19 prevalence in the general population and a number of available HCQpa, one may compute the maximum number of HCQpa for that total number of HCQpa considered that can have COVID-19 in order to still be able to conclude a lower COVID-19 prevalence in HCQpa (i.e., if there is one more case of COVID-19 than that maximum number, the COVID-19 prevalence in the HCQpa cannot be said to be lower than in the general population). Because the COVID-19 prevalence in the general population is not known with precision, we will consider different general population prevalence values. Among these contemplated prevalence values, one is derived from the official total number of confirmed cases, others by computing the total number of cases from the number of fatal COVID-19 cases so far and considering different case fatality rates per total cases. Our analyses show that systematic testing for COVID-19 in as few as 5,000 HCQpa is all that is needed for a test of whether HCQ has a prophylactic action against COVID-19, even for a COVID-19 prevalence value as low as 250 per 100,000, provided that test sensitivity is at least equal to its specificity. For higher COVID-19 prevalence values, the number of HCQpa needed is even lower.
目前尚无针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的疫苗。有人提出使用羟氯喹（HCQ）等药物进行治疗。然而，预防性使用HCQ药物的评估很少。我们建议利用自2019冠状病毒病（COVID-19）疫情爆发前就一直在长期服用HCQ药物的风湿性疾病患者（类风湿关节炎、脊柱关节病）的数据，以评估HCQ预防SARS-CoV-2感染的潜力。通过考虑HCQ长期用药患者中COVID-19的患病率是否显著低于普通人群（即所有非HCQ长期用药患者），这一点相对容易实现。即使HCQ长期用药患者中COVID-19的患病率确实显著较低，一些HCQ长期用药患者仍可能感染COVID-19（较低的患病率并不意味着患病率为零）。然而，给定普通人群中COVID-19的患病率值和可用的HCQ长期用药患者数量，人们可以计算出在考虑的HCQ长期用药患者总数中可能感染COVID-19的HCQ长期用药患者的最大数量，以便仍能得出HCQ长期用药患者中COVID-19患病率较低的结论（即，如果COVID-19病例数比该最大数量多一例，则不能说HCQ长期用药患者中COVID-19的患病率低于普通人群）。由于普通人群中COVID-19的患病率无法精确得知，我们将考虑不同的普通人群患病率值。在这些设想的患病率值中，一个是根据官方确诊病例总数得出的，其他的是通过根据迄今为止COVID-19死亡病例数计算病例总数，并考虑不同的总病例病死率得出的。我们的分析表明，即使对于每10万人中低至250例的COVID-19患病率值，只要检测灵敏度至少等于其特异性，对仅5000名HCQ长期用药患者进行COVID-19的系统检测就足以检验HCQ对COVID-19是否具有预防作用。对于更高的COVID-19患病率值，所需的HCQ长期用药患者数量甚至更低。
