COVID-19 postexposure prophylaxis: several trials underway, multicenter study launches in France

  • Mitjà O & al.
  • Lancet Glob Health
  • 19 Mar 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Antiviral drugs for postexposure prophylaxis (PEP) represent a potential strategy for preventing secondary COVID-19 transmission following initial contact exposure.
  • Clinical trials exploring prophylactic hydroxychloroquine are either underway or recruiting ( China , Spain , and South Korea).
  • A multicentre study is evaluating standard of care (SOC) plus remdesivir; plus lopinavir and ritonavir; plus lopinavir, ritonavir, and interferon-beta; or plus hydroxychloroquine.
  • Trial launched March 23 in France with 800 patients hospitalized with COVID-19; enrollment will scale to 3200 European patients.

Why this matters

  • Standard public health interventions (social distancing, cordon sanitaire, contact tracing) alone are insufficient.
  • Early pharmacological modeling, anecdotal reports suggest potential benefit of hydroxychloroquine (at approved doses) against SARS-CoV-2 infection and COVID-19, and possible amelioration of viral shedding. 

Key points

  • Strategies to protect individuals at high risk for COVID-19 acquisition (especially health care workers, close contacts) are urgently needed.
  • Secondary COVID-19 attack rates are ~15% among households, ~10% among close contacts.
  • Based on prior clinical experience (e.g., rifampicin PEP to prevent invasive meningococcal infection following contact with index case), starting PEP immediately post-COVID-19 symptom onset may reduce viral shedding in respiratory secretions (those in sputum peak ~5-6 days post-symptom onset, lasting up to 14 days).
  • Targeted PEP might reduce infection risk among close contacts.