Safety of Hydroxychloroquine for COVID-19 Prophylaxis in Healthcare Workers: A Cross-Sectional Study

TL;DR

This study examines the safety of hydroxychloroquine as a preventive treatment for healthcare workers in Mumbai, finding common side effects but no serious heart issues.

Contribution

The study provides new insights into the safety profile of hydroxychloroquine prophylaxis specifically among healthcare workers in a high-risk setting.

Findings

35.2% of participants reported adverse effects, primarily gastrointestinal symptoms.

10.5% of participants experienced cardiac adverse effects, but no serious complications were observed.

Adverse effects were more frequently reported among female participants.

Abstract

Background: In March 2020, the World Health Organization (WHO) declared SARS-CoV-2 a pandemic after identifying it as the causative agent of COVID-19. Hydroxychloroquine (HCQ) was widely used as a prophylactic measure among healthcare workers (HCWs). However, its use as a preventive medication in asymptomatic individuals, particularly given its known adverse effect profile, remains relatively unexplored. This study aimed to evaluate the safety of HCQ prophylaxis among HCWs in Mumbai, India.

Materials and methods: A survey-based, cross-sectional study was conducted using a self-designed questionnaire distributed to HCWs in Mumbai who had direct or indirect patient contact and were taking HCQ for COVID-19 prevention.

Results: A total of 125 responses were collected, with males accounting for 80 (64%) of the participants. The majority of HCWs had a medical doctor background, and the mean age was 41.8 years. Thirty-eight HCWs (30.4%) reported frequent exposure to COVID-19, while 106 (84.8%) had direct patient contact. A minority (34 participants, 27.2%) received HCQ prophylaxis for seven weeks, and 123 (98.4%) adhered to the standard prophylactic regimen. Comorbidities were present in 27 (21.6%) HCWs, with hypertension (19, 15.2%) being the most common.

Among the participants, 64 (51.2%) underwent an electrocardiogram (ECG) before prophylaxis, while 56 (44.8%) had follow-up ECGs. Adverse effects were reported by 44 (35.2%) HCWs, with a statistically significant higher incidence among females. The most common adverse effects were gastrointestinal symptoms (48, 38.4%). While HCWs with hypertension and diabetes mellitus experienced more adverse effects, this association was not statistically significant. Cardiac adverse effects were reported in 13 cases (10.5%); however, no significant cardiovascular complications were observed.

Conclusions: This study found a higher occurrence of adverse effects among female participants, though previous research does not provide conclusive evidence for this finding. The incidence of gastrointestinal side effects was consistent with other studies on HCQ prophylaxis among HCWs. Although HCWs with hypertension and diabetes mellitus experienced more adverse effects, these were not statistically significant. No serious cardiovascular effects were observed. Given the evolving landscape of COVID-19 treatment and prevention, further large-scale trials are necessary to establish the safety and efficacy of HCQ prophylaxis among HCWs.

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