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Naggie S, Milstone A, Castro M, Collins SP, Lakshmi S, Anderson DJ, Cahuayme-Zuniga L, Turner KB, Cohen LW, Currier J, Fraulo E, Friedland A, Garg J, George A, Mulder H, Olson RE, O'Brien EC, Rothman RL, Shenkman E, Shostak J, Woods CW, Anstrom KJ, Hernandez AF. Hydroxychloroquine for pre-exposure prophylaxis of COVID-19 in health care workers: a randomized, multicenter, placebo-controlled trial Healthcare Worker Exposure Response and Outcomes of Hydroxychloroquine (HERO-HCQ). Int J Infect Dis 2023; 129:40-48. [PMID: 36682681 PMCID: PMC9851717 DOI: 10.1016/j.ijid.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To determine whether hydroxychloroquine (HCQ) is safe and effective at preventing COVID-19 infections among health care workers (HCWs). METHODS In a 1: 1 randomized, placebo-controlled, double-blind, parallel-group, superiority trial at 34 US clinical centers, 1360 HCWs at risk for COVID-19 infection were enrolled between April and November 2020. Participants were randomized to HCQ or matched placebo. The HCQ dosing included a loading dose of HCQ 600 mg twice on day 1, followed by 400 mg daily for 29 days. The primary outcome was a composite of confirmed or suspected COVID-19 clinical infection by day 30, defined as new-onset fever, cough, or dyspnea and either a positive SARS-CoV-2 polymerase chain reaction test (confirmed) or a lack of confirmatory testing due to local restrictions (suspected). RESULTS Study enrollment closed before full accrual due to recruitment challenges. The primary end point occurred in 41 (6.0%) participants receiving HCQ and 53 (7.8%) participants receiving placebo. No difference in the proportion of participants experiencing clinical infection (estimated difference of -1.8%, 95% confidence interval -4.6-0.9%, P = 0.20) was identified nor any significant safety issues. CONCLUSION Oral HCQ taken as prescribed appeared safe among HCWs. No significant clinical benefits were observed. The study was not powered to detect a small but potentially important reduction in infection. TRIAL REGISTRATION NCT04334148.
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Affiliation(s)
- Susanna Naggie
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | | | - Mario Castro
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sean P Collins
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | - Lauren W Cohen
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Judith Currier
- University of California Los Angeles, Los Angeles, California, USA
| | - Elizabeth Fraulo
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Anne Friedland
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jyotsna Garg
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Anoop George
- Temple University, Philadelphia, Pennsylvania, USA
| | - Hillary Mulder
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Rachel E Olson
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | | | | | - Jack Shostak
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Christopher W Woods
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Kevin J Anstrom
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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Friedland A, Hernandez AF, Anstrom KJ, Chen-Lim ML, Cohen LW, Currier JS, Forrest CB, Fraser R, Fraulo E, George A, Handberg E, Jackman J, Koellhoffer J, Lawrence D, Leverty R, McAdams P, McCourt B, Mickley B, Naqvi SH, O'Brien EC, Olson R, Prater C, Rothman RL, Shenkman E, Shostak J, Turner KB, Webb L, Woods C, Naggie S. Design of the healthcare worker exposure response and outcomes (HERO) research platform. Contemp Clin Trials 2021; 109:106525. [PMID: 34371163 PMCID: PMC8349387 DOI: 10.1016/j.cct.2021.106525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/24/2021] [Accepted: 08/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The SARS CoV-2 virus has caused one of the deadliest pandemics in recent history, resulting in over 170 million deaths and global economic disruption. There remains an urgent need for clinical trials to test therapies for treatment and prevention. DESIGN An online research platform was created to support a registry community of healthcare workers (HCWs) to understand their experiences and conduct clinical studies to address their concerns. The first study, HERO-HCQ, was a double-blind, multicenter, randomized, pragmatic trial to evaluate the superiority of hydroxychloroquine (HCQ) vs placebo for pre-exposure prophylaxis (PrEP) of COVID-19 clinical infection in HCWs. Secondary objectives were to assess the efficacy of HCQ in preventing viral shedding of COVID-19 among HCWs and to assess the safety and tolerability of HCQ. METHODS HCWs joined the Registry and were pre-screened for trial interest and eligibility. Trial participants were randomized 1:1 to receive HCQ or placebo. On-site baseline assessment included a COVID-19 nasopharyngeal PCR and blood serology test. Weekly follow-up was done via an online portal and included screening for symptoms of COVID-19, self-reported testing, adverse events, and quality of life assessments. The on-site visit was repeated at Day 30. DISCUSSION The HERO research platform offers an approach to rapidly engage, screen, invite and enroll into clinical studies using a novel participant-facing online portal interface and remote data collection, enabling limited onsite procedures for conduct of a pragmatic clinical trial. This platform may be an example for future clinical trials of common conditions to enable more rapid evidence generation.
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Affiliation(s)
- Anne Friedland
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Mei Lin Chen-Lim
- Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Lauren W Cohen
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Judith S Currier
- University of California Los Angeles, Los Angeles, CA, United States of America
| | | | - Ryan Fraser
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Elizabeth Fraulo
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Anoop George
- Temple University Hospital, Philadelphia, PA, United States of America
| | - Eileen Handberg
- University of Florida, Gainesville, FL, United States of America
| | - Jennifer Jackman
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | | | - Daryl Lawrence
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Renee Leverty
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Patty McAdams
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Brian McCourt
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Brenda Mickley
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | | | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Rachel Olson
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Clyde Prater
- Williamson Medical Center, Franklin, TN, United States of America
| | - Russell L Rothman
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | | | - Jack Shostak
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Kisha Batey Turner
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Laura Webb
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Chris Woods
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Susanna Naggie
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America.
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Wu LT, Ling W, Burchett B, Blazer DG, Shostak J, Woody GE. Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network. Subst Abuse Rehabil 2010; 2010:13-22. [PMID: 21709734 PMCID: PMC3122483 DOI: 10.2147/sar.s15151] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE: Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study examined clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation. METHODS: The sample included 343 opioid-dependent patients enrolled in two national multi-site studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from 12 addiction treatment programs across the nation. Gender and racial/ethnic differences in addiction severity, human immunodeficiency virus (HIV) risk, and quality of life were examined. RESULTS: Women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems and report poorer health-related quality of life and functioning. Whites and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were more likely than whites to use heroin and cocaine and to have more severe alcohol and employment problems. CONCLUSIONS: Women and whites show more psychopathology than men and African Americans. These results highlight the need to monitor an increased trend of opioid addiction among women and whites and to develop effective combined psychosocial and pharmacologic treatments to meet the diverse needs of the expanding opioid-abusing population. Elevated levels of HIV risk behaviors among Hispanics and whites also warrant more research to delineate mechanisms and to reduce their risky behaviors.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Walter Ling
- David Geffen School of Medicine, NPI/Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Bruce Burchett
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Durham, NC, USA
| | - Dan G Blazer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Jack Shostak
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - George E Woody
- Department of Psychiatry, School of Medicine, University of Pennsylvania and Treatment Research Institute, Philadelphia, PA, USA
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