Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France

Abstract

Background: In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19. Methods: We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and > 10 day hospitalization) and viral shedding persistence (> 10 days). Results: A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 yearsrange 14-95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74-95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective betablocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision). Conclusion: Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.

Detection of SARS-CoV-2 from Patient Fecal Samples by Whole Genome Sequencing

“…Two recent studies that support targeting the endocytic pathway and autophagy as therapeutic strategies are by Arshad et al and Lagier et al, both of which show that HCQ was associated with a signi cant reduction of in-hospital mortality compared to those not receiving HCQ [31,32]. Numerous other studies have also reported the e cacy of CQ and/or HCQ in various treatment regimens for COVID-19 [33][34][35][36][37][38][39]. Adding to the complexity of COVID-19 treatment and prevention, is that SARS-CoV-2 appears to be mutating at an alarming rate, as reported in the Icelandic study which identi ed the presence of 291 sequence variants that were not present in the Global Initiative on Sharing All In uenza Data (GISAID) reference database as of March 22 (11).…”

Azithromycin and COVID‐19: Prompt early use at first signs of this infection in adults and children, an approach worthy of consideration

“…A follow‐up retrospective study from this French group evaluated 1061 patients, 46.4% male, mean age 43.6 years, with an age range of 14 to 95 years. It reported a favorable clinical outcome with a virologic cure in 973 of the 1061 patients within 10 days when using a combination of HCQ and azithromycin 2 . Other studies involving hospitalized patients have been less encouraging 3 .…”

Perspectives on the Early Quality of Evidence Guiding the Therapeutic Management of SARS CoV-2: A Systematic Literature Review

“…18.40, 95% CI 6.28 to 53.90), and medium and high National Early Warning Score (NEWS; OR: 9.48, 95% CI 3.25 to 27.66; OR = 10.05, 95% CI 3.16 to 32.02, respectively) were signi cantly associated with poor clinical outcome. Cardiac toxicity was not reported in the study [19]. Although cardiac toxicity was not reported in any of the studies, a study by Chorin et al reported an extension in QT interval in SARS-CoV-2-positive patients treated with hydroxychloroquine, suggesting a risk of arrhythmia [20].…”