Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19

Abstract

Objectives To assess the efficacy of hydroxychloroquine in combination with azithromycin in terms of clinical and biochemical outcomes in adult patients with COVID-19 hospitalized for acute respiratory distress syndrome (ARDS), and to describe the occurrence of adverse events. Method Retrospective comparative study, based in a quaternary private hospital in Rio de Janeiro, Brazil, involving 193 adult patients hospitalized for mild and moderate COVID-19 related ARSD, analyzing treatment efficacy based on clinical and biochemical outcomes. Results The active group comprised 101 (52.3%) patients using hydroxychloroquine associated with azithromycin and the control group 92 (47.7%) patients who did not take these medications. Median age was 59 (47–70) in the active group and 65 (47−77) in the control group (p < 0.05). Patients in the control group had greater extent of pulmonary involvement on baseline chest CT scans (p < 0.05). All other baseline variables (BMI, comorbidities, previous use of medications and biochemical assessments) were similar between groups. In the medication group, 25% (25 out of 101) were admitted to the ICU, compared to 21% (19 out of 92) in the control group (p > 0.05). No difference in mortality, duration of non-invasive oxygen use or duration of hospitalization was seen between groups. The therapeutic regimen was well tolerated, with only eight (7.9%) patients presenting gastrointestinal symptoms and eight (7.9%) patients withdrawn treatment due to QTc prolongation. Conclusions Patients treated with hydroxychloroquine combined with azithromycin and the control group had similar clinical outcomes. This therapeutic regimen was considered ineffective in hospitalized patients with mild to moderate COVID-19 related ARDS and was associated with few non-severe adverse events.

Hydroxychloroquine and mortality in COVID-19 patients: a systematic review and a meta-analysis of observational studies and randomized controlled trials

“…Forty-two articles were identified [ 7 , 9 , 12–51 ]. For 11 of them [ 12 , 15 , 17 , 19 , 21 , 23 , 25 , 31 , 32 , 34 , 47 ] it was possible to extract data necessary for comparing HCQ+AZM versus no HCQ+AZM. For all other studies, it was not possible to systematically distinguish if HCQ therapy was complemented or not with AZM.…”

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

“…A total of 74 articles reporting data on the safety of HCQ or CQ in patients treated for COVID-19 were found [ 207 , 208 , 209 , 210 , 211 , 212 , 213 , 214 , 215 , 216 , 217 , 218 , 219 , 220 , 221 , 222 , 223 , 224 , 225 , 226 , 227 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , ...…”

Efficacy of Chloroquine and Hydroxychloroquine for the Treatment of Hospitalized COVID-19 Patients: A Meta-Analysis

“…There were no significant differences between the pooled MD from imputed studies versus non-imputed studies (p = 0.17, see Supplementary Figure 9 ). Three observational studies [ 103 , 114 , 121 ] of the five remaining studies reported no significant differences between the median length of stay among patients taking hydroxychloroquine (with or without azithromycin) and patients receiving standard of care. The other two studies, specifically the RECOVERY trial [ 30 ] and a cohort study by Rosenberg et al [ 126 ], reported higher median lengths of stay in the hydroxychloroquine group compared with their respective control groups.…”

“…Twenty-one studies [ 30 , 31 , 86 , 89 , 90 , 92 , 94 , 97 , 98 , 101 , 102 , 106 , 112 , 114 , 117–119 , 121 , 125 , 126 , 130 ] with 25,343 hospitalized COVID-19 patients assessed the effect of chloroquine and hydroxychloroquine on incidences of mechanical ventilation. The overall pooled OR was 1.26 (95% CI: 0.85–1.87) with significant and severe heterogeneity (I 2 = 87%; p Q <0.01).…”