Lack of efficacy of hydroxychloroquine and azithromycin in patients hospitalized for COVID-19 pneumonia: A retrospective study

Abstract

Background Hydroxychloroquine combined with azithromycin (HCQ/AZI) has initially been used against coronavirus disease-2019 (COVID-19). In this retrospective study, we assessed the clinical effects of HCQ/AZI, with a 28-days follow-up. Methods In a registry-study which included patients hospitalized for COVID-19 between March 15 and April 2, 2020, we compared patients who received HCQ/AZI to those who did not, regarding a composite outcome of mortality and mechanical ventilation with a 28-days follow-up. QT was monitored for patients treated with HCQ/AZI. Were excluded patients in intensive care units, palliative care and ventilated within 24 hours of admission. Three analyses were performed to adjust for selection bias: propensity score matching, multivariable survival, and inverse probability score weighting (IPSW) analyses. Results Overall, 203 patients were included: 60 patients treated by HCQ/AZI and 143 control patients. During the 28-days follow-up, 32 (16.3%) patients presented the primary outcome and 23 (12.3%) patients died. Propensity-score matching identified 52 unique pairs of patients with similar characteristics. In the matched cohort (n = 104), HCQ/AZI was not associated with the primary composite outcome (log-rank p-value = 0.16). In the overall cohort (n = 203), survival and IPSW analyses also found no benefit from HCQ/AZI. In the HCQ/AZI group, 11 (18.3%) patients prolonged QT interval duration, requiring treatment cessation. Conclusions HCQ/AZI combination therapy was not associated with lower in-hospital mortality and mechanical ventilation rate, with a 28-days follow-up. In the HCQ/AZI group, 18.3% of patients presented a prolonged QT interval requiring treatment cessation, however, control group was not monitored for this adverse event, making comparison impossible.

Antibiotics Use in COVID-19 Patients: A Systematic Literature Review

“…The findings from the large RECOVERY trial confirmed several previous studies that found modest or no benefit in azithromycin use in patients admitted to hospital with COVID-19 [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

“…Two-hundred-forty-five studies were excluded for not reporting data on antibiotic use in COVID-19 patients. From the remaining 118 studies, 36 studies were included in this systematic review ( Figure 1 ) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…Of the 36 studies included in the systematic review, 32 studies were on the use of antibiotics in COVID-19 inpatients [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]; 4 reported on antibiotic use in COVID-19 outpatients [ 37 , 38 , 39 , 40 ].…”

Prevalence of overweight and obesity and their effect on COVID‐19 severity and hospitalization among younger than 50 years versus older than 50 years population: A systematic review and meta‐analysis

“…A detailed description of the studies included in the two groups is provided in Data S1 12–194 . The literature search yielded a total of 826 citations.…”

Atovaquone and Berberine Chloride Reduce SARS-CoV-2 Replication In Vitro

“…On the other hand, azithromycin, which was frequently prescribed alongside hydroxychloroquine to treat COVID-19, had no significant effect on viral titers in Vero E6 cells. Hydroxychloroquine and azithromycin have now been shown to have negative side effects and low to no efficacy in COVID-19 patients [29,30]. These results highlight that numerous, potentially efficacious, drugs should be tested in clinical settings because in vivo outcomes are not always reflected in in vitro systems and vice versa.…”