Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19

Abstract

BACKGROUND:Despite limited and conflicting data on the use of hydroxychloroquine in patients with Covid-19, the U.S. Food and Drug Administration has authorized the emergency use of this drug when clinical trials are unavailable or infeasible. Hydroxychloroquine, alone or in combination with azithromycin, is being widely used in Covid-19 therapy based on anecdotal and limited observational evidence. METHODS:We performed a retrospective analysis of data from patients hospitalized with confirmed SARS-CoV-2 infection in all United States Veterans Health Administration medical centers until April 11, 2020. Patients were categorized based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) as treatments in addition to standard supportive management for Covid-19. The two primary outcomes were death and the need for mechanical ventilation. We determined the association between treatment and the primary outcomes using competing risk hazard regression adjusting for clinical characteristics via propensity scores. Discharge and death were taken into account as competing risks and subdistribution hazard ratios are presented. RESULTS:A total of 368 patients were evaluated (HC, n=97; HC+AZ, n=113; no HC, n=158). Rates of death in the HC, HC+AZ, and no HC groups were 27.8%, 22.1%, 11.4%, respectively. Rates of ventilation in the HC, HC+AZ, and no HC groups were 13.3%, 6.9%, 14.1%, respectively.

Low dose of hydroxychloroquine reduces fatality of critically ill patients with COVID-19

“…HCQ (Geleris et al, 2020;Mahevas et al, 2020;Magagnoli et al, 2020). However, based on the results in these studies, it is very likely that they used high doses of HCQ, which might induce cardiotoxicity and death.…”

Treatment of patients with nonsevere and severe coronavirus disease 2019: an evidence-based guideline

“…22 As presented in the previous section, 1 observational study 23 in 120 patients with mixed-severity COVID-19 provides very low-quality evidence that lopinavir-ritonavir may increase viral clearance at day 23 (Appendix 3). 22 Very low-quality evidence from 181 patients with severe COVID-19 and 255 patients with mixedseverity disease in 2 observational studies (preprints) 37,38 raised the possibility that hydroxychloroquine may increase mortality and the need for mechanical ventilation (Appendix 3). 22…”

Negative nasopharyngeal SARS-CoV-2 PCR conversion in Response to different therapeutic interventions

“…We did not study the clinical usefulness of these interventions in term of clinical improvement such as attenuation of the disease severity or mortality reduction. However, we are aware of the negative study that showed no reduction in mechanical ventilation risk in patients hospitalized with Covid-19 and received HCQ, either with or without azithromycin (23).…”