Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19

Abstract

Background: Despite limited and conflicting evidence, hydroxychloroquine, alone or in combination with azithromycin, is widely used in COVID-19 therapy. Methods: We performed a retrospective study of electronic health records of patients hospitalized with confirmed SARS-CoV-2 infection in US Veterans Health Administration medical centers between March 9, 2020 and April 29, 2020. Patients hospitalized within 24 h of diagnosis were classified based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) or no HC as treatments. The primary outcomes were mortality and use of mechanical ventilation. Findings: A total of 807 patients were evaluated. Compared to the no HC group, after propensity score adjustment for clinical characteristics, the risk of death from any cause was higher in the HC group (adjusted hazard ratio [aHR], 1.83; 95% confidence interval [CI], 1.16-2.89; p = 0.009), but not in the HC+AZ group (aHR, 1.31; 95% CI, 0.80-2.15; p = 0.28). Both the propensity-score-adjusted risks of mechanical ventilation and death after mechanical ventilation were not significantly different in the HC group (aHR, 1.19; 95% CI, 0.78-1.82; p = 0.42 and aHR, 2.11; 95% CI, 0.96-4.62; p = 0.06, respectively) or in the HC+AZ group (aHR, 1.09; 95% CI, 0.72-1.66; p = 0.69 and aHR, 1.25; 95% CI, 0.59-2.68; p = 0.56, respectively) compared to the no HC group. Conclusions: Among patients hospitalized with COVID-19, this retrospective study did not identify any significant reduction in mortality or in the need for mechanical ventilation with hydroxychloroquine treatment with or without azithromycin.

WITHDRAWN: A Randomized Controlled Study Of Favipiravir Vs Hydroxychloroquine In COVID-19 Management: What Have We Learned So Far?

“…In another study, HCQ showed signi cant improvement in symptoms and radiological CT scan ndings [22] . One recent non-randomized study failed to demonstrate a bene t among patients hospitalized with an oxygen requirement A retrospective analysis of data from patients hospitalized with con rmed SARS-CoV-2 infection in all U.S. Veterans Health Administration medical centers until April 11, 2020 concluded that no clear evidence that the use of HCQ, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with COVID-19 [25]. An association of increased overall mortality was identi ed in patients treated with HCQ alone [26] .…”

Efficacy of various treatment modalities for nCOV‐2019: A systematic review and meta‐analysis

“…We included 12 RCTs, 3 non-RCTs and 20 observational (including retrospective/prospective cohort, case-control) studies. Eighteen studies were from China, 10,11,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] six from USA, [47][48][49][50][51][52] five from Italy, [53][54][55][56][57] two from France 6,58 and one each from Brazil, 59 Hong Kong, 60 Spain 61 and Greece. 62 There was no significant difference in the mean age and sex distribution between any of the treatment and comparator groups included in our meta-analysis.…”

“…Eight studies 6,10,31,32,[47][48][49]58 consisting of 3400 nCOV-2019 cases were included in the meta-analysis and were divided into two groups: 1522 subjects to hydroxychloroquine group and 1878 subjects to control group. Compared to the control group, hydroxychloroquine had an increased risk of having total adverse events (RR 1.82; 95% CI 1.57 to 2.12) and was associated with a longer time to clinical recovery (SMD 0.55; 95% CI 0.21 to 0.89).…”

“…The combination of hydroxychloroquine and azithromycin was tested in three studies 6,48,49 including 1591 nCOV-2019 cases wherein, 955 cases were allocated to the hydroxychloroquine + azithromycin treatment group and the rest 636 cases to the control group. The combination of hydroxychloroquine + azithromycin was significantly associated with a higher risk of all-cause mortality compared to the control group (RR 2.19; 95%CI 1.67 to 2.86), while no association was observed between the two in terms of overall clinical recovery (RR 1.05; 95%CI 0.77 to 1.42) ( Figure 7A,B).…”

A Preliminary Study on Various Types of 4-Aminoquinolines for Pre- or Post-Exposure Prophylaxis and for Treatment in Severe COVID-19

“…Researchers have even reported both prophylactic and therapeutic advantages of CQ for SARS-CoV infection [7]. However, other researchers have reported in a retrospective study with no de ned administration time that no evidence in the use of hydroxychloroquine either with or without azithromycin reduced the risk of a mechanical ventilator in patients hospitalized with COVID-19 [8]. [9] in an open-label nonrandomized clinical trial concluded that hydroxychloroquine showed a signi cant association with viral load reduction/disappearance in COVID-19 patients, and its effect is reinforced by azithromycin.…”