Clinical outcomes of patients with mild COVID-19 following treatment with hydroxychloroquine in an outpatient setting

Abstract

The role of hydroxychloroquine (HCQ) in early outpatient management of mild coronavirus disease 2019 (COVID-19) needs further investigation. This study was a multicenter, population-based national retrospective-cohort investigation of 28,759 adults with mild COVID-19 seen at the network of Comprehensive Healthcare Centers (CHC) between March and September 2020 throughout Iran. The baseline characteristics and outcome variables were extracted from the national integrated health system database. A total of 7,295 (25.37%) patients who presented with mild COVID-19 within 3 to 7 days of symptoms onset received HCQ (400 mg twice daily on day 1 followed by 200 mg twice daily for the next four days and were then followed for 14 days). The main outcome measures were hospitalization or death for six months follow-up. COVID-19-related hospitalizations or deaths occurred in 523 (7.17%) and 27 (0.37%) respectively, in HCQ recipients and 2,382 (11.10%) and 287 (1.34%) respectively, in non-recipients. The odds of hospitalization or death was reduced by 38% (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.56–0.68, p = < 0.001) and 73% (OR = 0.27; 95% CI: 0.18–0.41, p = < 0.001) in HCQ recipients and non-recipients. These effects were maintained after adjusting for age, comorbidities, and diagnostic modality. No serious HCQ-related adverse drug reactions were reported. In our large outpatient national cohort of adults with mild COVID-19 disease who were given HCQ early in the course of the disease, the odds of hospitalization or death was reduced significantly regardless of age or comorbidities.

A Clinical Monitoring Program of COVID-19 Outpatients: A Prospective Cohort Study

“…Due to lack of sufficient evidence on an effective treatment for mild COVID-19 [27,28], most previous trials in outpatient settings have been focused on clinical characteristics and epidemiologic factors rather than therapeutic regimens [14,15,[19][20][21]. However, the results of a large national cohort study of 7,295 patients with mild COVID-19 showed that the early administration of HCQ is associated with a lower rate of hospitalization and mortality as well as the absence of serious complications [29]. Similarly, HCQ was administered for almost all patients in the study according to the national guideline.…”

Hydroxychloroquine / azithromycin in COVID-19: The association between time to treatment and case fatality rate

“…The effect of HCQ on the outcome measures was maintained after adjusting for confounding factors and comorbidities. This effect remained significant whether patients were diagnosed based on positive RT-PCR or otherwise [ 42 ].…”

Early combination therapy with hydroxychloroquine and azithromycin reduces mortality in 10,429 COVID-19 outpatients

“…Health agencies in Western countries have focused on contagion control measures (lockdown), late-stage hospitalized patients, intensive care units, and vaccination, but for reasons that are yet to be clarified, early treatment has not been emphasized [2][3][4]. In eastern countries such as China, India, Iran, and Saudi Arabia, where early treatment and prevention with repurposed antivirals, particularly hydroxychloroquine (HCQ), has been widely implemented [5][6][7][8], lower IFRs than Western countries, where early treatment with orally available molecules has been overlooked or even discouraged, have been reported [1]. In addition, countries using chloroquine or HCQ as a treatment from the start of the epidemic had a much slower dynamic in daily deaths [9].…”