Early Hydroxychloroquine Is Associated with an Increase of Survival in COVID-19 Patients: An Observational Study

Abstract

Background: There is no treatment proven effective against COVID-19. Several drugs with in vitro potential against SARS-CoV-2 virus have been proposed. Hydroxychloroquine has in vitro anti-viral and immunomodulatory activity, but there is no current clinical evidence of its effectiveness changing the outcome of the disease. Methods: We enrolled all 18-85 years old inpatients from Central Defense Hospital “Gómez Ulla”, Madrid, Spain, who were hospitalised for COVID-19 and had a definitive outcome (dead or discharged). We used a statistical survival analysis to detect treatment differences associated with in-hospital death. Results: We analysed first 220 medical records. 166 patients met the inclusion criteria. 48,8 % of patients not treated with HCQ died, 22% of those treated with hydroxychloroquine (p=0,002). According to clinical picture at admission, hydroxychloroquine increased the mean cumulative survival in all groups from 1,4 to 1,8 times. This difference was statistically significant in the mild group. Conclusions: in a cohort of 166 patients from 18 to 85 years hospitalised with COVID-19, hydroxychloroquine treatment with 800mg added loading dose increased survival when patients were admitted in early stages of the disease. There was a non-statistically significant trend towards survival in all groups, which will have to be clarified in subsequent studies.

A pharmacological perspective of chloroquine in SARS-CoV-2 infection: An old drug for the fight against a new coronavirus?

“…One of these studies, however, reported results comparing the use of HCQ with that of another antiviral agent, lopinavir/ritonavir (LPV/r) [94] . The two observational studies conducted with the same dosage preceded by a LD resulted in opposite results, with the trial using the higher LD (800 mg/day) reporting positive results [99] . Among the studies using 600 mg of HCQ daily, four reported positive outcomes and three did not.…”

“…The results of a number of clinical trials and observational studies [80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99] have been reported so far, many of which present methodological limitations due to conditions of duress of an unexpected pandemic ( Table 1 ). Two studies also suffer from poor reporting, with no dosage being declared [ 88 , 95 ] and one of them including in the HCQ arm patients with worse baseline characteristics than the control group [88] .…”

Hydroxychloroquine: a comprehensive review and its controversial role in coronavirus disease 2019

“…Novales et al reported decreased mortality in patients treated with HCQ (27 out of 123, 22%) compared to the control arm (21 out of 43, 48.8%) in a retrospective analysis in patients admitted with COVID-19. Besides small sample size, lack of blinding and retrospective study method, other limitations of this study included use of other antiviral and anti-inflammatory medications, younger patients in the HCQ arm (61.5 years vs 68.7 years), and cause of mortality not specified [64]. A large retrospective population wide analysis of patients with confirmed/ suspected COVID-19 from Portugal compared the incidence of PCR positivity in those who were already on HCQ to those who were not [65].…”

A Saudi family with sickle cell disease presented with acute crises and COVID‐19 infection

“…7 A recently published observational study with a cohort of 166 patients, hospitalized due to COVID-19, showed increased mean survival by 1.4 to 1.8 times. 8 However, better evidence from an adequately powered randomized control trial is still not available.…”