Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review

Abstract

Background During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. Objective The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. Methods A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. Results The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. Conclusions In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic.

Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis

“…Overall, 10 201 patients from 25 different publications were included in this study. Seven of the studies assessed patients from the USA [ 10 , 15 – 20 ], 13 of the studies assessed patients from west Europe [ 8 , 21 – 32 ], two assessed patients from multiple countries [ 33 , 34 ], one assessed patients from Brazil [ 35 ], and two studies were from India [ 36 , 37 ]. The main characteristics of the 25 included studies were summarized in Table 1 .…”

Beneficial and harmful outcomes of tocilizumab in severe COVID‐19: A systematic review and meta‐analysis

“…The PRISMA flow diagram is detailed in Figure 1. The majority of included studies were carried out in different hospitals from countries in America and Europe, such as the United States (US) 46,47,[51][52][53][54][55]61,67,68,70,76,82,84,[86][87][88][89][90]92,94 , Italy (ITA) 41,[43][44][45]48,49,58,60,69,77,79,91,95 , Spain (SPA) 40,42,63,64,71,75,78,83,85 , and France (FRA). 56,57,59,62,96 A lesser number was conducted in Sweden (SWE) 50 , India (IND)…”

Efficacy of Chloroquine and Hydroxychloroquine for the Treatment of Hospitalized COVID-19 Patients: A Meta-Analysis

“…The risk of bias in observational studies was evaluated using ROBINS-I (see Figure 2 B & Supplementary Table 12 ). Eighteen studies (43%) [ 95 , 98 , 101 , 109 , 115 , 116 , 119 , 120 , 122 , 123 , 125–127 , 129–134 ] were rated as having a critical risk of bias, while another 18 studies (43%) [ 92–94 , 97 , 99 , 102–105 , 107 , 110–114 , 117 , 118 , 121 ] were rated as having a serious risk of bias. In general, studies were rated as having a serious or critical risk of bias due to confounding factors, poor descriptions of the regimen/interventions used, inadequate descriptions of treatment deviations and compliance and a lack of information in regards to a priori developed analysis plans and study protocols.…”

“…Twenty-one studies [ 30 , 31 , 86 , 89 , 90 , 92 , 94 , 97 , 98 , 101 , 102 , 106 , 112 , 114 , 117–119 , 121 , 125 , 126 , 130 ] with 25,343 hospitalized COVID-19 patients assessed the effect of chloroquine and hydroxychloroquine on incidences of mechanical ventilation. The overall pooled OR was 1.26 (95% CI: 0.85–1.87) with significant and severe heterogeneity (I 2 = 87%; p Q <0.01).…”