Examination of patient characteristics and hydroxychloroquine use based on the US Food and Drug Administration’s recommendation: a cross-sectional analysis in New York

Kim, Eun Ji; Coppa, Kevin; Hirsch, Jamie S.; Abrahams, Sara; Johnson, Jennifer; Lesser, Martin; Davidson, Karina W.; Conigliaro, Joseph

doi:10.1136/bmjopen-2020-042965

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…The main characteristics of the studies included in the meta-analyses are shown in Table 1 . Data from 3 independent cohorts were extracted from the study of Kim et al [ 46 ]; 7 articles were not published in peer reviewed journals; 4 observational studies reported unadjusted relative risks for the association between HCQ and mortality; 13 studies have been conducted in Europe, 17 in North America (Canada, USA or Mexico), 3 in Asia (China, Saudi Arabia) and three in other countries. The outcome considered was total mortality, with the exception of Geleris et al [ 18 ] in which the authors used a combined endpoint formed by intubation or death; the mortality was intra-hospital, with the exception of the studies [ 28 , 33 , 35 , 36 ], in which death was all-cause, all-location.…”

Section: Resultsmentioning

confidence: 99%

Hydroxychloroquine and mortality in COVID-19 patients: a systematic review and a meta-analysis of observational studies and randomized controlled trials

Castelnuovo

Costanzo

Cassone

et al. 2021

Pathogens and Global Health

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Background: Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19, but its association with mortality is unclear. We reviewed published literature for evidence of an association between HCQ (with or without azithromycin (AZM)) and total mortality in COVID-19 patients. Methods: Articles were retrieved until April 29 th , 2021 by searching in seven databases. Data were combined using the general-variance-based method. Results: A total of 25 cohort studies (N=41,339 patients) and 11 randomized clinical trials (RCTs; N=8,709) were found. The use of HCQ was not associated with mortality in meta-analysis of RCTs (pooled risk ratio (PRR): 1.08, 95%CI: 0.97-1.20; I 2 =0%), but it was associated with 20% lower mortality risk (PRR=0.80, 95%CI: 0.69-0.93; I 2 =80%) in pooling of cohort studies. The negative association with mortality was mainly apparent by pooling cohort studies that used lower doses of HCQ (≤400 mg/day; PRR=0.69, 95%CI: 0.57-0.87). Use of HCQ+AZM (11 studies) was associated with 25% non-statistically significant lower mortality risk (PPR=0.75; 0.51-1.10; P=0.15). Use of HCQ was not associated with severe adverse events (PRR=1.12, 95%CI: 0.88-1.44; I 2 =0%). Conclusions: HCQ use was not associated with mortality in COVID-19 patients in pooling results from RCTs (high level of certainty of evidence), but it was associated with 20% mortality reduction when findings from observational studies were combined (low level of certainty of evidence). The reduction of mortality was mainly apparent in observational studies where lower doses of HCQ were used. These findings might help disentangling the debate on HCQ use in COVID-19.

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Section: Resultsmentioning

confidence: 99%

Hydroxychloroquine and mortality in COVID-19 patients: a systematic review and a meta-analysis of observational studies and randomized controlled trials

Castelnuovo

Costanzo

Cassone

et al. 2021

Pathogens and Global Health

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“…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).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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Aims: To evaluate the efficacy and safety of hydroxychloroquine/chloroquine, with or without azithromycin, in treating hospitalized COVID-19 patients. Materials & methods: Data from randomized and observational studies were included in a random-effects meta-analysis. Primary outcomes included time to negative conversion of SARS-CoV-2 tests, length of stay, mortality, incidence of mechanical ventilation, time to normalization of body temperature, incidence of adverse events and incidence of QT prolongations. Results: Fifty-one studies (n = 61,221) were included. Hydroxychloroquine/chloroquine showed no efficacy in all primary efficacy outcomes, but was associated with increased odds of QT prolongations. Conclusion: Due to a lack of efficacy and increased odds of cardiac adverse events, hydroxychloroquine/chloroquine should not be used for treating hospitalized COVID-19 patients.

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“…Use of unproven treatments was widespread during the early stages of the pandemic. For example, studies reported rates of antimalarial agent administration ranging from 34.6% to 92.1% despite any clinical data to demonstrate efficacy (26)(27)(28). Frequent use of unproven treatments like antimalarials underscores the tensions inherent in clinical decision making during a pandemic and highlights the need for systems to rapidly generate clinical evidence to guide decision making during public health crises (29,30).…”

Section: Discussionmentioning

confidence: 99%

Willingness to Treat with Therapies of Unknown Effectiveness in Severe COVID-19: A Survey of Intensivist Physicians

Levin¹,

Davis²,

Bukowski³

et al. 2022

Annals ATS

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Rationale:Little is known about how physicians develop their beliefs about new treatments or update their beliefs in the face of new clinical evidence. These issues are particularly salient in the context of the COVID-19 pandemic, which created rapid demand for novel therapies in the absence of robust evidence.Objective: To identify psychological traits associated with physicians' willingness to treat with unproven therapies and willingness to update their treatment preferences in the setting of new evidence in the context of COVID-19. Methods:We administered a longitudinal e-mail survey to United States physicians board-certified in intensive care medicine in April and May, 2020 (phase one); and October and November, 2020 (phase two). We assessed five psychological traits potentially related to evidence-uptake: need for cognition, evidence skepticism, need for closure, risk tolerance, and research engagement. We then examined the relationship between these traits and physician preferences for pharmacological treatment for a hypothetical patient with severe COVID-19 pneumonia.Results: There were 592 responses to the phase one survey, conducted prior to publication of trial data.At this time physicians were most willing to treat with macrolide antibiotics (50.5%), followed by antimalaria agents (36.1%), corticosteroids (24.5%), antiretroviral agents (22.6%), and angiotensin inhibitors (4.4%). Greater evidence skepticism (relative risk, RR=1.40, 95% CI: 1.30 -1.52, p<0.001), greater need for closure (RR=1.19, 95% CI: 1.06 -1.34, p=0.003), and greater risk tolerance (RR=1.17, 95% CI: 1.08 -1.26, p<0.001) were associated with an increased willingness to treat; while greater need for cognition (RR: 0.85, 95% CI: 0.75 -0.96, p=0.010) and greater research engagement (RR=0.91, 95%

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Examination of patient characteristics and hydroxychloroquine use based on the US Food and Drug Administration’s recommendation: a cross-sectional analysis in New York

Cited by 6 publications

References 31 publications

Hydroxychloroquine and mortality in COVID-19 patients: a systematic review and a meta-analysis of observational studies and randomized controlled trials

Hydroxychloroquine and mortality in COVID-19 patients: a systematic review and a meta-analysis of observational studies and randomized controlled trials

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

Willingness to Treat with Therapies of Unknown Effectiveness in Severe COVID-19: A Survey of Intensivist Physicians

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