Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: a multi-center observational study

Abstract

Background Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. Methods We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. Results Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. Conclusions In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.

First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain

“…The use of hydroxychloroquine for the treatment of COVID-19 is controversial. Some studies have reported that this drug reduces mortality [18], but others have not confirmed this finding [19]. Our subjective clinical impression is that hydroxychloroquine can be useful in the first days of hospitalization.…”

“…Coronavirus disease-19 (COVID- 19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious health threat globally. Several countries have seen a two-wave pattern of reported cases, with a first wave in spring and a second in late summer and autumn [1][2][3][4][5][6].…”

G6PD distribution in sub-Saharan Africa and potential risks of using chloroquine/hydroxychloroquine based treatments for COVID-19

“…These reviews conclude that there is currently insufficient evidence for the use of CQ/HCQ as effective COVID-19 treatments. To date (February 2021), the debate about the efficacy of HQC in the treatment of COVID-19 patients is continuing with many conflicting reports [ 50 , 51 ]. As additional randomised controlled trials have been recommended [ 1 ], we urge that G6PD deficiency-related effects be considered in African participants in these studies.…”

Clinical Efficacy of Hydroxychloroquine in Patients with COVID-19: Findings from an Observational Comparative Study in Saudi Arabia

“…This lack of benefits could be due to the inability of HCQ to kill the SARS-CoV-2 virus beyond in vitro settings or could be due to the timing of using the medicine late in the disease progression pathway. The latter explanation is based on the possible benefits of HCQ in mildly symptomatic [36] or asymptomatic patients in whom perhaps the suggested mechanism of reducing viral load (and reducing transmission) is not onerous.…”