Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants

Catteau, Lucy; Dauby, Nicolás; Montourcy, Marion; Bottieau, Emmanuel; Hautekiet, Joris; Goetghebeur, Els; Ierssel, Sabrina H. van; Duysburgh, Els; Oyen, Herman Van; Wyndham-Thomas, Chloé; Beckhoven, Dominique Van

doi:10.1016/j.ijantimicag.2020.106144

Cited by 115 publications

(110 citation statements)

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“…However, our study did not find any significant difference in the ratio of AST/ALT in patients with oxygen therapy and the ones without. Although the requirement of oxygen therapy and AST/ALT could be a marker of illness severity, other treatment process, such as hydroxychloroquine and corticosteroids [ 31 , 32 ], might also influence the hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

The independent factors associated with oxygen therapy in COVID-19 patients under 65 years old

Wang

Liang

et al. 2021

PLoS ONE

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Background The number of hospitalized young coronavirus disease 2019 (COVID-19) patients has increased significantly. However, specific data about COVID-19 patients under 65 years old who are admitted to the hospital are scarce. Methods The COVID-19 patients under 65 years old who were admitted to the hospital in Sichuan Province, Renmin Hospital of Wuhan University, and Wuhan Red Cross Hospital were included in this study. Demographic information, laboratory data and clinical treatment courses were extracted from electronic medical records. Risk factors associated with oxygen therapy were explored. Results Eight hundred thirty-three COVID-19 patients under 65 years old were included. Of the included patients, 29.4% had one or more comorbidities. Oxygen therapy was required in 63.1% of these patients, and the mortality was 2.9% among the oxygen therapy patients. Fever (odds ratio [OR] 2.072, 95% confidence interval [CI] 1.312–3.271, p = 0.002), dyspnea (OR 2.522, 95% CI 1.213–5.243, p = 0.013), chest distress (OR 2.278, 95% CI 1.160–4.473, p = 0.017), elevated respiratory rate (OR 1.114, 95% CI 1.010–1.228, p = 0.031), and decreased albumin (OR 0.932, 95% CI 0.880–0.987, p = 0.016) and globulin levels (OR 0.929, 95% 0.881–0.980, p = 0.007) were independent factors related to oxygen therapy. Conclusions Oxygen therapy is highly required in COVID-19 patients under 65 years old who are admitted to the hospital, but the success rate is high. Respiratory failure-related symptoms, elevated respiratory rate, low albumin and globulin levels, and fever at admission are independent risk factors related to the requirement of oxygen.

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Section: Discussionmentioning

confidence: 99%

The independent factors associated with oxygen therapy in COVID-19 patients under 65 years old

Wang

Liang

et al. 2021

PLoS ONE

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“…Those receiving low-dose HCQ therapy reported a reduction of the risk of death as assessed by multivariate analysis. 14 …”

Section: Agents With Anti-malarial Activitymentioning

confidence: 99%

Experimental Pharmacotherapy for COVID-19: The Latest Advances

Pagliano¹,

Scarpati²,

Sellitto³

et al. 2021

JEP

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The coronavirus infectious disease-2019 (COVID-19) has overwhelmed like a shock wave in a completely unprepared world. Despite coronavirus infections were involved in previous epidemic outbreaks, no antiviral agent was developed for specific treatment. As a consequence, since the beginning of this pandemic, both repositioned and experimental drugs were used to treat the infected patients without evidence of clinical efficacy. Just based on experience coming from the use of antiviral agents to treat other viruses (eg, lopinavir/ritonavir, remdesivir) and supposed antiviral or immunomodulatory activities of drugs with no approved antiviral indications (eg hydroxychloroquine, tocilizumab), clinicians have faced the ongoing pandemic. Currently, after about 9 months from the COVID-19 spread, there is still no antiviral agent capable of ensuring the cure of this syndrome. Clinical trials are beginning to confirm the benefits of some drugs, while for other compounds, efficacy and safety have not yet been confirmed. Randomized clinical trials (RCT) have denied or downsized the beneficial effects attributed to certain molecules, such as aminoquinolines, largely used in clinical practice at the beginning of COVID-19 spread. Conversely, at the same time, they have provided evidence for unexpected effectiveness of other agents that have been underutilized, such as steroids, which were not used in SARS treatment because of the threatened effect on viral replication. Evidence deriving from pathologic studies have demonstrated that the prothrombotic effects of SARS-CoV-2 can be prevented by heparin prophylaxis, underlining the need for personalized treatment for patients with severe disease. The main aim of this review is to synthesize the available information and evidence on both repositioned and experimental drugs for the treatment of COVID-19, focusing on the need to exercise caution on the use of unproven medical therapies.

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“…Twenty-eight articles were identi ed [7,9,11,12,. For ten of them [11,15,17,19,21,23,25,31,32,34] it was possible to extract data necessary for comparing HCQ+AZM versus no HCQ+AZM.…”

Section: Search Strategymentioning

confidence: 99%

“…Is there any interaction with other anti-COVID19 drugs? In the last few months, at least three large, well-conducted observational studies have been published showing a protective effect of HCQ on mortality risk in hospitalized COBID-19 patients [7,11,12]. All three studies have not been included in previous meta-analysis [13], and used HCQ doses lower than those administered in randomized clinical trial (RCT), such as the Recovery or the Solidarity trials [9,14].…”

Section: Introductionmentioning

confidence: 99%

Low Dose Hydroxychloroquine is Associated with Lower Mortality in COVID-19: A Meta-Analysis of 27 Studies and 44,684 Patients

Castelnuovo

Costanzo

Cassone

et al. 2020

Preprint

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Background: Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19, but its association with mortality is not well characterized. We conducted two meta-analyses to evaluate the association between HCQ (with or without azithromycin (AZM)) and total mortality in COVID-19 patients.Methods: Articles were retrieved until November 10th, 2020 by searching in seven databases. Data were combined using the general variance-based method.Results: A total of 27 articles were found (N=44,684 patients, including N=7,803 from 5 randomized clinical trials (RCTs)). Overall, the use of HCQ was associated with 22% lower mortality risk (pooled risk ratio: 0.78, 95%CI: 0.67 to 0.91; I2=80%, random effects). This association was found reversed when pooling only RCTs (16.7% of the overall weight; pooled risk ratio: 1.11, 0.99 to 1.24) or studies in which daily dose >400 mg or total dose >4,400 mg were used (pooled risk ratio: 1.10, 95%CI: 0.99 to 1.23 in both cases). Overall, HCQ+AZM (10 studies) was also associated with 28% lower mortality risk, but uncertainty was large (95%CI: 0.48 to 1.08; P=0.11). Use of HCQ was not associated with severe adverse events.Conclusions: HCQ use was not associated with mortality reduction in COVID-19 patients when 5 RCTs only were evaluated, while a 9% to 33% reduced mortality was observed when observational studies were also included. The association was mainly apparent in studies that used lower doses of HCQ. These findings can help disentangling the debate on HCQ use in COVID-19.

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Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants

Abstract: Highlights Hydroxychloroquine (HCQ) 2400 mg over 5 days was used in Belgium for COVID-19. Impact of HCQ on mortality among 8075 patients with COVID-19 was assessed. Lower mortality in HCQ-treated patients as compared to supportive care. Lower mortality was irrespective of symptom duration.

Cited by 115 publications

References 45 publications

The independent factors associated with oxygen therapy in COVID-19 patients under 65 years old

The independent factors associated with oxygen therapy in COVID-19 patients under 65 years old

Experimental Pharmacotherapy for COVID-19: The Latest Advances

Low Dose Hydroxychloroquine is Associated with Lower Mortality in COVID-19: A Meta-Analysis of 27 Studies and 44,684 Patients

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