The efficacy and safety of hydroxychloroquine in COVID19 patients : a multicenter national retrospective cohort

Abstract

BackgroundHydroxychloroquine is an antimalarial drug that received worldwide news and media attention in the treatment of COVID-19 patients. This drug was used based on its antimicrobial and antiviral properties despite lack of definite evidence of clinical efficacy. In this study, we aim to assess the efficacy and safety of using Hydroxychloroquine in treatment of COVID-19 patients who are admitted in acute care hospitals in Bahrain.MethodologyWe conducted retrospective cohort study on a random sample of admitted COVID19 patients between 24 February and 31 July 2020. The study was conducted in four acute care COVID19 hospitals in Bahrain. Data was extracted from the medical records. The primary endpoint was the requirement of non-invasive ventilation, intubation or death. Secondary endpoint was length of hospitalization for survivors. Three methods of analysis were used to control for confounding factors: logistic multivariate regression, propensity score adjusted regression and matched propensity score analysis.ResultsA random sample of 1571 patients were included, 440 of which received HCQ (treatment group) and 1131 did not receive it (control group). Our results showed that HCQ did not have a significant effect on primary outcomes due to COVID-19 infection when compared to controls after adjusting for confounders (OR 1.43 95% CI 0.85 to 2.37, P value=0.17). Co-administration of azithromycin had no effect on primary outcomes (OR 2.7 95% CI 0.82 to 8.85 P value =0.10). HCQ was found to be associated with increased risk of hypoglycemia (OR 10.9 95% CI 1.72 - 69.49, P value =0.011) and diarrhea(OR 2.8, 95% CI 1.4-5.5, P value =0.003), but not QT prolongation(OR=1.92, 95% CI 0.95-3.9, P value =0.06) or cardiac arrhythmia.(OR=1.06, 95% CI 0.55-2.05, P value =0.85).ConclusionOur results showed no significant beneficial effect of using hydroxychloroquine on the outcome of COVID-19 patients. Moreover, the risk of hypoglycemia due to hydroxychloroquine would possess a significant risk for out of hospital use.

COVID-19 pandemic: Can zinc supplementation provide an additional shield against the infection?

“…In a recent clinical observation, zinc sulfate, in combination with hydroxychloroquine and azithromycin, has shown to provide better therapeutic benefits to the COVID-19 infected patients than patients who received hydroxychloroquine and azithromycin, without zinc; an increased frequency of hospital discharge and reduced mortality are documented in zinc sulfate added-COVID-19 patients [47] . It needs to mention that hydroxychloroquine's potential utility to treat COVID-19 patients is debated, particularly the side effects of this drug beyond the acceptable range, and requires careful clinical consideration [48] , [49] , [50] , [51] , [52] . Additional controlled studies will also be required to gain better insight into the role and applications of zinc in COVID-19 infection.…”