Hydroxychloroquine Studies

Low Dose of Hydroxychloroquine Reduces Fatality of Critically Ill Patients With COVID-19 (15th March)

China Life Science

Does hydroxychloroquine reduce the death risk of critically ill COVID-19 patients.

Retrospective study

550 critically ill COVID-19 patients

Wuhan, from February 1, 2020 to April 4, 2020.

550 patients received comparable basic treatments including antiviral drugs and antibiotics

48 of them were treated with oral HCQ for 7-10 days

Primary endpoint is fatality of patients, and inflammatory cytokine levels

Compared between HCQ and non-hydroxychloroquine (NHCQ) groups

18.8% (9/48) deaths in HCQ group

47.4% (238/502) in the NHCQ group (P less than 0.001)

Inflammatory cytokine IL-6 significantly reduced in the HCL group

But there was no change in the NHCQ group

HCQ is highly effective in reducing deaths by reducing the cytokine storm

HCQ should be prescribed for critically ill COVID-19 patients

Hydroxychloroquine

Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. (NEJM 7th May)

CONCLUSIONS

Hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of intubation or death

Findings do not support the use of hydroxychloroquine at present, outside randomized clinical trials testing its efficacy

Clinical guidance at our medical center has been updated to remove the suggestion that patients with Covid-19 be treated with hydroxychloroquine

Hydroxychloroquine or chloroquine, with or without a macrolide, for the treatment of COVID-19, a multinational registry analysis (22nd May)

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Background

Azithromycin, clarithromycin, (erythromycin)

HC and C are generally safe when used for approved indications such as autoimmune disease or malaria

The safety and benefit of these treatment regimens are poorly evaluated in COVID-19.

Hydroxychloroquine has been shown to have in-vitro activity against the SARS-CoV-2

Recently published human trials, along with other unpublished data, suggest that it could decrease the duration of viral shedding and symptoms if given early.

Method

671 hospitals in six continents

Included patients hospitalised between Dec 20, 2019, and April 14, 2020

With a positive laboratory finding for SARS-CoV-2

Patients treated within 48 h of diagnosis

4 patient groups, total n = 14,888

Chloroquine alone, n = 1,868

Chloroquine with a macrolide, n = 3,783

Hydroxychloroquine alone n = 3,016

Hydroxychloroquine with a macrolide n = 6,221

Patients who received none of these treatments, n = 81,144

Excluded patients

Patients in whom treatments were started more than 48 hours after diagnosis

Patients on mechanical ventilation

Patients who received remdesivir

Findings

96 032 patients with COVID-19 were hospitalised during the study period and met the inclusion criteria.

Controlled for multiple confounding factors

Age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity

In hospital Mortality de-novo ventricular arrhythmia

Control group 9·3% 0.3%

Hydroxychloroquine 18·0% 6.1%

Hydroxychloroquine

with a macrolide 23·8% 8.1%

Chloroquine 16·4% 4.3%

Chloroquine

with a macrolide 22·2% 6.5%

Interpretation

Unable to confirm a benefit of hydroxychloroquine or chloroquine

Used alone or with a macrolide

Each of these drug regimens was associated with;

Decreased in-hospital survival, p less than 0·0001

Increased frequency of ventricular arrhythmias when used for treatment of COVID-19

Independent predictors of in-hospital mortality

Age

BMI

Black race or Hispanic ethnicity

Coronary artery disease

Congestive heart failure

History of arrhythmia

Diabetes

Hypertension

Hyperlipidaemia

COPD

Current smoker

Immunosuppressed condition

Associated with reduced in-hospital mortality risk

Female

Asian origin

ACE inhibitors (but not angiotensin receptor blockers)

Statins