Dr John Campbell
@campbellteaching·3.3M subscribers·3.1K videos
Hydroxychloroquine as a therapeutic
Posted
November 11, 2020
Views
58,857
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2,330
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November 11, 2020
58,857
2,330
1,257
6.09%
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19:57Now PlayingBackground
Hydroxychloroquine has been widely promoted as a potential therapy
Anti-inflammatory, reduced production of pro-inflammatory cytokines
Antiviral activity
Ionophore for zinc
Invitro reduced viral entry into cells
Adopted into routine care for hospitalized adults with COVID-19
UK recovery trial, (5th June, 2020)
)304604/fulltext
11,000 patients from 175 NHS hospitals in the UK
No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19
WHO Solidarity trial
December 2019 to April 2020, 96,000 patients
Showed an increased risk of dying in hospital and de novo ventricular arrhythmia
800 mg BD for one day
then
400 mg BD for 10 days
Total of 22 doses
Previous video on Hydroxychloroquine
Does Hydroxychloroquine work (10th May, 2020)
Hydroxychloroquine, Studies (27th May, 2020)
Hydroxychloroquine, evidence of efficacy (27th August 2020)
Pandemic Science, Reinfections and hydroxychloroquine (28th August, 2020)
Effect of Hydroxychloroquine on Clinical Status at 14 Days in Hospitalized Patients With COVID-19
JAMA, 9th November
Multicenter, blinded, placebo-controlled randomized trial
Conducted at 34 hospitals in the US
Adults hospitalized with respiratory symptoms
Severe acute respiratory syndrome
April 2 and June 19, 2020
Trial was stopped at the fourth interim analysis for futility with a sample size of 479 patients
Interventions group, n = 242
Hydroxychloroquine
400 mg twice daily for 2 doses
then 200 mg twice daily for 8 doses
A total of 10 doses over 5 days
Placebo group n = 237
Given placebo meds
Outcomes and Measures
The primary outcome was clinical status 14 days after randomization
Assessed with a 7-category ordinal scale
Ranging from 1 (death) to 7 (discharged able to do normal duties)
1, death
2, hospitalized, receiving extracorporeal membrane oxygenation (ECMO) or invasive mechanical ventilation
3, hospitalized, receiving noninvasive mechanical ventilation or nasal high-flow oxygen therapy
4, hospitalized, receiving supplemental oxygen without positive pressure or high flow
5, hospitalized, not receiving supplemental oxygen
6, not hospitalized and unable to perform normal activities
7, not hospitalized and able to perform normal activities
Also 12 secondary outcomes, including 28-day mortality.
Participants
Female, 44.3%
Hispanic/Latinx, 23.4%
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Black, 20.1%
Receiving supplemental oxygen, 46.8%
Oxygen with pressure,11.5%
Invasive mechanical ventilation, 6.7%
Median duration of symptoms prior to randomization was 5 days
Result
Clinical status on the ordinal outcome scale at 14 days did not significantly differ between the hydroxychloroquine and placebo groups
aOR, 1.02
None of the 12 secondary outcomes were significantly different between groups
At 28 days after randomization
Hydroxychloroquine group
25 of 241 patients (10.4%) had died
Placebo group
25 of 236 (10.6%) had died
aOR, 1.07
Conclusions and Relevance
Among adults hospitalized with respiratory illness from COVID-19
Hydroxychloroquine, did not significantly improve clinical status at day 14 or reduce deaths at 28 days
These findings do not support the use of hydroxychloroquine for treatment of COVID-19 among hospitalized adults.
