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0 0.5 1 1.5 2+ Mortality 17% Improvement Relative Risk Death/intubation -75% HCQ for COVID-19  Abdulrahman et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? PSM retrospective 446 patients in Bahrain Higher death/intubation with HCQ (not stat. sig., p=0.24) Abdulrahman et al., medRxiv, November 2020 Favors HCQ Favors control

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

Abdulrahman et al., medRxiv, doi:10.1101/2020.11.25.20234914
Nov 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 422 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Retrospective analysis of acute care patients in Bahrain not showing a significant effect of HCQ. Confounding by indication is likely. Matching appears not to have matched for baseline severity. 17.5% of HCQ patients required oxygen while only 12.6% of control patients did.
Although the 17% lower mortality is not statistically significant, it is consistent with the significant 25% lower mortality [20‑29%] from meta analysis of the 250 mortality results to date.
risk of death, 16.7% lower, RR 0.83, p = 1.00, treatment 5 of 223 (2.2%), control 6 of 223 (2.7%), NNT 223, PSM.
risk of death/intubation, 75.0% higher, RR 1.75, p = 0.24, treatment 12 of 223 (5.4%), control 7 of 223 (3.1%), adjusted per study, PSM.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Abdulrahman et al., 30 Nov 2020, retrospective, propensity score matching, Bahrain, preprint, 9 authors.
This PaperHCQAll
The efficacy and safety of hydroxychloroquine in COVID19 patients : a multicenter national retrospective cohort
Abdulkarim Abdulrahman, Islam Alsayed, Marwa Almadhi, Jumana Alarayed, Sara Jaafar Mohammed, Aesha Khalid Sharif, Khadija Alansari, Abdulla I Alawadhi, Manaf Alqahtani
Background Hydroxychloroquine 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. Methodology We 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. Results A 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). Conclusion Our 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.
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Late treatment
is less effective
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