The Effect of Hydroxychloroquine on In-Hospital Mortality in COVID-19
HCA Healthcare Journal of Medicine, doi:10.36518/2689-0216.1169
Background Hydroxychloroquine (HCQ) is an antimalarial medication that has been tested against various viral illnesses. The available evidence regarding the role of HCQ in the coronavirus disease 2019 (COVID-19) remains controversial.
Methods This is a comparative retrospective cohort study that aims to evaluate the efficacy and safety of HCQ in hospitalized patients with COVID-19. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included ICU admission rate, mechanical ventilation, prolonged length of stay (LOS), QTc prolongation and cardiac arrest.
Results A cohort of 175 hospitalized patients with COVID-19 were included with a median (interquartile range [IQR]) age of 66 [48-79] years. Of whom, 82 (47%) patients received HCQ. The overall mortality rate was 34.1%; 95% CI [23.7-44.6] and 16.1%; 95% CI [8.5-23.7] in the HCQ group vs. the control group, respectively (p = 0.67). A Cox regression analysis was performed adjusting for age, gender, BMI, SpO2/FiO2 ratio and CXR findings, and demonstrated that the association between HCQ use and the all-cause in-hospital mortality was not statistically significant (HR = 1.15; 95% CI [0.54-2.48]; p-value = 0.72). Patients who received HCQ were more likely to be admitted to the intensive care unit, require mechanical ventilation and have a prolonged LOS compared to those who did not receive the medication. No statistically significant difference was found in the likelihood of QTc prolongation or cardiac arrest.
Conclusions The use of HCQ in patients hospitalized with COVID-19 confers no benefit in patient morbidity or mortality.
Original Research The Effect of Hydroxychloroquine on In-Hospital Mortality in COVID-19
Conflicts of Interest The authors declare they have no conflicts of interest. The authors are employees of JFK Medical Center, a hospital affiliated with the journal's publisher. This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
Arshad, Kilgore, Chaudhry, Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19, Int J Infect Dis, doi:10.1016/j.ijid.2020.06.099
Bessière, Roccia, Delinière, Assessment of QT Intervals in a Case Series of Patients with Coronavirus Disease 2019 (COVID-19) Infection Treated with Hydroxychloroquine Alone or in Combination with Azithromycin in an Intensive Care Unit, JAMA Cardiol, doi:10.1001/jamacardio.2020.1787
Boulware, Pullen, Bangdiwala, A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19, N Engl J Med, doi:10.1056/nejmoa2016638
Gautret, Lagier, Parola, Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study, Travel Med Infect Dis, doi:10.1016/j.tmaid.2020.101663
Geleris, Sun, Platt, Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19, N Engl J Med, doi:10.1056/nejmoa2012410
Holshue, Debolt, Lindquist, First Case of 2019 Novel Coronavirus in the United States, N Engl J Med, doi:10.1056/nejmoa2001191
Liu, Cao, Xu, Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discov, doi:10.1038/s41421-020-0156-0
Maa, Targeting endosomal acidification by chloroquine analogs as a promising strategy for the treatment of emerging viral diseases, Pharmacol Res Perspect, doi:10.1002/prp2.293
Mahévas, Tran, Roumier, Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data, BMJ, doi:10.1136/bmj.m1844
Mehra, Ruschitzka, Patel, Retraction: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis [retraction of: Lancet, Lancet, doi:10.1016/s0140-6736(20)31324-6
Mercuro, Yen, Shim, Risk of QT Interval Prolongation Associated with Use of Hydroxychloroquine with or without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19), JAMA Cardiol, doi:10.1001/jamacardio.2020.1834
Million, Lagier, Gautret, Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. Travel Med Infect Dis, doi:10.1016/j.tmaid.2020.101738
Quan, Li, Couris, Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries, Am J Epidemiol, doi:10.1093/aje/kwq433
Recovery Collaborative Group, Horby, Lim, Dexamethasone in Hospitalized Patients with Covid-19: Preliminary Report
Rosenberg, Dufort, Udo, Association of Treatment with Hydroxychloroquine or Azithromycin with In-Hospital Mortality in Patients With COVID-19 in New York State, JAMA, doi:10.1001/jama.2020.8630
Seymour, Liu, Iwashyna, Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), JAMA, doi:10.1001/jama.2016.0288
Skipper, Pastick, Engen, Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19: A Randomized Trial, Ann Intern Med, doi:10.7326/m20-4207
Tang, Cao, Han, Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial, BMJ, doi:10.1136/bmj.m1849
Wang, Cao, Zhang, Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res, doi:10.1038/s41422-020-0282-0