Doxycycline and Hydroxychloroquine as Treatment for High-Risk COVID-19 Patients: Experience from Case Series of 54 Patients in Long-Term Care Facilities
MD, MPH, FCCP Imtiaz Ahmad, MD Mohammud Alam, MD, MPH Ryan Saadi, Saborny Mahmud, BS Emily Saadi
doi:10.1101/2020.05.18.20066902
Importance: Patients in long-term care facilities (LTCF) are at a high-risk of contracting COVID-19 due to advanced age and multiple comorbidities. Without effective treatments, outbreaks in such facilities will become commonplace and will result in severe morbidity and mortality. The effectiveness of doxycycline (DOXY) and hydroxychloroquine (HCQ) combination therapy in high risk COVID-19 patients in longterm care facilities is not yet understood. Objective: The goal of this analysis is to describe outcomes after use of DOXY-HCQ combination in high-risk COVID-19 patients in LTCF. Design: Case-series analysis. Setting: Three (3) LTCFs in New York. Participants: From March 19 to March 30, 2020, fifty-four (54) patients, residents of three (3) LTCFs in New York and diagnosed (confirmed or presumed) with COVID-19, were included in this analysis. Exposure: All patients who were diagnosed (confirmed or presumed) with COVID-19 received DOXY-HCQ combination therapy along with standard of care. Main Outcomes and Measures: Patients characteristics, clinical recovery, radiological improvements, medication side-effects, hospital transfer, and death were assessed as outcome measures. Results: A series of fifty-four (54) high-risk patients, who developed a sudden onset of fever, cough, and shortness of breath (SOB) and were diagnosed or presumed to have COVID-19, were started with a combination of DOXY-HCQ and 85% (n=46) patients showed clinical recovery defined as: resolution of .
So far, no study was published from the United States using HCQ alone or in combination with AZ or DOXY. As a matter of fact, this study is the first case series conducted globally using a combination of DOXY-HCQ in COVID-19 patients in nursing home settings. We treated our moderate to severe patients in out-of-hospital settings and prevented hospital transfer in the majority of patients. Naive Indirect Comparison showed a better outcome than the data reported in MMWR (reported on March 26, 2020) 17 from a long-term care facility in King County, Washington where 57% of patients were hospitalized and 22% patients died. This effect can possibly be explained by the anti-inflammatory mechanism of action of DOXY-HCQ. However, data from the LTCF from King County, Washington was found to be similar to our population. These data also showed a reduction of hospitalization by 44% among LTCF residents compared to previously reported data by similar populations in MMWR. A limitation of our case-series analysis is that there was no control population available.
Conclusion: DOXY and HCQ combination therapy is known to be anti-inflammatory, and immunomodulatory in both in-vitro and in-vivo studies. In addition, HCQ has anti-viral properties. Although this sample size is small (n=54), the results suggest that early intervention of DOXY-HCQ may improve the clinical outcome of high-risk COVID-19 patients suffering from moderate-severe symptoms in LTCF. These data is also associated with a..
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doi:10.1161/01.cir.0000089090.05757.34DOI record:
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"abstract": "<jats:title>Abstract</jats:title><jats:sec><jats:title>Importance</jats:title><jats:p>Patients in long-term care facilities (LTCF) are at a high-risk of contracting COVID-19 due to advanced age and multiple comorbidities. Without effective treatments, outbreaks in such facilities will become commonplace and will result in severe morbidity and mortality. The effectiveness of doxycycline (DOXY) and hydroxychloroquine (HCQ) combination therapy in high risk COVID-19 patients in longterm care facilities is not yet understood.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>The goal of this analysis is to describe outcomes after use of DOXY-HCQ combination in high-risk COVID-19 patients in LTCF.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Case-series analysis.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Three (3) LTCFs in New York.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>From March 19 to March 30, 2020, fifty-four (54) patients, residents of three (3) LTCFs in New York and diagnosed (confirmed or presumed) with COVID-19, were included in this analysis.</jats:p></jats:sec><jats:sec><jats:title>Exposure</jats:title><jats:p>All patients who were diagnosed (confirmed or presumed) with COVID-19 received DOXY-HCQ combination therapy along with standard of care.</jats:p></jats:sec><jats:sec><jats:title>Main Outcomes and Measures</jats:title><jats:p>Patients characteristics, clinical recovery, radiological improvements, medication side-effects, hospital transfer, and death were assessed as outcome measures.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A series of fifty-four (54) high-risk patients, who developed a sudden onset of fever, cough, and shortness of breath (SOB) and were diagnosed or presumed to have COVID-19, were started with a combination of DOXY-HCQ and 85% (n=46) patients showed clinical recovery defined as: resolution of fever and SOB, or a return to baseline setting if patients are ventilator-dependent. A total of 11% (n=6) patients were transferred to acute care hospitals due to clinical deterioration and 6% (n=3) patients died in the facilities. Naive Indirect Comparison suggests these data were significantly better outcomes than the data reported in MMWR (reported on March 26, 2020) from a long-term care facility in King County, Washington where 57% patients were hospitalized, and 22% patients died.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The clinical experience of this case series indicates DOXY-HCQ treatment in high-risk COVID-19 patients is associated with a reduction in clinical recovery, decreased transfer to hospital and decreased mortality were observed after treatment with DOXY-HCQ.</jats:p></jats:sec>",
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