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0 0.5 1 1.5 2+ Mortality 18% Improvement Relative Risk Mortality (b) -9% ICU admission -9% ICU admission (b) -71% HCQ for COVID-19  Albani et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 816 patients in Italy Lower mortality with HCQ (not stat. sig., p=0.15) Albani et al., J, Clinical Medicine, Aug 2020 Favors HCQ Favors control

Impact of Azithromycin and/or Hydroxychloroquine on Hospital Mortality in COVID-19

Albani et al., J, Clinical Medicine, doi:10.3390/jcm9092800
Aug 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 421 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.
3,800+ studies for 60+ treatments.
Retrospective 1376 hospitalized patients in Italy, 211 treated with HCQ and 166 with HCQ+AZ.
Although the 18% lower mortality is not statistically significant, it is consistent with the significant 24% lower mortality [20‑29%] from meta analysis of the 249 mortality results to date.
This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication likely; substantial confounding by time likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically.
risk of death, 18.4% lower, RR 0.82, p = 0.15, treatment 60 of 211 (28.4%), control 172 of 605 (28.4%), adjusted per study, odds ratio converted to relative risk, HCQ vs. neither.
risk of death, 9.0% higher, RR 1.09, p = 0.54, treatment 60 of 211 (28.4%), control 172 of 605 (28.4%), adjusted per study, odds ratio converted to relative risk, HCQ+AZ vs. neither.
risk of ICU admission, 9.2% higher, RR 1.09, p = 0.70, treatment 73 of 211 (34.6%), control 46 of 605 (7.6%), adjusted per study, odds ratio converted to relative risk, HCQ vs. neither.
risk of ICU admission, 71.3% higher, RR 1.71, p < 0.001, treatment 73 of 211 (34.6%), control 46 of 605 (7.6%), adjusted per study, odds ratio converted to relative risk, HCQ+AZ vs. neither.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Albani et al., 30 Aug 2020, retrospective, Italy, peer-reviewed, 11 authors.
This PaperHCQAll
Impact of Azithromycin and/or Hydroxychloroquine on Hospital Mortality in COVID-19
Filippo Albani, Federica Fusina, Alessia Giovannini, Pierluigi Ferretti, Anna Granato, Chiara Prezioso, Danilo Divizia, Alessandra Sabaini, Marco Marri, Elena Malpetti, Giuseppe Natalini
Journal of Clinical Medicine, doi:10.3390/jcm9092800
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to widespread use of hydroxychloroquine and azithromycin despite the lack of conclusive evidence for their safety and efficacy. We evaluated the association between treatment with hydroxychloroquine and/or azithromycin and hospital mortality as the primary outcome. We compared the hospital mortality of patients treated with hydroxychloroquine alone, azithromycin alone, or their combination to the mortality of patients who received neither drug. A logistic multivariate model with overlap weight propensity score was used for estimation of odds ratios (ORs) with 95% confidence intervals (95% CIs). One thousand four hundred and three patients with SARS-CoV-2 infection were admitted to the hospital. At the time of the analysis, the outcome was available for 1376 (98%) of them. Five hundred and eighty-seven patients (42%) received azithromycin and 377 patients (27%) received hydroxychloroquine, alone or in combination. In-hospital mortality was 26%. After the adjusted analysis, azithromycin alone was associated with lower mortality (OR 0.60, 95% CI 0.42-0.85) compared to no treatment. Hydroxychloroquine alone (OR 0.76, 95% CI 0.53-1.08) and the combination of azithromycin and hydroxychloroquine (OR 1.13, 95% CI 0.77-1.69) were not associated with hospital mortality. In this cohort of patients, azithromycin alone was associated with lower hospital mortality but hydroxychloroquine was not associated with increased or reduced mortality. While we await randomized clinical trials, these data support the use of azithromycin in novel coronavirus disease 2019 (COVID-19) and can contribute to better understanding of its role in further meta-analyses.
Conflicts of Interest: The authors declare no conflict of interest.
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Late treatment
is less effective
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