Impact of Azithromycin and/or Hydroxychloroquine on Hospital Mortality in COVID-19
Albani et al.
, Impact of Azithromycin and/or Hydroxychloroquine on Hospital Mortality in COVID-19
, J, Clinical Medicine, doi:10.3390/jcm9092800
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 22% lower mortality [18‑27%]
from meta analysis of the 232 mortality results to date
This study is excluded in the after exclusion results of meta
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.
Abstract: Journal of
Impact of Azithromycin and/or Hydroxychloroquine
on Hospital Mortality in COVID-19
Filippo Albani 1, * , Federica Fusina 1 , Alessia Giovannini 1 , Pierluigi Ferretti 1 ,
Anna Granato 1 , Chiara Prezioso 1,2 , Danilo Divizia 1 , Alessandra Sabaini 1 , Marco Marri 3 ,
Elena Malpetti 1 and Giuseppe Natalini 1
Department of Anesthesia, Intensive Care and Pain Medicine, Fondazione Poliambulanza Istituto
Ospedaliero, 25124 Brescia, Italy; email@example.com (F.F.); firstname.lastname@example.org (A.G.);
email@example.com (P.F.); firstname.lastname@example.org (A.G.);
email@example.com (C.P.); firstname.lastname@example.org (D.D.);
email@example.com (A.S.); firstname.lastname@example.org (E.M.);
Department of Intensive Care Medicine and Anaesthesiology, Fondazione Policlinico Universitario
A. Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Department of Information and Communications Technology, Fondazione Poliambulanza Istituto
Ospedaliero, 25124 Brescia, Italy; email@example.com
Received: 26 July 2020; Accepted: 27 August 2020; Published: 30 August 2020
Abstract: 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.
Keywords: azithromycin; hydroxychloroquine; SARS-CoV-2
is less effective
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