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0 0.5 1 1.5 2+ Time to viral clearance 3% Improvement Relative Risk HCQ for COVID-19  An et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 226 patients in South Korea No significant difference in viral clearance An et al., medRxiv, July 2020 Favors HCQ Favors control

Treatment Response to Hydroxychloroquine and Antibiotics for mild to moderate COVID-19: a retrospective cohort study from South Korea

Jul 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 of hospitalized patients with 31 HCQ patients and 195 standard treatment patients, not showing a significant difference in terms of viral clearance or recovery. There was no mortality in either group.
"It is notable that HQ plus antibiotics group had worse baseline clinical profiles (i.e. higher percentage of moderate severity patients, more patients with fever >=37.5C, higher average body temperature) and prognostic indicators such as age, LDH, lymphocyte count, and CRP".
We note that propensity score matching removed almost all of the male patients in the control group (40% -> 5%) but increased the percentage of male patients in the treatment group. This provides a large advantage to the control group because there is a very large difference in severity and mortality based on gender
In terms of viral RNA clearance we note that other research has found that "active viral replication drops quickly after the first week, and viable virus was not found after the second week of illness despite the persistence of PCR detection of RNA”
Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture. Porter show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.
time to viral clearance, 3.0% lower, HR 0.97, p = 0.92, treatment 31, control 195.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
An et al., 7 Jul 2020, retrospective, South Korea, preprint, 12 authors.
This PaperHCQAll
Treatment Response to Hydroxychloroquine and Antibiotics for mild to moderate COVID-19: a retrospective cohort study from South Korea
Min Ho An, MD Min Seo Kim, MD Yu-Kyung Park, MD, PhD Bong-Ok Kim, MD Seok Ho Kang, PhD Won Jun Kim, MD Sung Kyu Park, MD, PhD Hea-Woon Park, MD Wonjong Yang, MD Joonyoung Jang, MD, KMD Soon-Woo Jang, DSS, PhD Tae-Ho Hwang
Objectives: To assess the efficacy of hydroxychloroquine on mild-moderate COVID-19 patients in South Korea. Methods: A retrospective cohort study of the 358 laboratory-confirmed SARS-CoV-2 (COVID-19) patients was conducted. 226 patients met inclusion criteria for analysis. Propensity score matching (PSM) and Cox regression method were utilized to control and adjust for confounding factors. Mild to moderate COVID-19 patients were managed with hydroxychloroquine (HQ) plus antibiotics (n = 31) or conservative treatment (n = 195). Results: Kaplan-Meier curves drawn using propensity score-matched data revealed no differences between the length of time to viral clearance and duration of hospital stay between the two treatment arms (p=0.18, p=0.088). Multivariable Cox regression analysis similarly showed that time to viral clearance(Hazard ratio (HR) 0.97, [95%-confidence interval (CI): 0.57-1.67]) and symptom duration(HR 1.05, [95%-CI: 0.62-1.78]) were not different between groups. No severe adverse event or death was observed in either group. Conclusions: HQ with antibiotics was not associated with better clinical outcomes in terms of time to viral clearance, length of hospital stay, and duration of symptoms compared to conservative treatment alone. Large prospective randomized trials are necessary for definitive conclusions.
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Late treatment
is less effective
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