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0 0.5 1 1.5 2+ Mortality 4% Improvement Relative Risk Mortality (b) -21% HCQ for COVID-19  Annie et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 734 patients in the USA No significant difference in mortality Annie et al., Pharmacotherapy, October 2020 Favors HCQ Favors control

Hydroxychloroquine in hospitalized COVID-19 patients: Real world experience assessing mortality

Annie et al., Pharmacotherapy, doi:10.1002/phar.2467
Oct 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 422 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.
4,000+ studies for 60+ treatments.
Retrospective database analysis with PSM not including COVID-19 severity, finding mortality OR 0.95 [0.62-1.46] for HCQ, and 1.24 [0.70-2.22] for HCQ+AZ. Confounding by indication likely.
This study is excluded in the after exclusion results of meta analysis: confounding by indication is likely and adjustments do not consider COVID-19 severity at baseline.
risk of death, 4.3% lower, RR 0.96, p = 0.83, treatment 48 of 367 (13.1%), control 50 of 367 (13.6%), NNT 183, odds ratio converted to relative risk.
risk of death, 20.5% higher, RR 1.21, p = 0.46, treatment 29 of 199 (14.6%), control 24 of 199 (12.1%), odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Annie et al., 12 Oct 2020, retrospective, database analysis, USA, peer-reviewed, 5 authors.
This PaperHCQAll
Hydroxychloroquine in Hospitalized Patients with COVID‐19: Real‐World Experience Assessing Mortality
Frank H Annie, Cristian Sirbu, Keely R Frazier, Mike Broce, B Daniel Lucas
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, doi:10.1002/phar.2467
INTRODUCTION Hydroxychloroquine (HCQ) for coronavirus disease 2019 (COVID-19) is presently being used off-label or within a clinical trial. OBJECTIVES We investigated a multinational database of patients with COVID-19 with real-world data containing outcomes and their relationship to HCQ use. The primary outcome was all-cause mortality within 30 days of follow-up. METHODS This was a retrospective cohort study of patients receiving HCQ within 48 hours of hospital admission. Medications, preexisting conditions, clinical measures on admission, and outcomes were recorded. RESULTS Among patients with a diagnosis of COVID-19 in our propensity-matched cohort, the mean ages AE SD were 62.3 AE 15.9 years (53.7% male) and 61.9 AE 16.0 years (53.0% male) in the HCQ and no-HCQ groups, respectively. There was no difference in overall 30-day mortality between the HCQ and no-HCQ groups (HCQ 13.1%, n=367; no HCQ 13.6%, n=367; odds ratio 0.95, 95% confidence interval 0.62-1.46) after propensity matching. Although statistically insignificant, the HCQazithromycin (AZ) group had an overall mortality rate of 14.6% (n=199) compared with propensitymatched no-HCQ-AZ cohort's rate of 12.1% (n=199, OR 1.24, 95% CI 0.70-2.22). Importantly, however, there was no trend in this cohort's overall mortality/arrhythmogenesis outcome (HCQ-AZ 17.1%, no HCQ-no AZ 17.1%; OR 1.0, 95% CI 0.6-1.7). CONCLUSIONS We report from a large retrospective multinational database analysis of COVID-19 outcomes with HCQ and overall mortality in hospitalized patients. There was no statistically significant increase in mortality and mortality-arrhythmia with HCQ or HCQ-AZ.
Supporting Information The following supporting information is available in the online version of this paper:
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Late treatment
is less effective
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