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0 0.5 1 1.5 2+ Mortality 68% Improvement Relative Risk HCQ for COVID-19  Ashraf et al.  EARLY TREATMENT Is early treatment with HCQ beneficial for COVID-19? Retrospective 100 patients in Iran Lower mortality with HCQ (not stat. sig., p=0.15) Ashraf et al., medRxiv doi:10.1101/202.., Apr 2020 Favors HCQ Favors control

COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes

Ashraf et al., medRxiv doi:10.1101/2020.04.20.20072421.t
Apr 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.
Small limited trial with 100 patients concluding that HCQ improved clinical outcome, OR 0.016 [0.002-0.11] in regression analysis.
risk of death, 67.5% lower, RR 0.32, p = 0.15, treatment 10 of 77 (13.0%), control 2 of 5 (40.0%), NNT 3.7.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ashraf et al., 24 Apr 2020, retrospective, database analysis, Iran, preprint, median age 58.0, 16 authors, dosage 200mg bid daily, 400mg qd was used when combined with Lopinavir-Ritonavir.
This PaperHCQAll
COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes
Mohammad Ali Ashraf, Nasim Shokouhi, Elham Shirali, Fateme Davari-Tanha, Omeed Memar, Alireza Kamalipour, Ayein Azarnoush, Avin Mabadi, Adele Ossareh, Milad Sanginabadi, Talat Mokhtari Azad, Leila Aghaghazvini, Sara Ghaderkhani, Tahereh Poordast, Alieh Pourdast, Pershang Nazemi
Background There is a growing need for information regarding the recent coronavirus disease of 2019 . We present a comprehensive report of Covid-19 patients in Iran. Methods One hundred hospitalized patients with Covid-19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and post-discharge follow-up were analyzed. Results The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated Creactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), lymphocytopenia (74.2 %) on admission. Lower lobes of the lung were most commonly involved, and ground-glass opacity (81.8%) was the most frequent finding in CT scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom relapse, (8.6%) were readmitted to the hospital, and 3 patients (4.3%) died. Conclusions This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with Covid-19. The most common presenting symptoms are non-specific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom relapse.
Competing interests. The authors declare that they have no competing interests. Authors' contributions. MS and LA interpreted the data regarding radiologic findings in this study. SA, TP, AP, and PN made substantial contributions in the designing and the concept of the study. AA, AM, and AS had contribution in acquisition and analysis of the data. TMA had a role in writing the manuscript and interpretation the data regarding the PCR confirmation of the patients. MA had major contribution in interpretation of data and writing the main manuscript. OM and AK had substantially revised the manuscript. NS, ES, FD had major roles in acquisition and interpretation regarding lab findings and post-discharge follow-up data. Every author thoroughly read the entire manuscript and checked for the accuracy of the data, protocol method, and analysis. mild, moderate, and severe disease was as below according to the national guideline: Patients with a flu-like syndrome with/without fever, who did not have any signs of infiltration in lung imaging were classified as having mild disease. The moderate group was defined as symptomatic patients with pulmonary infiltration or at least one of the admission criteria, as explained in the figure. The severe group constituted patients who have at least one of the following criteria: 1. Reduced consciousness; 2. Respiratory rate (RR) ≥30; 3. Blood pressure (BP)BP<90/60; 4. Multi lobular infiltration; 5. Hypoxemia. Supplementary Files
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