Impact of hydroxychloroquine on disease progression and ICU admissions in patients with SARS-CoV-2 infection
Awad et al.,
Impact of hydroxychloroquine on disease progression and ICU admissions in patients with SARS-CoV-2 infection,
American Journal of Health-System Pharmacy, doi:10.1093/ajhp/zxab056
This paper has inconsistent values - the number of treatment and control patients differs in the text and Table 1, we have used treatment 188 and control 148. Retrospective 336 hospitalized patients in the USA showing higher mortality, ICU admission, and intubation with treatment.
Confounding by indication is likely. Time varying confounding is also likely due to declining usage over the early period when overall treatment protocols were also improving dramatically. Authors and reviewers appear to be unfamiliar with either of these.
This study is excluded in the after exclusion results of meta
analysis:
substantial
confounding by time likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically; substantial unadjusted
confounding by indication likely.
risk of death, 19.1% higher, RR 1.19, p = 0.60, treatment 56 of 188 (29.8%), control 37 of 148 (25.0%).
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risk of mechanical ventilation, 460.7% higher, RR 5.61, p < 0.001, treatment 64 of 188 (34.0%), control 9 of 148 (6.1%), adjusted per study, odds ratio converted to relative risk.
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risk of ICU admission, 463.4% higher, RR 5.63, p < 0.001, treatment 67 of 188 (35.6%), control 9 of 148 (6.1%), adjusted per study, odds ratio converted to relative risk.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Awad et al., 18 Feb 2021, retrospective, USA, peer-reviewed, 4 authors.
Abstract: CLINICAL REPORT
Impact of hydroxychloroquine on disease progression
and ICU admissions in patients with SARS-CoV-2
infection
Nirvana Awad, PharmD, BCPS,
Montefiore Nyack Hospital, Nyack, NY,
USA
Daryl S. Schiller, PharmD, FASHP,
BCPS-AQ ID, Montefiore Nyack
Hospital, Nyack, NY, USA
Azfar Chak, MD, Montefiore Nyack
Hospital, Nyack, NY, USA
Methods. A retrospective, observational cohort study was conducted to
determine selected treatment outcomes in 336 patients hospitalized with
COVID-19 at an acute care community hospital in the Hudson Valley region
of New York from March 20 to April 20, 2020. Eligibility included admission
to the hospital, a laboratory-confirmed diagnosis of SARS-CoV-2 infection, and no need for intubation or intensive care at admission. The median
(interquartile range) ages of patients who received hydroxychloroquine
(n = 188) and those who did not (n = 148) were 68 (58-82) and 64 (5173) years, respectively. In a multivariable model that included age, gender, obesity, diabetes, and hydroxychloroquine use, patients who received
hydroxychloroquine were significantly more likely than those not treated
with the drug to be transferred to an ICU (odds ratio, [OR], 8.1; 95% confidence interval [CI]: 3.8-17) and significantly more likely to be intubated
(OR, 7.99; 95% CI, 3.76-16.91); these associations were not influenced
by disease severity. In-hospital mortality did not differ significantly with
disease severity between those who did and those who did not receive
hydroxychloroquine.
Conclusion. Hydroxychloroquine use was significantly associated with
increased risks of ICU admission and intubation in patients with mild,
moderate, and severe symptoms of COVID-19. There were no significant between-group differences in mortality with use vs nonuse of
hydroxychloroquine.
Keywords: coronavirus, hydroxychloroquine, infection
Am J Health-Syst Pharm. 2021;78:689-696
C
Address correspondence to Dr. Awad
(awadn@montefiorenyack.org).
Published by Oxford University Press
on behalf of the American Society of
Health-System Pharmacists 2021. This
work is written by (a) US Government
employee(s) and is in the public domain
in the US.
DOI 10.1093/ajhp/zxab056
oronavirus disease 2019 (COVID19) caused by severe acute respiratory syndrome-coronavirus 2
(SARS-CoV-2) has been characterized as a global pandemic, with a current case-fatality rate of 2.2% in the
United States alone.1 In New York State,
COVID-19 had resulted in over 33,000
deaths as of November 17, 2020—the
largest COVID-19 mortality burden
in the nation.2 The illness course has
been variable and unpredictable, as
many patients infected with SARSCoV-2 remain asymptomatic or have
AM J HEALTH-SYST PHARM
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mild symptoms, while others progress to developing severe pneumonia
requiring mechanical ventilation.
Therapeutic agents under investigation
target different phases of COVID-19,
including acute viral illness and pulmonary and proinflammatory phases.
Due to the rapid spread and progression of COVID-19, effective treatments
are desperately needed.
Numerous medications, including
hydroxychloroquine, have been used
to treat COVID-19 because of their antiviral and anti-inflammatory properties.
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April 15, 2021 689
Magda Fulman, PharmD, BCPS,
Montefiore Nyack Hospital, Nyack, NY,
USA
Purpose. To evaluate whether use of hydroxychloroquine was..
Late treatment
is less effective
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