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Impact of hydroxychloroquine on disease progression and ICU admissions in patients with SARS-CoV-2 infection

Awad et al., American Journal of Health-System Pharmacy, doi:10.1093/ajhp/zxab056
Feb 2021  
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Mortality -19% Improvement Relative Risk Ventilation -461% ICU admission -463% HCQ for COVID-19  Awad et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 336 patients in the USA Higher ventilation (p<0.0001) and ICU admission (p<0.0001) c19hcq.org Awad et al., American J. Health-System.., Feb 2021 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
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%).
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.
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.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Awad et al., 18 Feb 2021, retrospective, USA, peer-reviewed, 4 authors.
This PaperHCQAll
Impact of hydroxychloroquine on disease progression and ICU admissions in patients with SARS-CoV-2 infection
PharmD, BCPS Nirvana Awad, PharmD, FASHP Daryl S Schiller, PharmD, BCPS Magda Fulman, MD Azfar Chak
American Journal of Health-System Pharmacy, doi:10.1093/ajhp/zxab056
Purpose. To evaluate whether use of hydroxychloroquine was associated with a reduced likelihood of intensive care unit (ICU) admission in patients with coronavirus disease 2019 (COVID-19) in the early weeks of the pandemic. 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 (51-73) 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.
Disclosures The authors have declared no potential conflicts of interest. REVIEW & RECERTIFICATION REWARD PROGRAM The Right Course for Your Career Pay $0 for Enrollment and Exam Preparation Resources
References
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Late treatment
is less effective
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