Outcomes after early treatment with hydroxychloroquine and azithromycin: An analysis of a database of 30,423 COVID-19 patients
New Microbes and New Infections, doi:10.1016/j.nmni.2023.101188
Background: Many studies have evaluated the use of hydroxychloroquine in COVID-19. Most retrospective observational studies demonstrate a benefit of using HCQ on mortality, but not most randomized clinical trials. Methods: We analyzed raw data collected from a cohort of 30,423 patients with COVID-19 cared for at IHU Méditerranée Infection in Marseille France and extracted from the DRYAD open data platform. We performed univariate and multivariable logistic regressions with all-cause mortality within six weeks. Multivariable logistic regressions were adjusted for sex, age group (<50, 50-69, 70-89 and > 89 years), periods (or variants), and type of patient management. Results: Among 30,202 patients for whom information on treatment was available, 191/23,172 (0.82%) patients treated with HCQ-AZ died, compared to 344/7030 (4.89%) who did not receive treatment with HCQ-AZ. HCQ-AZ therapy was associated with a lower mortality than treatment without HCQ-AZ (odds ratio (OR) 0.16; 95% confidence interval (CI), 0.14-0.19). After adjustment for sex, age, period, and patient management, HCQ-AZ was associated with a significantly lower mortality rate (adjusted OR (aOR) 0.55, 95% CI 0.45-0.68). On a subsample of 21,664 patients with available variant information, results remained robust after adjustment on sex, age, patient management and variant (aOR 0.55; 95% CI 0.44-0.69). On a subsample of 16,063 patients, HCQ-AZ was still associated with a significantly lower mortality rate (aOR 0.47, 95%CI 0.29-0.75) after adjustment for sex, age, period, patient management, vaccination status and comorbidities. Conclusion: Analysis of this large online database showed that HCQ-AZ was consistently associated with the lowest mortality.
Transparency declaration DR (the guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies in the study as planned (and, if relevant, registered) have been explained.
Declaration of competing interest The authors have completed the Unified Competing Interest form (available on request from the corresponding author). DR declares grants, contracts, royalties and/or licenses from Hitachi High-Technologies Corporation, Tokyo, Japan. DR is a scientific board member of Eurofins. DR is founder and shareholder of four startups, none which have yet generated an income: a microbial culture company (Culture Top), two biotechnology companies (Techno-Jouvence and Gene and Green TK), and a rapid diagnosis of infectious diseases company (Pocramé). PB, MM and PMC declare no support from any organization for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.
Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi. org/10.1016/j.nmni.2023.101188.
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