Treatment with hydroxychloroquine vs nitazoxanide in patients with COVID-19: brief report

Calderón et al., PAMJ - Clinical Medicine, doi:10.11604/pamj-cm.2021.7.15.30981, Nov 2021

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HCQ for COVID-19

1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 423 studies, used in 59 countries.

Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine treatments.

5,700+ studies for 169 treatments. c19hcq.org

Planned RCT of HCQ vs. HCQ+nitazoxanide which was aborted due to the retracted Surgisphere paper. Authors retrospectively analyze a small set of HCQ vs. nitazoxanide patients (which were protocol deviations in the planned RCT), showing reduced hospitalization time and ICU admission with nitazoxanide.

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Study covers HCQ and nitazoxanide.

risk of death, 214.8% higher, RR 3.15, p = 0.38, treatment 5 of 27 (18.5%), control 1 of 17 (5.9%).

risk of mechanical ventilation, 651.9% higher, RR 7.52, p = 0.15, treatment 4 of 27 (14.8%), control 0 of 17 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm).

risk of ICU admission, 145.5% higher, RR 2.45, p < 0.001, treatment 16 of 27 (59.3%), control 0 of 17 (0.0%), adjusted per study, inverted to make RR<1 favor treatment.

hospitalization time, 107.4% higher, relative time 2.07, p = 0.006, treatment 27, control 17.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Calderón et al., 23 Nov 2021, retrospective, Mexico, peer-reviewed, 7 authors, dosage 200mg bid days 1-7.

This Paper HCQ All

Treatment with hydroxychloroquine vs nitazoxanide in patients with COVID-19: brief report

José Meneses Calderón, Srivatsan Padmanabhan, Fernando Manuel, Carranza Salazar, David Californias Hernández, Alfredo Israel Díaz Martínez, César Humberto, Botello Ortiz, Hugo Mendieta Zerón, Fernando Manuel Carranza Salazar, César Humberto Botello Ortiz, Hugo Mendieta Zéron

doi:10.11604/pamj-cm.2021.7.15.30981

Introduction: coronavirus pandemic has led to 1.8 million deaths worldwide as of May 1 st , 2021. Nitazoxanide (NTZ) is currently being studied in several ambulatory clinical trials to control viral infections including SARS-CoV-2. This study evaluates the effect of treatment with NTZ compared to Hydroxychloroquine (HCQ) in hospitalized patients. Methods: in this clinical study performed from May to August 2020, two groups of COVID-19 patients were compared: A) a control group treated with HCQ 200 mg PO twice a day for seven days and B) an experimental group treated with NTZ 500 mg PO every 6 hours for seven days. Student's t-test between the two groups and Relative Risk (RR) with a 95% confidence interval (CI), were calculated. In all cases a P<0.05 was considered statistically significant. Results: twenty-seven ( 27 ) patients (females 17, males 10) treated with HCQ and 17 patients (females 8, males 9) administered NTZ were included in the study (mean age 44.6 ± 14.4 years old). At the moment of hospital admission, the following variables were statistically significant: BMI (P=0.0225) and leucocyte counts (P=0.069). In the follow-up period, the statistically significant variables were hospital length of stay (P=0.003257) and Intensive Care Units (ICU) admission with a lower RR in the group taking NTZ vs HCQ of 0.4074 (95% CI: 0.2451 to 0.5927, attributable risk (P1 -P2): 0.5926, P≤0.0001, NNT: 1.688). Conclusion: in comparison to HCQ, NTZ significantly reduces the risk to be hospitalized in the ICU and this approach could be replicated easily in any hospital.

Competing interests The authors declare no competing interests. Authors' contributions

References

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Late treatment
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