Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients with COVID-19: A Nationwide Observational Study of 8075 Participants
et al., Int. J. Antimicrobial Agents,
Retrospective 8,075 hospitalized patients, 4,542 low-dose HCQ, 3,533 control. 35% lower mortality for HCQ (17.7% vs. 27.1%), adjusted HR 0.68 [0.62–0.76]. Low-dose HCQ monotherapy was independently associated with lower mortality in hospitalized patients.
Patients exposed to others therapies (TCZ, AZ, LPV/RTV) were excluded.
Statistical analysis was performed by an independent group. Calendar time of prescription and immortal time bias
was taken into account. Corticosteroids prescriptions was low in both groups.
risk of death, 32.0% lower, HR 0.68, p < 0.001, treatment 804 of 4,542 (17.7%), control 957 of 3,533 (27.1%), NNT 11.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Catteau et al., 24 Aug 2020, retrospective, database analysis, Belgium, peer-reviewed, 11 authors, average treatment delay 5.0 days.
Abstract: International Journal of Antimicrobial Agents 56 (2020) 106144
Contents lists available at ScienceDirect
International Journal of Antimicrobial Agents
journal homepage: www.elsevier.com/locate/ijantimicag
Low-dose hydroxychloroquine therapy and mortality in hospitalised
patients with COVID-19: a nationwide observational study of 8075
Lucy Catteau a,1, Nicolas Dauby b,c,d,1,∗, Marion Montourcy a, Emmanuel Bottieau e,
Joris Hautekiet a,f, Els Goetghebeur f, Sabrina van Ierssel g, Els Duysburgh a, Herman Van
Oyen a,h, Chloé Wyndham-Thomas a, Dominique Van Beckhoven a , Belgian Collaborative
Group on COVID-19 Hospital Surveillance2
Department of Epidemiology and public health, Sciensano, Brussels, Belgium
Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium
Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Brussels, Belgium
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp (UZA), Edegem, Belgium
Public Health and Primary Care, Gent University, Gent, Belgium
a r t i c l e
i n f o
a b s t r a c t
Hydroxychloroquine (HCQ) has been largely used and investigated as therapy for COVID-19 across various settings at a total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of
low-dose HCQ (total 2400 mg over 5 days) was recommended for hospitalised patients with COVID-19.
We conducted a retrospective analysis of in-hospital mortality in the Belgian national COVID-19 hospital
surveillance data. Patients treated either with HCQ monotherapy and supportive care (HCQ group) were
compared with patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors. Of 8075 patients with complete discharge data on 24 May 2020
and diagnosed before 1 May 2020, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ
group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable
analysis, mortality was lower in the HCQ group compared with the no-HCQ group [adjusted hazard ratio
(aHR) = 0.684, 95% conﬁdence interval (CI) 0.617–0.758]. Compared with the no-HCQ group, mortality
in the HCQ group was reduced both in patients diagnosed ≤5 days (n = 3975) and >5 days (n = 3487)
after symptom onset [aHR = 0.701 (95% CI 0.617–0.796) and aHR = 0.647 (95% CI 0.525–0.797), respectively]. Compared with supportive care only, low-dose HCQ monotherapy was independently associated
with lower mortality in hospitalised patients with COVID-19 diagnosed and treated early or later after
© 2020 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.
is less effective
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