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0 0.5 1 1.5 2+ Mortality 32% Improvement Relative Risk HCQ for COVID-19  Catteau et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 8,075 patients in Belgium Lower mortality with HCQ (p<0.000001) Catteau et al., Int. J. Antimicrobial .., Aug 2020 Favors HCQ Favors control

Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients with COVID-19: A Nationwide Observational Study of 8075 Participants

Catteau et al., Int. J. Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106144
Aug 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 421 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
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.
This PaperHCQAll
Abstract: International Journal of Antimicrobial Agents 56 (2020) 106144 Contents lists available at ScienceDirect International Journal of Antimicrobial Agents journal homepage: Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants 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 a Department of Epidemiology and public health, Sciensano, Brussels, Belgium Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium c Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium d Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Brussels, Belgium e Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium f Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium g Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp (UZA), Edegem, Belgium h Public Health and Primary Care, Gent University, Gent, Belgium b a r t i c l e Keywords: Hydroxychloroquine COVID-19 SARS-CoV-2 Mortality Observational study 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 symptom onset. © 2020 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.
Late treatment
is less effective
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