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0 0.5 1 1.5 2+ Median time to PCR- -22% Improvement Relative Risk HCQ for COVID-19  Choi et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 1,402 patients in South Korea Slower viral clearance with HCQ (p=0.0001) Choi et al., Int. J. Infectious Diseases, Oct 2020 Favors HCQ Favors control

Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

Choi et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.10.062
Oct 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.
Health insurance database analysis failing to adjust for disease severity and not finding a significant difference in time to PCR- for LPV/r and HCQ.
There are large differences in severity across groups. Authors did PSM but chose not to prioritize severity, resulting in incomparable groups, e.g., baseline pneumonia of 44% in the HCQ group and 15% in the control group (after PSM).
Authors note this but offer no explanation for not correcting for severity: "However, the disease severity and proportion of accompanying pneumonia were still significantly higher in the LPV/r and HCQ-group".
Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture. Porter show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.
This study is excluded in the after exclusion results of meta analysis: excessive unadjusted differences between groups.
median time to PCR-, 22.0% higher, relative time 1.22, p < 0.001, treatment 701, control 701.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Choi et al., 27 Oct 2020, retrospective, database analysis, South Korea, peer-reviewed, 8 authors.
This PaperHCQAll
Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study
Min Joo Choi, Minsun Kang, So Youn Shin, Ji Yun Noh, Hee Jin Cheong, Woo Joo Kim, Jaehun Jung, Joon Young Song
International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.10.062
We aimed to compare the antiviral effect of hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/r) in patients with COVID-19. Methods: Nationwide retrospective case-control study was conducted to compare the effect of HCQ and LPV/r on viral shedding duration among patients with mild-to-moderate COVID-19 using the reimbursement data of National Health Insurance Service. After propensity score matching (PSM), multivariate analysis was conducted to determine statistically significant risk factors associated with prolonged viral shedding. Results: Overall, 4197 patients with mild-to-moderate COVID-19 were included. Patients were categorized into three groups: LPV/r (n = 1268), HCQ (n = 801), and standard care without HCQ or LPV/r (controls, n = 2128). The median viral shedding duration was 23 (IQR 17-32), 23 , and 18 (IQR 12-25) days in the LPV/r, HCQ, and control groups, respectively. Even after PSM, the viral shedding duration was not significantly different between LPV/r and HCQ groups: 23 (IQR, 17-32) days versus 23 (IQR, 16-32) days. On multivariate analysis, old age, malignancy, steroid use, and concomitant pneumonia were statistically significant risk factors for prolonged viral shedding. Conclusion: The viral shedding duration was similar between HCQ and LPV/r treatment groups. There was no benefit in improving viral clearance compared to the control group.
Conflict of interest We declare no conflict of interest. Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi:
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Late treatment
is less effective
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