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0 0.5 1 1.5 2+ Median time to PCR- -22% Improvement Relative Risk Choi et al. HCQ for COVID-19 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, doi:10.1016/j.ijid.2020.10.062 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
Choi et al., Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus.., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.10.062
Oct 2020   Source   PDF  
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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". 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.
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Abstract: International Journal of Infectious Diseases 102 (2021) 275–281 Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage: 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 Choia , Minsun Kangb , So Youn Shina , Ji Yun Nohc , Hee Jin Cheongc, Woo Joo Kimc , Jaehun Jungb,d,**, Joon Young Songc,* a Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea c Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea d Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea b A R T I C L E I N F O A B S T R A C T Article history: Received 9 September 2020 Received in revised form 18 October 2020 Accepted 22 October 2020 Objectives: 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 (IQR 16–32), 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. © 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( Keywords: COVID-19 SARS-CoV-2 Hydroxychloroquine Lopinavir Ritonavir
Late treatment
is less effective
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