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0 0.5 1 1.5 2+ Mortality 26% Improvement Relative Risk Mortality, early 2020 28% Mortality, late 2020 -10% Delgado et al. HCQ for COVID-19 LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 9,638 patients in the USA (March - December 2020) Lower mortality with HCQ (p=0.0025) Delgado et al., Research Square, doi:10.21203/ Favors HCQ Favors control
Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the “fail-and-learn” strategy during the first two waves of the pandemic in 2020
Delgado et al., Research Square, doi:10.21203/ (Preprint)
Delgado et al., Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the.., Research Square, doi:10.21203/ (Preprint)
Feb 2023   Source   PDF  
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PSM retrospective 9,638 patients in the USA, showing significantly lower mortality with HCQ in early 2020 (1,157 HCQ patients), and no significant difference in late 2020 (82 HCQ patients). The few patients treated in the later period may be in more serious condition due to the effort required to overcome the politicization and censorship in the study country. Authors refer to their result as "no relevant benefit in mortality between the two surges".
risk of death, 26.0% lower, OR 0.74, p = 0.002, treatment 1,239, control 8,399, both periods combined, RR approximated with OR.
risk of death, 28.0% lower, OR 0.72, p = 0.001, treatment 1,157, control 2,064, early 2020, propensity score matching, RR approximated with OR.
risk of death, 10.0% higher, OR 1.10, p = 0.82, treatment 82, control 6,335, late 2020, propensity score matching, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Delgado et al., 20 Feb 2023, retrospective, USA, preprint, 7 authors, study period 1 March, 2020 - 31 December, 2020.
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Abstract: Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the “fail-and-learn” strategy during the first two waves of the pandemic in 2020 Adam C. Delgado Sky Ridge Medical Center Brendon Cornett HCA Healthcare Continental Division Ye Ji Choi HCA Healthcare Continental Division Christina Colosimo Sky Ridge Medical Center Vincent P. Stahel University of Colorado Oliwier Dziadkowiec HCA Healthcare Continental Division Philip F. Stahel (  ) East Carolina University Research Article Keywords: COVID-19, corticosteroids, remdesivir, azithromycin, hydroxychloroquine, tocilizumab, mechanical ventilation, mortality Posted Date: February 20th, 2023 DOI: License:   This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/14 Abstract Background: The early surge of the novel coronavirus disease 2019 (COVID-19) pandemic introduced a significant clinical challenge due to the high case-fatality rate in absence of evidence-based treatment recommendations. The empirical modalities were relegated to historical expertise from the traditional management of acute respiratory distress syndrome (ARDS) in conjunction with off-label pharmaceutical agents endorsed under the “emergency use authorization” paradigm by regulatory agencies. This study was designed to evaluate the insights from the “fail-and-learn” strategy in 2020 before the availability of COVID-19 vaccines and access to reliable insights from high-quality randomized controlled trials. Methods: A retrospective, multicenter, propensity-matched, case-control study was performed on a data registry comprising 186 hospitals from a national health care system in the United States, designed to investigate the efficacy of empirical treatment modalities during the early surge of the COVID-19 pandemic in 2020. Reflective of the time-windows of the initial two surges of the pandemic in 2020, patients were stratified into “early” (March 1–June 30) versus “late” (July 1–December 31) study cohorts. Logistic regression was applied to determine the efficacy of prevalent medications (remdesivir, azithromycin, hydroxychloroquine, corticosteroids, tocilizumab) and supplemental oxygen delivery modalities (invasive vs. non-invasive ventilation) on patient outcomes. The primary outcome measure was in-hospital mortality. Group comparisons were adjusted for covariates related to age, gender, ethnicity, body weight, comorbidities, and treatment modalities pertinent to organ failure replacement. Results: From a total of 87,788 patients in the multicenter data registry screened in this study, 9,638 patients were included who received 19,763 COVID-19 medications during the first two waves of the 2020 pandemic.The results showed inconclusive variable results pertinent to the impact of empirical medications on patient outcomes. In contrast, the necessity for oxygen supply showed significantly increased odds of mortality beyond the effect of the investigational medications. Of all the covariates associated with increased mortality, invasive mechanical ventilation had the highest odds ratios of 8.34 in the first surge and 9.46 in in the second surge of the pandemic (P<0.01). Conclusion: This retrospective multicenter observational cohort study on 9,638 hospitalized patients with severe COVID-19 during revealed that the necessity for invasive ventilation had the highest odds of..
Late treatment
is less effective
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