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0 0.5 1 1.5 2+ Mortality 79% Improvement Relative Risk Hospitalization 82% HCQ for COVID-19  Derwand et al.  EARLY TREATMENT Is early treatment with HCQ + AZ and zinc beneficial for COVID-19? Retrospective 518 patients in the USA Lower hospitalization with HCQ + AZ and zinc (p=0.001) Derwand et al., Int. J. Antimicrobial .., Jul 2020 Favors HCQ Favors control

COVID-19 Outpatients – Early Risk-Stratified Treatment with Zinc Plus Low Dose Hydroxychloroquine and Azithromycin: A Retrospective Case Series Study

Derwand et al., International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106214 (date from preprint)
Jul 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.
79% lower mortality and 82% lower hospitalization with early HCQ+AZ+Z. No cardiac side effects. Retrospective 518 patients (141 treated, 377 control).
Study covers zinc and HCQ.
risk of death, 79.4% lower, RR 0.21, p = 0.12, treatment 1 of 141 (0.7%), control 13 of 377 (3.4%), NNT 37, odds ratio converted to relative risk.
risk of hospitalization, 81.6% lower, RR 0.18, p < 0.001, treatment 4 of 141 (2.8%), control 58 of 377 (15.4%), NNT 8.0, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Derwand et al., 3 Jul 2020, retrospective, USA, peer-reviewed, 3 authors, average treatment delay 4.0 days, dosage 200mg bid days 1-5, this trial uses multiple treatments in the treatment arm (combined with AZ and zinc) - results of individual treatments may vary.
This PaperHCQAll
COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study
Roland Derwand, Martin Scholz, Vladimir Zelenko
International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106214
The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3-6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40-67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer ( P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06-0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03-1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.
Competing interests RD is/was at the time of writing an employee of Alexion Pharma Germany GmbH, and his engagement and contribution to this study and publication was private and independent from his employer; MS is/was at the time of writing External Senior Advisor for the company LEUKOCARE (Munich, Germany) and is/was Manging Director at Starts-and -Ups Consulting (Frankfurt, Germany); VZ is/was a general practitioner in New York State (USA). Ethical approval This study was approved by the Western Institutional Review Board and was exempt under 45 CFR § 46.104(d)(4). Ref. Number: D4-Excemption-Zelenko (06-16-2020).
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