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0 0.5 1 1.5 2+ Lack of improvement ≥1.. 37% Improvement Relative Risk Persistence ≥1 year 14% Presence of symptoms 19% HCQ  Ganesh et al.  LATE TREATMENT  DB RCT Is late treatment with HCQ beneficial for COVID-19? Double-blind RCT 179 patients in Canada No significant difference in outcomes seen Ganesh et al., CMAJ Open, July 2023 Favors HCQ Favors control

Patient-reported outcomes of neurologic and neuropsychiatric symptoms in mild COVID-19: a prospective cohort study

Ganesh et al., CMAJ Open, doi:10.9778/cmajo.20220248, NCT04329611
Jul 2023  
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Long term neurologic and neuropsychiatric followup for a 7 day delayed treatment RCT showing lower risk of symptoms with treatment, without statistical significance.
When a patient reported a symptom, they were asked whether they were still experiencing that symptom, and to choose between these three options when comparing the symptom to their pre-COVID-19 state: (1) “Yes, this problem remains the same”; (2) “Yes, but there’s been SOME improvement”; or (3) “No, this is back to normal”. The patient was classified as having “no improvement” at 1-year if they reported ≥1 symptom at both visits, for which they indicated that the problem remained the same at 1-year. Persistence refers to patients reporting ≥1 symptom that emerged post-COVID-19 and was still present at the time of assessment. For presence of symptoms, the patient reported ≥1 symptom that emerged with or after their COVID-19 infection at some point prior to the time of assessment.
lack of improvement ≥1 year, 37.0% lower, OR 0.63, p = 0.15, treatment 90, control 89, RR approximated with OR.
persistence ≥1 year, 14.0% lower, OR 0.86, p = 0.16, treatment 90, control 89, RR approximated with OR.
presence of symptoms, 19.0% lower, OR 0.81, p = 0.37, treatment 90, control 89, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ganesh et al., 31 Jul 2023, Double Blind Randomized Controlled Trial, placebo-controlled, Canada, peer-reviewed, median age 45.0, 14 authors, trial NCT04329611 (history).
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Patient-reported outcomes of neurologic and neuropsychiatric symptoms in mild COVID-19: a prospective cohort study
Aravind Ganesh, MSc Ryan E Rosentreter, Yushi Chen, MD Rahul Mehta, MD Graham A Mcleod, MD Miranda W Wan, MD Jonathan D Krett, MD Yasamin Mahjoub, MD Angela S Lee, MD Ilan S Schwartz, PhD Lawrence P Richer, MD MSc Luanne M Metz, MD Eric E Smith, MD MPH Michael D Hill
CMAJ Open, doi:10.9778/cmajo.20220248
here is growing appreciation that various neurologic and neuropsychiatric symptoms may be seen in patients with COVID-19. 1 Meta-analyses have shown a range of neurologic symptoms, including headache, myalgia and confusion, and rarer critical manifestations such as stroke and seizures, in one-third of patients admitted to hospital. 2,3 However, a major limitation to the generalizability of such frequency estimates is that published studies have generally included only patients admitted to hospital or those who were critically ill. 2, 4 Most patients with COVID-19 do not require hospital admission. The prevalence and spectrum of symptoms among communitydwelling patients with milder COVID-19 may be quite different.
Ethics approval The Conjoint Health Research Ethics Board of the University of Calgary approved the study (REB20-0790). Competing interests: Aravind Ganesh reports membership on the editorial boards of Neurology, Stroke and Neurology Clinical Practice; consulting fees and honoraria from Atheneum, MD Analytics, Figure 1 Funding: This work was supported by the Calgary Health Trust, the University of Calgary, Alberta Innovates, Alberta Health Services and the Government of Alberta. Hydroxychloroquine and matching placebo were provided by Apotex. The funders had no role in study design, interpretation or publication. Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: -nd/4.0/ Data sharing: Deidentified data are available on request to the corresponding author with an accompanying proposal and analysis plan. Supplemental information: For reviewer comments and the original submission of this manuscript, please see E696/suppl/DC1.
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Late treatment
is less effective
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