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0 0.5 1 1.5 2+ Mortality 12% Improvement Relative Risk Mortality (b) 86% Mortality (c) -557% Hospitalization 12% Case -14% HCQ for COVID-19  Gentry et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 10,948 patients in the USA (March - September 2020) Study underpowered for serious outcomes Gentry et al., The American J. the Med.., Sep 2022 Favors HCQ Favors control

Development of SARS-CoV-2 infection in patients with rheumatic conditions on hydroxychloroquine monotherapy vs. patients without rheumatic conditions: a retrospective, propensity-matched cohort study

Gentry et al., The American Journal of the Medical Sciences, doi:10.1016/j.amjms.2022.08.006
Sep 2022  
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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.
Updated version of Gentry showing no significant difference in outcomes with HCQ use. The previous version is more informative because authors previously analyzed rheumatic disease patients, while they now compare rheumatic disease patients with non-rheumatic disease patients. Systemic autoimmune disease patients have very different baseline risk for COVID-19, for example Ferri et al. show OR 4.42, p<0.001 Ferri. In Table 3, the counts and the odds ratio do not match for ICU admission. 13 variables were statistically significantly different after PSM. There was no inpatient mortality with HCQ, compared to 3 deaths without HCQ. Outpatient deaths may be more likely to be due to other causes, as most COVID-19 patients in the US are hospitalized before death.
This study is excluded in meta analysis: patients in this study are a subset of those in a larger study; not adjusting for the different baseline risk of systemic autoimmune patients.
risk of death, 12.0% lower, RR 0.88, p = 0.99, treatment 3 of 41 (7.3%), control 3 of 36 (8.3%), NNT 98, odds ratio converted to relative risk, COVID-19 mortality.
risk of death, 85.7% lower, RR 0.14, p = 0.99, treatment 0 of 6 (0.0%), control 3 of 6 (50.0%), NNT 2.0, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), COVID-19 mortality - inpatients.
risk of death, 557.1% higher, RR 6.57, p = 0.99, treatment 3 of 35 (8.6%), control 0 of 30 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm), COVID-19 mortality - outpatients.
risk of hospitalization, 12.2% lower, RR 0.88, p = 0.81, treatment 6 of 41 (14.6%), control 6 of 36 (16.7%), NNT 49, COVID-19 hospitalization.
risk of case, 13.9% higher, RR 1.14, p = 0.57, treatment 41 of 5,474 (0.7%), control 36 of 5,474 (0.7%), odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gentry et al., 11 Sep 2022, retrospective, USA, peer-reviewed, 6 authors, study period 1 March, 2020 - 30 September, 2020. Contact:
This PaperHCQAll
Development of SARS-CoV-2 infection in patients with rheumatic conditions on hydroxychloroquine monotherapy vs. patients without rheumatic conditions: A retrospective, propensity-matched cohort study
PharmD, BCPS Chris A Gentry, MD Sharanjeet K Thind, PharmD, BCPS Riley J Williams II, PharmD, BCPS Sage C Hendrickson, BCPS George Kurdgelashvili, MD, FACP Mary Beth Humphrey
The American Journal of the Medical Sciences, doi:10.1016/j.amjms.2022.08.006
Development of SARS-CoV-2 infection in patients with rheumatic conditions on hydroxychloroquine monotherapy vs. patients without rheumatic conditions: a retrospective, propensity-matched cohort study,
Abella, Jolkovsky, Biney, Uspal, Hyman et al., Efficacy and safety of hydroxychloroquine vs placebo for pre-exposure SARS-CoV-2 prophylaxis among health care workers, JAMA Intern Med, doi:10.1001/jamainternmed.2020.6319
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Goa, Yang, Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies, Biosci Trends, doi:10.5582/bst.2020.01047
Kashour, Riaz, Garbati, Aldosary, Tlayjeh et al., Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis, J Antimicrob Chemother, doi:10.1093/jac/dkaa403
Lai, Shih, Ko, Tang, Hsueh, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges, Int J Antimicrobe Agents, doi:10.1016/j.ijantimicag.2020.105924
Mahevas, Tran, Roumier, Chabrol, Paule et al., Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data, BMJ, doi:10.1136/bmj.m1844
Mitja, Corbacho-Monne, Ubals, Alemany, Suner et al., A cluster-randomized trial of hydroxychloroquine for prevention of Covid-19, N Engl J Med, doi:10.1056/NEJMoa2021801
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Rajasingham, Bangdiwala, Nicol, Skipper, Pastick et al., Hydroxychloroquine as pre-exposure prophylaxis for COVID-19 in healthcare workers: a randomized trial, Clin Infect Dis, doi:10.1093/cid/ciaa1571
Rosenberg, Dufort, Udo, Wilberschied, Kumar et al., Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State, JAMA, doi:10.1001/jama.2020.8630
Thorpe, Hydroxychloroquine as postexposure prophylaxis to prevent severe acute respiratory syndrome coronavirus 2 infection, Ann Intern Med, doi:10.7326/M20-6519
Wang, Cao, Zhang, Yang, Liu et al., Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res, doi:10.1038/s41422-020-0282-0
Yao, Ye, Zhang, Cui, Huang et al., In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), Clin Infect Dis, doi:10.1093/cid/ciaa237
Zhao, Zhang, Zheng, Tai, Simpson et al., Serious cardiovascular adverse events associated with hydroxychloroquine/chloroquine alone or with azithromycin in patients with COVID-19: a pharmacovigilance analysis of the FDA adverse event reporting system (FAERS)
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