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0 0.5 1 1.5 2+ Mortality -22% Improvement Relative Risk Mortality (b) -21% Ventilation -55% Ventilation (b) -33% HCQ for COVID-19  Gerlovin et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 1,199 patients in the USA Higher ventilation with HCQ (p=0.02) Gerlovin et al., American J. Epidemiol.., Jun 2021 Favors HCQ Favors control

Pharmacoepidemiology, Machine Learning and COVID-19: An intent-to-treat analysis of hydroxychloroquine, with or without azithromycin, and COVID-19 outcomes amongst hospitalized US Veterans

Gerlovin et al., American Journal of Epidemiology, doi:10.1093/aje/kwab183
Jun 2021  
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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.
Retrospective 1,769 hospitalized patients in the USA showing no significant differences for HCQ, and higher intubation for HCQ+AZ.
risk of death, 22.0% higher, HR 1.22, p = 0.18, treatment 90 of 429 (21.0%), control 141 of 770 (18.3%), adjusted per study, HCQ+AZ.
risk of death, 21.0% higher, HR 1.21, p = 0.33, treatment 49 of 228 (21.5%), control 141 of 770 (18.3%), adjusted per study, HCQ.
risk of mechanical ventilation, 55.0% higher, HR 1.55, p = 0.02, treatment 64 of 429 (14.9%), control 69 of 770 (9.0%), adjusted per study, HCQ+AZ.
risk of mechanical ventilation, 33.0% higher, HR 1.33, p = 0.25, treatment 32 of 228 (14.0%), control 69 of 770 (9.0%), adjusted per study, HCQ.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gerlovin et al., 24 Jun 2021, retrospective, USA, peer-reviewed, 21 authors.
This PaperHCQAll
Pharmacoepidemiology, Machine Learning, and COVID-19: An Intent-to-Treat Analysis of Hydroxychloroquine, With or Without Azithromycin, and COVID-19 Outcomes Among Hospitalized US Veterans
Dr Hanna Gerlovin, Daniel C Posner, Yuk-Lam Ho, Christopher T Rentsch, Janet P Tate, Joseph T King Jr, Katherine E Kurgansky, Ioana Danciu, Lauren Costa, Franciel A Linares, Ian D Goethert, Daniel A Jacobson, Matthew S Freiberg, Edmon Begoli, Sumitra Muralidhar, Rachel B Ramoni, Georgia Tourassi, J Michael Gaziano, Amy C Justice, David R Gagnon, Kelly Cho
American Journal of Epidemiology, doi:10.1093/aje/kwab183
Hydroxychloroquine (HCQ) was proposed as an early therapy for coronavirus disease 2019 (COVID-19) after in vitro studies indicated possible benefit. Previous in vivo observational studies have presented conf licting results, though recent randomized clinical trials have reported no benefit from HCQ among patients hospitalized with COVID-19. We examined the effects of HCQ alone and in combination with azithromycin in a hospitalized population of US veterans with COVID-19, using a propensity score-adjusted survival analysis with imputation of missing data. According to electronic health record data from the US Department of Veterans Affairs health care system, 64,055 US Veterans were tested for the virus that causes COVID-19 between March 1, 2020 and April 30, 2020. Of the 7,193 veterans who tested positive, 2,809 were hospitalized, and 657 individuals were prescribed HCQ within the first 48-hours of hospitalization for the treatment of COVID-19. There was no apparent benefit associated with HCQ receipt, alone or in combination with azithromycin, and there was an increased risk of intubation when HCQ was used in combination with azithromycin (hazard ratio = 1.55; 95% confidence interval: 1.07, 2.24). In conclusion, we assessed the effectiveness of HCQ with or without azithromycin in treatment of patients hospitalized with COVID-19, using a national sample of the US veteran population. Using rigorous study design and analytic methods to reduce confounding and bias, we found no evidence of a survival benefit from the administration of HCQ.
Hydroxychloroquine and Azithromycin for COVID-19 2417 Conflict of interest: none declared.
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Late treatment
is less effective
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