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0 0.5 1 1.5 2+ Mortality 9% Improvement Relative Risk ICU admission -20% Hospitalization time 12% no CI HCQ for COVID-19  Lamback et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 193 patients in Brazil No significant difference in outcomes seen Lamback et al., The Brazilian J. Infec.., Feb 2021 Favors HCQ Favors control

Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19

Lamback et al., The Brazilian Journal of Infectious Diseases, doi:10.1016/j.bjid.2021.101549
Feb 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 193 hospitalized patients in Brazil not finding a significant difference with HCQ.
The control group was composed of patients refusing HCQ or with contraindications. Time based confounding is very likely because HCQ became more controversial in Brazil over the time covered (Mar - Jun 2020), while overall treatment protocols during this period improved dramatically, i.e., more control patients (those refusing HCQ) likely come later in the period when treatment protocols were greatly improved.
The paper does not mention the word "confounding" or make any adjustments.
This study is excluded in the after exclusion results of meta analysis: substantial confounding by time likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically.
risk of death, 8.9% lower, RR 0.91, p = 0.83, treatment 11 of 101 (10.9%), control 11 of 92 (12.0%), NNT 94.
risk of ICU admission, 19.9% higher, RR 1.20, p = 0.61, treatment 25 of 101 (24.8%), control 19 of 92 (20.7%).
hospitalization time, 12.5% lower, relative time 0.88, treatment 101, control 92.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lamback et al., 19 Feb 2021, retrospective, Brazil, peer-reviewed, 10 authors.
This PaperHCQAll
Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19
Elisa Baranski Lamback, Monica Amorim De Oliveira, Andrea Ferreira Haddad, André Filipe Marcondes Vieira, Armando Leão Ferreira Neto, Taciana Da Silva Maia, Juliana De Rezende Chrisman, Pedro Pimenta De Mello Spineti, Marco Antonio De Mattos, Eduardo Costa
The Brazilian Journal of Infectious Diseases, doi:10.1016/j.bjid.2021.101549
Objectives: To assess the efficacy of hydroxychloroquine in combination with azithromycin in terms of clinical and biochemical outcomes in adult patients with COVID-19 hospitalized for acute respiratory distress syndrome (ARDS), and to describe the occurrence of adverse events. Method: Retrospective comparative study, based in a quaternary private hospital in Rio de Janeiro, Brazil, involving 193 adult patients hospitalized for mild and moderate COVID-19 related ARSD, analyzing treatment efficacy based on clinical and biochemical outcomes. Results: The active group comprised 101 (52.3%) patients using hydroxychloroquine associated with azithromycin and the control group 92 (47.7%) patients who did not take these medications. Median age was 59 (47-70) in the active group and 65 (47−77) in the control group (p < 0.05). Patients in the control group had greater extent of pulmonary involvement on baseline chest CT scans (p < 0.05). All other baseline variables (BMI, comorbidities, previous use of medications and biochemical assessments) were similar between groups. In the medication group, 25% (25 out of 101) were admitted to the ICU, compared to 21% (19 out of 92) in the control group (p > 0.05). No difference in mortality, duration of non-invasive oxygen use or duration of hospitalization was seen between groups. The therapeutic regimen was well tolerated, with only eight (7.9%) patients presenting gastrointestinal symptoms and eight (7.9%) patients withdrawn treatment due to QTc prolongation. Conclusions: Patients treated with hydroxychloroquine combined with azithromycin and the control group had similar clinical outcomes. This therapeutic regimen was considered
Conflict of interest The authors declare no conflicts of interest.
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Ldh, lactate dehydrogenase
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Late treatment
is less effective
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