Effect of combination therapy of hydroxychloroquine and azithromycin on mortality in COVID-19 patients

DOI record: { "DOI": "10.1111/cts.12860", "ISSN": [ "1752-8054", "1752-8062" ], "URL": "http://dx.doi.org/10.1111/cts.12860", "abstract": "<jats:p>Conflicting evidence regarding the use of hydroxychloroquine (HCQ) and azithromycin for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection do exist. We performed a retrospective single‐center cohort study including 377 consecutive patients admitted for pneumonia related to coronavirus disease 2019 (COVID‐19). Of these, 297 were in combination treatment, 17 were on HCQ alone, and 63 did not receive either of these 2 drugs because of contraindications. The primary end point was in‐hospital death. Mean age was 71.8 ± 13.4 years and 34.2% were women. We recorded 146 deaths: 35 in no treatment, 7 in HCQ treatment group, and 102 in HCQ + azithromycin treatment group (log rank test for Kaplan–Meier curve <jats:italic>P</jats:italic> &lt; 0.001). At multivariable Cox proportional hazard regression analysis, age (hazard ratio (HR) 1.057, 95% confidence interval (CI) 1.035–1.079, <jats:italic>P</jats:italic> &lt; 0.001), mechanical ventilation/continuous positive airway pressure (HR 2.726, 95% CI 1.823–4.074, <jats:italic>P</jats:italic> &lt; 0.001), and C reactive protein above the median (HR 2.191, 95% CI 1.479–3.246, <jats:italic>P</jats:italic> &lt; 0.001) were directly associated with death, whereas use of HCQ + azithromycin (vs. no treatment; HR 0.265, 95% CI 0.171–0.412, <jats:italic>P</jats:italic> &lt; 0.001) was inversely associated. In this study, we found a reduced in‐hospital mortality in patients treated with a combination of HCQ and azithromycin after adjustment for comorbidities. A large randomized trial is necessary to confirm these findings.</jats:p>", "alternative-id": [ "10.1111/cts.12860" ], "assertion": [ { "group": { "label": "Publication History", "name": "publication_history" }, "label": "Received", "name": "received", "order": 0, "value": "2020-06-23" }, { "group": { "label": "Publication History", "name": "publication_history" }, "label": "Accepted", "name": "accepted", "order": 1, "value": "2020-07-13" }, { "group": { "label": "Publication History", "name": "publication_history" }, "label": "Published", "name": "published", "order": 2, "value": "2020-10-13" } ], "author": [ { "affiliation": [ { "name": "Infectious Disease Department Policlinico di Monza Monza Italy" } ], "family": "Lauriola", "given": "Marinella", "sequence": "first" }, { "affiliation": [ { "name": "Department of Oncology and Hemato‐Oncology Università degli Studi di Milano Milan Italy" } ], "family": "Pani", "given": "Arianna", "sequence": "additional" }, { "affiliation": [ { "name": "Internal Medicine Department Policlinico di Monza Monza Italy" } ], "family": "Ippoliti", "given": "Giovanbattista", "sequence": "additional" }, { "affiliation": [ { "name": "Cardiology Department Policlinico di Monza Monza Italy" } ], "family": "Mortara", "given": "Andrea", "sequence": "additional" }, { "affiliation": [ { "name": "Internal Medicine Department Policlinico di Monza Monza Italy" } ], "family": "Milighetti", "given": "Stefano", "sequence": "additional" }, { "affiliation": [ { "name": "Internal Medicine Department Policlinico di Monza Monza Italy" } ], "family": "Mazen", "given": "Marjieh", "sequence": "additional" }, { "affiliation": [ { "name": "Internal Medicine Department Policlinico di Monza Monza Italy" }, { "name": "Department of Medicine and Surgery Università degli Studi di Milano Bicocca Milan Italy" } ], "family": "Perseghin", "given": "Gianluca", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Clinical, Internal, Anesthesiologic, and Cardiovascular Sciences Sapienza University of Rome Rome Italy" } ], "family": "Pastori", "given": "Daniele", "sequence": "additional" }, { "affiliation": [ { "name": "Intensive Care Unit Policlinico di Monza Monza Italy" } ], "family": "Grosso", "given": "Paolo", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Oncology and Hemato‐Oncology Università degli Studi di Milano Milan Italy" } ], "family": "Scaglione", "given": "Francesco", "sequence": "additional" } ], "container-title": "Clinical and Translational Science", "container-title-short": "Clinical Translational Sci", "content-domain": { "crossmark-restriction": true, "domain": [ "ascpt.onlinelibrary.wiley.com" ] }, "created": { "date-parts": [ [ 2020, 9, 16 ] ], "date-time": "2020-09-16T07:33:36Z", "timestamp": 1600241616000 }, "deposited": { "date-parts": [ [ 2023, 9, 4 ] ], "date-time": "2023-09-04T09:28:23Z", "timestamp": 1693819703000 }, "indexed": { "date-parts": [ [ 2024, 3, 24 ] ], "date-time": "2024-03-24T02:01:13Z", "timestamp": 1711245673219 }, "is-referenced-by-count": 34, "issue": "6", "issued": { "date-parts": [ [ 2020, 10, 13 ] ] }, "journal-issue": { "issue": "6", "published-print": { "date-parts": [ [ 2020, 11 ] ] } }, "language": "en", "license": [ { "URL": "http://creativecommons.org/licenses/by-nc/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2020, 10, 13 ] ], "date-time": "2020-10-13T00:00:00Z", "timestamp": 1602547200000 } } ], "link": [ { "URL": "https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fcts.12860", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/cts.12860", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://onlinelibrary.wiley.com/doi/full-xml/10.1111/cts.12860", "content-type": "application/xml", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://ascpt.onlinelibrary.wiley.com/doi/pdf/10.1111/cts.12860", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "311", "original-title": [], "page": "1071-1076", "prefix": "10.1111", "published": { "date-parts": [ [ 2020, 10, 13 ] ] }, "published-online": { "date-parts": [ [ 2020, 10, 13 ] ] }, "published-print": { "date-parts": [ [ 2020, 11 ] ] }, "publisher": "Wiley", "reference": [ { "DOI": "10.1056/NEJMoa2001282", "doi-asserted-by": "publisher", "key": "e_1_2_8_1_1" }, { "article-title": "Remdesivir for the treatment of Covid‐19 ‐ preliminary report", "author": "Beigel J.H.", "journal-title": "N. 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