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0 0.5 1 1.5 2+ Mortality 74% Improvement Relative Risk HCQ for COVID-19  Lauriola et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 360 patients in Italy Lower mortality with HCQ (p=0.001) Lauriola et al., Clinical and Translat.., Sep 2020 Favors HCQ Favors control

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

Lauriola et al., Clinical and Translational Science, doi:10.1111/cts.12860
Sep 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 422 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.
4,000+ studies for 60+ treatments.
Retrospective 377 patients, 73% reduction in mortality with HCQ+AZ, adjusted hazard ratio HR 0.27 [0.17-0.41]. Mean age 71.8. No serious adverse events. Subject to incomplete adjustment for confounders.
risk of death, 73.5% lower, HR 0.27, p < 0.001, treatment 102 of 297 (34.3%), control 35 of 63 (55.6%), NNT 4.7, adjusted per study.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lauriola et al., 14 Sep 2020, retrospective, Italy, peer-reviewed, mean age 71.8, 10 authors.
This PaperHCQAll
Effect of Combination Therapy of Hydroxychloroquine and Azithromycin on Mortality in Patients With COVID‐19
Marinella Lauriola, Arianna Pani, Giovanbattista Ippoliti, Andrea Mortara, Stefano Milighetti, Marjieh Mazen, Gianluca Perseghin, Daniele Pastori, Paolo Grosso, Francesco Scaglione
Clinical and Translational Science, doi:10.1111/cts.12860
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 P < 0.001). At multivariable Cox proportional hazard regression analysis, age (hazard ratio (HR) 1.057, 95% confidence interval (CI) 1.035-1.079, P < 0.001), mechanical ventilation/continuous positive airway pressure (HR 2.726, 95% CI 1.823-4.074, P < 0.001), and C reactive protein above the median (HR 2.191, 95% CI 1.479-3.246, P < 0.001) were directly associated with death, whereas use of HCQ + azithromycin (vs. no treatment; HR 0.265, 95% CI 0.171-0.412, P < 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.
Conflict of Interest. All authors declared no competing interests for this work. Author Contributions. M.L., A.P., G.I., A.M., S.M., M.M., G.P., D.P., P.G., and F.S. wrote the manuscript. A.P., F.S., and M.L. designed the research. D.P. analyzed the data.
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Late treatment
is less effective
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