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0 0.5 1 1.5 2+ Mortality 42% Improvement Relative Risk Treatment escalation 6% Viral+ at day 7 15% HCQ for COVID-19  Lecronier et al.  ICU PATIENTS Is very late treatment with HCQ beneficial for COVID-19? Retrospective 80 patients in France Lower mortality with HCQ (not stat. sig., p=0.24) Lecronier et al., Critical Care, 2020, Jul 2020 Favors HCQ Favors control

Comparison of hydroxychloroquine, lopinavir/ritonavir, and standard of care in critically ill patients with SARS-CoV-2 pneumonia: an opportunistic retrospective analysis

Lecronier et al., Critical Care, 24:418, 2020, doi:10.1186/s13054-020-03117-9
Jul 2020  
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Retrospective 80 ICU patients, 22 SOC, 20 lopinavir/ritonavir, 38 HCQ. 28 day mortality 24% (HCQ) versus 41% (SOC), a 41% decrease, but not statistically significant due to very small sample sizes. No statistically significant differences found for treatment escalation, ventilator-free days, viral load, or mortality. Authors consider treatment escalation more important than mortality, for unknown reasons.
This study is excluded in the after exclusion results of meta analysis: very late stage, >50% on oxygen/ventilation at baseline.
risk of death, 42.0% lower, RR 0.58, p = 0.24, treatment 9 of 38 (23.7%), control 9 of 22 (40.9%), NNT 5.8.
risk of treatment escalation, 6.0% lower, RR 0.94, p = 0.73, treatment 15 of 38 (39.5%), control 9 of 22 (40.9%), NNT 70.
risk of viral+ at day 7, 15.0% lower, RR 0.85, p = 0.61, treatment 19 of 26 (73.1%), control 12 of 14 (85.7%), NNT 7.9.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lecronier et al., 11 Jul 2020, retrospective, France, peer-reviewed, baseline oxygen required 100.0%, 25 authors, HCQ vs. control.
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Comparison of hydroxychloroquine, lopinavir/ritonavir, and standard of care in critically ill patients with SARS-CoV-2 pneumonia: an opportunistic retrospective analysis
Marie Lecronier, Alexandra Beurton, Sonia Burrel, Luc Haudebourg, Robin Deleris, Julien Le Marec, Sara Virolle, Safaa Nemlaghi, Côme Bureau, Pierre Mora, Martin De Sarcus, Olivier Clovet, Baptiste Duceau, Paul Henri Grisot, Marie Hélène Pari, Jérémy Arzoine, Ulrich Clarac, David Boutolleau, Mathieu Raux, Julie Delemazure, Morgane Faure, Maxens Decavele, Elise Morawiec, Julien Mayaux, Alexandre Demoule, Martin Dres
Critical Care, doi:10.1186/s13054-020-03117-9
Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak is spreading worldwide. To date, no specific treatment has convincingly demonstrated its efficacy. Hydroxychloroquine and lopinavir/ ritonavir have potential interest, but virological and clinical data are scarce, especially in critically ill patients. Methods: The present report took the opportunity of compassionate use and successive drug shortages to compare the effects of two therapeutic options, lopinavir/ritonavir and hydroxychloroquine, as compared to standard of care only. The primary outcomes were treatment escalation (intubation, extra-corporeal membrane oxygenation support, or renal replacement therapy) after day 1 until day 28. Secondary outcomes included ventilator-free days at day 28, mortality at day 14 and day 28, treatment safety issues and changes in respiratory tracts, and plasma viral load (as estimated by cycle threshold value) between admission and day 7.
Abbreviations ICU: Intensive care unit; SAPS II: Simplified Acute Physiology Score II; SOFA: Sequential Organ Failure Assessment; SARS-CoV-2: Severe acute respiratory syndrome coronavirus-2; ECMO: Extra-corporeal membrane oxygenation; IQR: Interquartile range; CT: Cycle threshold; RT-PCR: Reverse transcription polymerase chain reaction Authors' contributions ML, LH, RD, and AB collected the patient's data. ML and MD analyzed the patient's data and have written the manuscript. All authors contributed to drafting the manuscript or critically revising it for important intellectual content and approved the final version of the manuscript. Funding None Ethics approval and consent to participate The Research Ethics Committee of Sorbonne University approved the project (CER 2020-36). Oral information about this retrospective analysis was given to patients or relatives. Consent for publication Not applicable Competing interests Martin Dres received fees from Lungpacer (expertise, lectures). A Demoule reports personal fees from Medtronic; grants, personal fees, and non-financial support from Philips; personal fees from Baxter; personal fees from Hamilton; personal fees and non-financial support from Fisher & Paykel; grants from French Ministry of Health; personal fees from Getinge; grants and personal fees from Respinor; and grants and non-financial support from Lungpacer, outside the submitted work. The other authors have no conflicts of interest to declare. Author..
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Late treatment
is less effective
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