Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19
Magagnoli et al.,
Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19,
Med (2020), doi:10.1016/j.medj.2020.06.001 (date from earlier preprint)
Retrospective 807 hospitalized patients, no statistically significant reduction in mortality or the need for mechanical ventilation with HCQ or HCQ+AZ, or for death with HCQ+AZ, HR 1.83,
p=0.009 for HCQ mortality.
The preprint notes that HCQ was more likely to be prescribed to patients with more severe disease, however this was deleted in the published version.
425 patients had dispositions of death or discharge by the end of the study period and thus did not encounter the issue of length-biased sampling and differential rates of right-censored observations among the groups.
Also see:
[mediterranee-infection.com]
risk of death, 11.0% lower, HR 0.89, p = 0.74, treatment 39 of 148 (26.4%), control 18 of 163 (11.0%), adjusted per study, HCQ+AZ w/dispositions.
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risk of death, 1.0% lower, HR 0.99, p = 0.98, treatment 30 of 114 (26.3%), control 18 of 163 (11.0%), adjusted per study, HCQ w/dispositions.
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risk of death, 31.0% higher, HR 1.31, p = 0.28, treatment 49 of 214 (22.9%), control 37 of 395 (9.4%), adjusted per study, HCQ+AZ.
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risk of death, 83.0% higher, HR 1.83, p = 0.009, treatment 38 of 198 (19.2%), control 37 of 395 (9.4%), adjusted per study, HCQ.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Magagnoli et al., 21 Apr 2020, retrospective, database analysis, USA, peer-reviewed, 7 authors.
Abstract: ll
Clinical Advances
Outcomes of Hydroxychloroquine Usage in
United States Veterans Hospitalized with
COVID-19
Joseph Magagnoli, Siddharth
Narendran, Felipe Pereira,
Tammy H. Cummings, James W.
Hardin, S. Scott Sutton,
Jayakrishna Ambati
sutton@cop.sc.edu (S.S.S.)
ja9qr@virginia.edu (J.A.)
HIGHLIGHTS
Hydroxychloroquine (HC) use did
not reduce the risk of ventilation
or death
HC with azithromycin (AZ) did not
reduce the risk of ventilation or
death
HC, with or without AZ, was
associated with longer length of
hospital stay
In this nationwide retrospective analysis of 807 patients hospitalized with COVID19, Magagnoli et al. report that, after adjusting for several COVID-19-relevant
clinical and demographic characteristics, hydroxychloroquine use, with or without
azithromycin, did not improve mortality or reduce the need for mechanical
ventilation compared to no hydroxychloroquine use.
Magagnoli et al., Med 1, 1–14
November 1, 2020 ª 2020 Elsevier Inc.
https://doi.org/10.1016/j.medj.2020.06.001
Please cite this article in press as: Magagnoli et al., Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID19, Med (2020), https://doi.org/10.1016/j.medj.2020.06.001
ll
Clinical Advances
Outcomes of Hydroxychloroquine Usage in United
States Veterans Hospitalized with COVID-19
Joseph Magagnoli,1,2,8 Siddharth Narendran,4,5,8 Felipe Pereira,4,5,8 Tammy H. Cummings,1,2
James W. Hardin,1,3 S. Scott Sutton,1,2,* and Jayakrishna Ambati4,5,6,7,9,*
SUMMARY
Context and Significance
Background: Despite limited and conflicting evidence, hydroxychloroquine, alone or in combination with azithromycin, is widely used in
COVID-19 therapy.
Methods: We performed a retrospective study of electronic health records of patients hospitalized with confirmed SARS-CoV-2 infection in
US Veterans Health Administration medical centers between March 9,
2020 and April 29, 2020. Patients hospitalized within 24 h of diagnosis
were classified based on their exposure to hydroxychloroquine alone
(HC) or with azithromycin (HC+AZ) or no HC as treatments. The primary
outcomes were mortality and use of mechanical ventilation.
Findings: A total of 807 patients were evaluated. Compared to the no
HC group, after propensity score adjustment for clinical characteristics,
the risk of death from any cause was higher in the HC group (adjusted
hazard ratio [aHR], 1.83; 95% confidence interval [CI], 1.16–2.89; p =
0.009), but not in the HC+AZ group (aHR, 1.31; 95% CI, 0.80–2.15; p =
0.28). Both the propensity-score-adjusted risks of mechanical ventilation and death after mechanical ventilation were not significantly
different in the HC group (aHR, 1.19; 95% CI, 0.78–1.82; p = 0.42 and
aHR, 2.11; 95% CI, 0.96–4.62; p = 0.06, respectively) or in the HC+AZ
group (aHR, 1.09; 95% CI, 0.72–1.66; p = 0.69 and aHR, 1.25; 95% CI,
0.59–2.68; p = 0.56, respectively) compared to the no HC group.
Conclusions: Among patients hospitalized with COVID-19, this retrospective study did not identify any significant reduction in mortality or
in the need for mechanical ventilation with hydroxychloroquine treatment with or without azithromycin.
Funding: University of Virginia Strategic Investment Fund
Despite limited and conflicting
evidence, hydroxychloroquine,
with or without azithromycin, is
extensively used to treat COVID19. Given the known side effects
of these drugs, there is an urgent
need to evaluate their
effectiveness in COVID-19. In this
nationwide retrospective..
Late treatment
is less effective
Please send us corrections, updates, or comments. Vaccines and
treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, or intervention
is 100% available and effective for all current and future variants. We do not
provide medical advice. Before taking any medication, consult a qualified
physician who can provide personalized advice and details of risks and
benefits based on your medical history and situation.
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