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All Studies   Meta Analysis    Recent:   

Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data

Mahévas et al., BMJ 2020, doi:10.1136/bmj.m1844
May 2020  
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Mortality -20% Improvement Relative Risk HCQ for COVID-19  Mahévas et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 173 patients in France Study underpowered to detect differences c19hcq.org Mahévas et al., BMJ 2020, May 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Observational study of 181 patients with advanced disease requiring oxygen showing no benefit for HCQ. Power of study appears too low to support conclusions1.
None of the 15 patients receiving HCQ+AZ were transferred to intensive care or died compared to 23% overall.
risk of death, 20.0% higher, HR 1.20, p = 0.75, treatment 9 of 84 (10.7%), control 8 of 89 (9.0%), adjusted per study.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mahévas et al., 14 May 2020, retrospective, France, peer-reviewed, 34 authors, average treatment delay 7.0 days.
This PaperHCQAll
Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data
Matthieu Mahévas, Viet-Thi Tran, Mathilde Roumier, Amélie Chabrol, Romain Paule, Constance Guillaud, Elena Fois, Raphael Lepeule, Tali-Anne Szwebel, François-Xavier Lescure, Frédéric Schlemmer, Marie Matignon, Mehdi Khellaf, Etienne Crickx, Benjamin Terrier, Caroline Morbieu, Paul Legendre, Julien Dang, Yoland Schoindre, Jean-Michel Pawlotsky, Marc Michel, Elodie Perrodeau, Nicolas Carlier, Nicolas Roche, Victoire De Lastours, Clément Ourghanlian, Solen Kerneis, Philippe Ménager, Luc Mouthon, Etienne Audureau, Philippe Ravaud, Bertrand Godeau, Sébastien Gallien, Nathalie Costedoat-Chalumeau
BMJ, doi:10.1136/bmj.m1844
OBJECTIVE To assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen. DESIGN Comparative observational study using data collected from routine care. SETTING Four French tertiary care centres providing care to patients with covid-19 pneumonia between 12 March and 31 March 2020. PARTICIPANTS 181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care. CONCLUSIONS Hydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen.
RESEARCH No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
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Secondary outcomes were overall survival, survival without acute respiratory ' 'distress syndrome, weaning from oxygen, and discharge from hospital to home or rehabilitation ' '(all at day 21). Analyses were adjusted for confounding factors by inverse probability of ' 'treatment weighting.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>In the main analysis, 84 patients who received hydroxychloroquine within ' '48 hours of admission to hospital (treatment group) were compared with 89 patients who did ' 'not receive hydroxychloroquine (control group). Eight additional patients received ' 'hydroxychloroquine more than 48 hours after admission. In the weighted analyses, the survival ' 'rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and ' '75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). ' 'Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, ' '0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the ' 'treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of ' 'patients in the treatment group had been weaned from oxygen compared with 76% in the control ' 'group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the ' 'treatment group (10%) experienced electrocardiographic modifications that required ' 'discontinuation of treatment.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>Hydroxychloroquine has received worldwide attention as a potential ' 'treatment for covid-19 because of positive results from small studies. 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Late treatment
is less effective
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