Hydroxychloroquine is associated with slower viral clearance in clinical COVID-19 patients with mild to moderate disease: A retrospective study
Mallat et al.
, Hydroxychloroquine is associated with slower viral clearance in clinical COVID-19 patients with mild to..
, Medicine (Baltimore), doi:10.1097/MD.0000000000023720 (date from earlier preprint)
Very small retrospective analysis of 34 patients finding slower binary PCR viral clearance with HCQ. No information on severity for treatment versus control is provided. No deaths, ICU admission, or mechanical ventilation. Binary PCR does not distinguish replication-competence. HCQ treatment started very late for many patients with >= 9 days for 25%.
time to viral-, 203.0% higher, relative time 3.03, p = 0.02, treatment 23, control 11, inverted to make RR<1 favor treatment.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mallat et al., 2 May 2020, retrospective, United Arab Emirates, peer-reviewed, 8 authors, average treatment delay 4.0 days.
Hydroxychloroquine is associated with slower viral
clearance in clinical COVID-19 patients with mild
to moderate disease
Jihad Mallat, MD, MSca,b,c, , Fadi Hamed, MDa, Maher Balkis, MDd, Mohamed A. Mohamed, MDe,
Mohamad Mooty, MDd, Asim Malik, MDd, Ahmad Nusair, MDd, Maria-Fernanda Bonilla, MDd
There are conﬂicting data regarding the use of hydroxychloroquine (HCQ) in COVID-19 hospitalized patients. The objective of this
study was to assess the efﬁcacy of HCQ in increasing SARS-CoV-2 viral clearance.
Hospitalized adult patients with conﬁrmed SARS-CoV-2 infection were retrospectively included in the study. The primary outcome
was the time from a conﬁrmed positive nasopharyngeal swab to turn negative. A negative nasopharyngeal swab conversion was
deﬁned as a conﬁrmed SARS-CoV-2 case followed by 2 negative results using RT-PCR assay with samples obtained 24 hours apart.
Multiple linear regression analysis was used to adjust for potential confounders.
Thirty-four conﬁrmed COVID-19 patients completed the study. Nineteen (55.9%) patients presented with symptoms, and 14
(41.2%) had pneumonia. Only 21 (61.8%) patients received HCQ. The time to SARS-CoV-2 negativity nasopharyngeal test was
signiﬁcantly longer in patients who received HCQ than those who did not receive HCQ [17 (13–21) vs 10 (4–13) days, P = .023]. HCQ
was independently associated with time to negativity test after adjustment for potential confounders (symptoms, comorbidities,
antiviral drugs, pneumonia, or oxygen therapy) in multivariable Cox proportional hazards regression analysis (hazard ratio = 0.33,
95% conﬁdence interval: 0.13–0.9, P = .024). On day 14, 47.8% (14/23) patients tested negative in the HCQ group compared with
90.9% (10/11) patients who did not receive HCQ (P = .016).
HCQ was associated with a slower viral clearance in COVID-19 patients with mild to moderate disease. Data from ongoing
randomized clinical trials with HCQ should provide a deﬁnitive answer regarding the efﬁcacy and safety of this treatment.
Abbreviations: HCQ = hydroxychloroquine, RT-PCR = real-time reverse-transcriptase–polymerase chain reaction.
Keywords: COVID-19 infection, hydroxychloroquine, time to COVID test negativity, viral clearance
then, the virus has extended around the world, crossing the
Middle East and North Africa region, to Europe and then
currently to North America, which has become the epicenter of
the pandemic. As of April 19, 2020, a total of around 2,241,778
conﬁrmed cases have been documented globally, with more than
152,551 deaths worldwide.
Therefore, the focus of therapeutic intervention has been to
decrease the duration of viral shedding and thus limit the spread
of the virus, and slow the progression of the disease. Besides
antiviral drugs, chloroquine and hydroxychloroquine (antimalarial drugs) have been proposed as potential agents that
could reduce the viral load and the transmission of the virus.
Chloroquine analogs appear to block viral entry to cells by
inhibiting the acidiﬁcation of endosomes and glycosylation of
host receptors.[3–5] Hydroxychloroquine (HCQ) has been
demonstrated to be effective in inhibiting SARS-CoV-2 infection
in vitro studies.[6,7]
Clinical studies have shown conﬂicting results. French studies
suggested that HCQ,..
is less effective
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