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0 0.5 1 1.5 2+ Time to viral- -203% Improvement Relative Risk HCQ for COVID-19  Mallat et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 34 patients in United Arab Emirates Slower viral clearance with HCQ (p=0.024) Mallat et al., Medicine, May 2020 Favors HCQ Favors control

Hydroxychloroquine is associated with slower viral clearance in clinical COVID-19 patients with mild to moderate disease: A retrospective study

Mallat et al., Medicine (Baltimore), doi:10.1097/MD.0000000000023720 (date from preprint)
May 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 421 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.
3,800+ studies for 60+ treatments.
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.
This PaperHCQAll
Hydroxychloroquine is associated with slower viral clearance in clinical COVID-19 patients with mild to moderate disease
MD, MSc Jihad Mallat, MD Fadi Hamed, MD Maher Balkis, MD e , Mohamed A Mohamed, MD d Mohamad Mooty, MD Asim Malik, MD d , Ahmad Nusair, MD Maria-Fernanda Bonilla
Medicine, doi:10.1097/md.0000000000023720
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.
Author contributions Mallat had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Hcq, Mallat, = hydroxychloroquine, Medicine
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Late treatment
is less effective
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