Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis
Mehra et al., The Lancet, May 22, 2020, doi: 10.1016/S0140-6736(20)31180-6
Mehra et al., Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational.., The Lancet, May 22, 2020, doi: 10.1016/S0140-6736(20)31180-6
Incorrect at first read (implausible death, ventilation, and population numbers). This paper was retracted.
Mehra et al., 22 May 2020, peer-reviewed, 4 authors.
Abstract: Articles
Hydroxychloroquine or chloroquine with or without a
macrolide for treatment of COVID-19: a multinational
registry analysis
TE
D
Mandeep R Mehra, Sapan S Desai, Frank Ruschitzka, Amit N Patel
Summary
Background Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being
widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when
used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment
regimens are poorly evaluated in COVID-19.
A
C
Methods We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a
macrolide for treatment of COVID-19. The registry comprised data from 671 hospitals in six continents. We included
patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2.
Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment
groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a
macrolide), and patients who received none of these treatments formed the control group. Patients for whom one of
the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation,
as well as patients who received remdesivir, were excluded. The main outcomes of interest were in-hospital mortality
and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or
ventricular fibrillation).
R
ET
R
Findings 96 032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study
period and met the inclusion criteria. Of these, 14 888 patients were in the treatment groups (1868 received
chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received
hydroxychloroquine with a macrolide) and 81 144 patients were in the control group. 10 698 (11·1%) patients died in
hospital. After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying
cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition,
and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine
(18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531),
chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each
independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%),
hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983),
chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were
independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.
Published Online
May 22, 2020
https://doi.org/10.1016/
S0140-6736(20)31180-6
This online publication has been
corrected. The corrected version
first appeared at thelancet.com
on May 29, 2020
See Online/Comment
https://doi.org/10.1016/
S0140-6736(20)31174-0
Brigham and Women’s Hospital
Heart and Vascular Center and
Harvard Medical School,
Boston, MA, USA
(Prof M R Mehra..
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.
FLCCC and
WCH
provide treatment protocols.
Submit