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0 0.5 1 1.5 2+ Mortality 11% Improvement Relative Risk HCQ for COVID-19  Paccoud et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 89 patients in France No significant difference in mortality c19hcq.org Paccoud et al., Clinical Infectious Di.., Jun 2020 Favors HCQ Favors control

Compassionate use of hydroxychloroquine in clinical practice for patients with mild to severe Covid-19 in a French university hospital

Paccoud et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa791
Jun 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 422 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.
4,100+ studies for 60+ treatments. c19hcq.org
Retrospective of 89 hospitalized patients, survival HR 0.89 [0.23-3.47], not statistically significant. Authors note that unmeasured confounders may have persisted and the study may be underpowered.
risk of death, 11.0% lower, HR 0.89, p = 0.88, treatment 21 of 38 (55.3%), control 26 of 46 (56.5%), NNT 79, adjusted per study.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Paccoud et al., 18 Jun 2020, retrospective, France, peer-reviewed, 20 authors.
This PaperHCQAll
Compassionate Use of Hydroxychloroquine in Clinical Practice for Patients With Mild to Severe COVID-19 in a French University Hospital
Olivier Paccoud, Florence Tubach, Amandine Baptiste, Alexandre Bleibtreu, David Hajage, Gentiane Monsel, Gianpiero Tebano, David Boutolleau, Elise Klement, Nagisa Godefroy, Romain Palich, Oula Itani, Antoine Faiçal, Marc-Antoine Valantin, Roland Tubiana, Sonia Burrel, Vincent Calvez, Eric Caumes, Anne-Geneviève Marcelin, Valérie Pourcher
Clinical Infectious Diseases, doi:10.1093/cid/ciaa791
Background. Data from nonrandomized studies have suggested that hydroxychloroquine could be an effective therapeutic agent against coronavirus disease 2019 (COVID-19). Methods. We conducted an observational, retrospective cohort study involving hospitalized adult patients with confirmed, mild to severe COVID-19 in a French university hospital. Patients who received hydroxychloroquine (200 mg 3 times daily dosage for 10 days) on a compassionate basis in addition to standard of care (SOC) were compared with patients without contraindications to hydroxychloroquine who received SOC alone. A propensity score-weighted analysis was performed to control for confounders: age, sex, time between symptom onset and admission ≤ 7 days, Charlson comorbidity index, medical history of arterial hypertension, obesity, National Early Warning Score 2 (NEWS2) score at admission, and pneumonia severity. The primary endpoint was time to unfavorable outcome, defined as: death, admission to an intensive care unit, or decision to withdraw or withhold life-sustaining treatments, whichever came first. Results. Data from 89 patients with laboratory-confirmed COVID-19 were analyzed, 84 of whom were considered in the primary analysis; 38 patients treated with hydroxychloroquine and 46 patients treated with SOC alone. At admission, the mean age of patients was 66 years, the median Charlson comorbidity index was 3, and the median NEWS2 severity score was 3. After propensity score weighting, treatment with hydroxychloroquine was not associated with a significantly reduced risk of unfavorable outcome (hazard ratio, 0.90 [95% confidence interval, .38-2.1], P = .81). Overall survival was not significantly different between the 2 groups (hazard ratio, 0.89 [0.23; 3.47], P = 1). Conclusion. In hospitalized adults with COVID-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to SOC. Unmeasured confounders may have persisted however, despite careful propensity-weighted analysis and the study might be underpowered. Ongoing controlled trials in patients with varying degrees of initial severity on a larger scale will help determine whether there is a place for hydroxychloroquine in the treatment of COVID-19. In hospitalized adults with COVID-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to SOC.
Supplementary Data Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author. Notes
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{ 'DOI': '10.1093/cid/ciaa791', 'ISSN': ['1058-4838', '1537-6591'], 'URL': 'http://dx.doi.org/10.1093/cid/ciaa791', 'abstract': '<jats:title>Abstract</jats:title>\n' ' <jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>Data from nonrandomized studies have suggested that ' 'hydroxychloroquine could be an effective therapeutic agent against coronavirus disease 2019 ' '(COVID-19).</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>We conducted an observational, retrospective cohort study involving ' 'hospitalized adult patients with confirmed, mild to severe COVID-19 in a French university ' 'hospital. Patients who received hydroxychloroquine (200 mg 3 times daily dosage for 10 days) ' 'on a compassionate basis in addition to standard of care (SOC) were compared with patients ' 'without contraindications to hydroxychloroquine who received SOC alone. A propensity ' 'score-weighted analysis was performed to control for confounders: age, sex, time between ' 'symptom onset and admission\u2005≤\u20057 days, Charlson comorbidity index, medical history ' 'of arterial hypertension, obesity, National Early Warning Score 2 (NEWS2) score at admission, ' 'and pneumonia severity. The primary endpoint was time to unfavorable outcome, defined as: ' 'death, admission to an intensive care unit, or decision to withdraw or withhold ' 'life-sustaining treatments, whichever came first.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Data from 89 patients with laboratory-confirmed COVID-19 were ' 'analyzed, 84 of whom were considered in the primary analysis; 38 patients treated with ' 'hydroxychloroquine and 46 patients treated with SOC alone. At admission, the mean age of ' 'patients was 66 years, the median Charlson comorbidity index was 3, and the median NEWS2 ' 'severity score was 3. After propensity score weighting, treatment with hydroxychloroquine was ' 'not associated with a significantly reduced risk of unfavorable outcome (hazard ratio, 0.90 ' '[95% confidence interval, .38–2.1], P\u2005=\u2005.81). Overall survival was not ' 'significantly different between the 2 groups (hazard ratio, 0.89 [0.23; 3.47], P\u2005=\u2005' '1).</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>In hospitalized adults with COVID-19, no significant reduction of ' 'the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to SOC. ' 'Unmeasured confounders may have persisted however, despite careful propensity-weighted ' 'analysis and the study might be underpowered. Ongoing controlled trials in patients with ' 'varying degrees of initial severity on a larger scale will help determine whether there is a ' 'place for hydroxychloroquine in the treatment of COVID-19. In hospitalized adults with ' 'COVID-19, no significant reduction of the risk of unfavorable outcomes was observed with ' 'hydroxychloroquine in comparison to SOC.</jats:p>\n' ' </jats:sec>', 'author': [ { 'affiliation': [ { 'name': 'Assistance Publique — Hôpitaux de Paris, Hôpitaux Universitaires ' 'Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses ' 'et Tropicales, Paris, France'}], 'family': 'Paccoud', 'given': 'Olivier', 'sequence': 'first'}, { 'affiliation': [ { 'name': 'Sorbonne Université, INSERM UMR 1136, Département de Santé ' 'Publique, Unité de Recherche Clinique Pitié Salpêtrière — ' 'Charles Foix, Centre de Pharmaco-épidémiologie de l’AP-HP, ' 'Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, ' 'France'}], 'family': 'Tubach', 'given': 'Florence', 'sequence': 'additional'}, { 'affiliation': [ { 'name': 'Sorbonne Université, INSERM UMR 1136, Département de Santé ' 'Publique, Unité de Recherche Clinique Pitié Salpêtrière — ' 'Charles Foix, Centre 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Paris, France'}], 'family': 'Monsel', 'given': 'Gentiane', 'sequence': 'additional'}, { 'affiliation': [ { 'name': 'Assistance Publique — Hôpitaux de Paris, Hôpitaux Universitaires ' 'Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses ' 'et Tropicales, Paris, France'}], 'family': 'Tebano', 'given': 'Gianpiero', 'sequence': 'additional'}, { 'affiliation': [ { 'name': 'Sorbonne Université, INSERM, Institut Pierre Louis ' 'd’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux ' 'Universitaires Pitié-Salpêtrière—Charles Foix, laboratoire de ' 'virologie, Paris, France'}, { 'name': 'Sorbonne Université, INSERM 1136, Institut Pierre Louis ' 'd’Epidémiologie et de Santé Publique, Paris, France'}], 'family': 'Boutolleau', 'given': 'David', 'sequence': 'additional'}, { 'affiliation': [ { 'name': 'Assistance Publique — Hôpitaux de Paris, Hôpitaux Universitaires ' 'Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses ' 'et Tropicales, Paris, France'}], 'family': 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Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment 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.
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