Outcomes of Persons With COVID-19 in Hospitals With and Without Standard Treatment With (Hydroxy)chloroquine
Peters et al.
, Outcomes of Persons With COVID-19 in Hospitals With and Without Standard Treatment With (Hydroxy)chloroquine
, Clinical Microbiology and Infection, doi:10.1016/j.cmi.2020.10.004 (date from earlier preprint)
Retrospective study of HCQ use in 9 hospitals in the Netherlands, showing no significant difference in mortality with HCQ/CQ or dexamethasone. Late stage (admitted to hospital with positive test or CT scan abnormalities). 4 of 7 hospitals started treatment only after further deterioration. Short cutoff (21 days) - other studies have shown treated patient cases resolved faster and more control patients remaining in hospital at this time.
In the preprint, 58 of 341 control patients died. In the journal version, 53 of 353 control patients died.
Significant differences between hospitals - HCQ hospitals had significantly older patients with significantly more comorbidities. Non-HCQ hospitals were "tertiary academic centres" whereas HCQ hospitals were "secondary care hospitals". Residual confounding likely. This study compares overcrowded regular hospitals with undercrowded academic hospitals.
A subset of patients were excluded due to transfer to other hospitals. This introduces bias because patients in critical condition are not transferred. For examples, patients benefiting from HCQ treatment may have been transferred to the tertiary centres and excluded from analysis, increasing the percentage of critical cases in the secondary hospitals.
Among the seven (H)CQ-hospitals, the timing of start of (H)CQ treatment differed; three hospitals started at the moment of COVID-19 diagnosis, four started after diagnosis but only when patients clinically deteriorated e.g., when there was an increase in respiratory rate or increase in use of supplemental oxygen.
Most patients received CQ instead of the safer HCQ, receiving late treatment with CQ. Patients were given an initial dose of 600mg CQ then every 12 hours, for 5 days a dose of 300 mg, for a total of 3600mg CQ. This dose is likely to be toxic, see for example [apps.who.int]
Authors mention a subset of hospitals started treatment relatively earlier, which seems like the most important area to analyze, but no results are provided.
This study is excluded in the after exclusion results of meta
excessive unadjusted differences between groups.
risk of death, 9.0% higher, HR 1.09, p = 0.57, treatment 419 of 1,596 (26.3%), control 53 of 353 (15.0%), adjusted per study.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Peters et al., 15 Aug 2020, retrospective, Netherlands, peer-reviewed, 21 authors.
Abstract: Clinical Microbiology and Infection 27 (2021) 264e268
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Clinical Microbiology and Infection
journal homepage: www.clinicalmicrobiologyandinfection.com
Outcomes of persons with coronavirus disease 2019 in hospitals with
and without standard treatment with (hydroxy)chloroquine
Edgar JG. Peters 1, *, Didier Collard 2, Sander Van Assen 3, Martijn Beudel 4,
Marije K. Bomers 1, Jacqueline Buijs 5, Lianne R. De Haan 6, Wouter De Ruijter 7,
e A. Douma 6, Paul WG. Elbers 8, Abraham Goorhuis 9,
Niels C. Gritters van den Oever 10, Lieve GHH. Knarren 11, Hazra S. Moeniralam 12,
Remy LM. Mostard 13, Marian JR. Quanjel 14, Auke C. Reidinga 15, Roos Renckens 16,
Joop PW. Van Den Bergh 11, Imro N. Vlasveld 15, 17, Jonne J. Sikkens 1, on behalf of the
CovidPredict Study Group
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam, the
Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
Treant Zorggroep, Department of Internal Medicine/Infectious Diseases, Emmen, the Netherlands
Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam, the Netherlands
Zuyderland Medical Center, Department of Internal Medicine, Heerlen/Sittard, the Netherlands
Flevoziekenhuis, Department of Internal Medicine, Almere, the Netherlands
Noordwest Ziekenhuisgroep, Intensive Care Unit, Alkmaar, the Netherlands
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular
Sciences, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam, the Netherlands
Treant Zorggroep, Intensive Care Unit, Emmen, the Netherlands
Viecuri MC Noord-Limburg, Department of Internal Medicine, Venlo, the Netherlands
St Antonius Ziekenhuis, Department of Internal Medicine and Intensive Care Unit, Nieuwegein, the Netherlands
Zuyderland Medical Center, Department of Pulmonology, Heerlen/Sittard, the Netherlands
St Antonius Ziekenhuis, Department of Pulmonology, Nieuwegein, the Netherlands
Martini Hospital, Intensive Care Unit, Groningen, the Netherlands
Noordwest Ziekenhuisgroep, Department of Internal Medicine, Alkmaar, the Netherlands
Martini Hospital, Department of Internal Medicine, Groningen, the Netherlands
a r t i c l e i n f o
Received 8 July 2020
Received in revised form
1 October 2020
Accepted 3 October 2020
Available online 14 October 2020
Editor: L. Scudeller
Coronavirus disease 2019
Severe acute respiratory syndrome
a b s t r a c t
Objective: To compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in
hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine.
Methods: We analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion
dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported
the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (hydroxy)chloroquine,
two hospitals did not. Primary outcome was 21-day..
is less effective
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