Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine
Edgar Jg. Peters, Didier Collard, Sander Van Assen, Martijn Beudel, Marije K Bomers, Jacqueline Buijs, Lianne R De Haan, Wouter De Ruijter, Renée A Douma, Paul Wg. Elbers, Abraham Goorhuis, Niels C Gritters Van Den Oever, Lieve Ghh. Knarren, Hazra S Moeniralam, Remy Lm. Mostard, Marian Jr. Quanjel, Auke C Reidinga, Roos Renckens, Joop Pw. Van Den Bergh, Imro N Vlasveld, Jonne J Sikkens
Clinical Microbiology and Infection, doi:10.1016/j.cmi.2020.10.004
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 all-cause mortality. We performed a survival analysis using log-rank test and Cox regression with adjustment for age, sex and covariates based on premorbid health, disease severity and the use of steroids for adult respiratory distress syndrome, including dexamethasone. Results: Among 1949 individuals, 21-day mortality was 21.5% in 1596 patients treated in hospitals that routinely prescribed (hydroxy)chloroquine, and 15.0% in 353 patients treated in hospitals that did not. In the adjusted Cox regression models this difference disappeared, with an adjusted hazard ratio of 1.09 (95% CI 0.81e1.47). When stratified by treatment actually received in individual patients, the use of (hydroxy)chloroquine was associated with an increased 21-day mortality (HR 1.58; 95% CI 1.24e2.02) in the full model.
Transparency declaration The authors declare that they have no conflicts of interest. Funding D. Collard is supported by a ZonMw grant (project no.: 10430022010002).
Contribution of authors All authors have made substantial contributions to the following: the conception and design of the study, or acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be submitted.
Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.cmi.2020.10.004.
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