Chronic Hydroxychloroquine Therapy and COVID-19 Outcomes: A Retrospective Case-Control Analysis
et al., Journal of the American Academy of Dermatology,
Retrospective 50 COVID-19 patients that take chronic HCQ, compared to a matched sample of patients not taking chronic HCQ, showing lower mortality and ICU admission, and shorter hospitalization for HCQ patients, but not statistically significant due to the small number of events.
The actual benefit for HCQ could be much larger. The study does not address the risk of being sick enough to visit the hospital. HCQ users are likely systemic autoimmune disease patients and authors do not adjust for the very different baseline risk for these patients. Other research shows that the risk of COVID-19 for systemic autoimmune disease patients is much higher overall, Ferri et al. show OR 4.42, p
Although the 25% lower mortality is not statistically significant, it is consistent with the significant 25% lower mortality [20‑29%]
from meta analysis of the 247 mortality results to date
This study is excluded in the after exclusion results of meta
not fully adjusting for the different baseline risk of systemic autoimmune patients.
risk of death, 25.1% lower, RR 0.75, p = 0.77, treatment 4 of 50 (8.0%), control 11 of 103 (10.7%), NNT 37, from all patients.
risk of hospitalization, 22.2% lower, RR 0.78, p = 0.29, treatment 17 of 50 (34.0%), control 45 of 103 (43.7%), NNT 10.
hospitalization time, 41.2% lower, relative time 0.59, p = 0.12, treatment 21, control 54.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Rangel et al., 10 Jan 2021, retrospective, USA, peer-reviewed, 5 authors.
Abstract: J AM ACAD DERMATOL
VOLUME 84, NUMBER 6
Medicine, Boston University School of Medicine,
Drs Hartman and La are cofirst authors.
Funding sources: Supported by an American Skin
Association research grant (120795 to Dr
IRB approval status: Not applicable.
Reprints not available from the authors.
Correspondence to: Rebecca I. Hartman, MD, MPH,
Harvard Medical School, BWH Department of
Dermatology, 221 Longwood Ave, Boston, MA
Conflicts of interest
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therapy and COVID-19 outcomes: A
retrospective case-control analysis
To the Editor: Hydroxychloroquine (HCQ) has failed
to show significant therapeutic benefit for patients
with coronavirus disease-2019 (COVID-19) in recent
studies, although interest in this medication’s
potential pre- and postprophylactic efficacy remains,
with 1 retrospective study showing reduced
COVID-19 infection among patients taking chronic
HCQ.1,2 In this study, we sought to evaluate
COVID-19 clinical outcomes in patients taking
chronic HCQ for an underlying condition as well as
in a matched cohort not taking HCQ at time of
Research Letters 1769
Table I. Hydroxychloroquine indication, dosage,
and duration at time of COVID-19 diagnosis
HCQ indication, dosage, and duration (N = 50)
Systemic lupus erythematosus
Connective tissue disease
Mixed connective tissue disease
Erythema nodosum during
chronic fatigue syndrome
200 mg HCQ daily
200 mg HCQ 2 times daily
(400 mg total)
200 mg HCQ 3 times daily
(600 mg total)
Mean duration of HCQ therapy
before COVID-19 diagnosis (IQR)
COVID-19, Coronavirus disease-2019; HCQ, hydroxychloroquine;
IQR, interquartile range.
We identified all patients with severe acute
respiratory syndrome coronavirus 2 seen at New
York University from March to April 2020 using
International Classification of Diseases, 10th
revision codes and included patients taking HCQ
for $6 weeks before their COVID-19 diagnosis.
Control subjects were randomly selected from the
remaining severe acute respiratory syndrome
coronavirus 2epositive patients with automated
matching for age, gender, and immunosuppressive
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