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Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study

Rivera et al., Cancer Discovery, doi:10.1158/2159-8290.CD-20-0941
Jul 2020  
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Mortality -2% Improvement Relative Risk HCQ for COVID-19  Rivera et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 506 patients in the USA No significant difference in mortality c19hcq.org Rivera et al., Cancer Discovery, July 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Retrospective cancer patients, showing adjusted OR 1.03 [0.62-1.73] for HCQ. The study reports the number of HCQ+AZ patients but they do not provide results for HCQ+AZ (only HCQ + any other treatment). Significant confounding by indication and compassionate use is likely.
risk of death, 2.4% higher, RR 1.02, p = 0.92, treatment 44 of 179 (24.6%), control 59 of 327 (18.0%), adjusted per study, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Rivera et al., 22 Jul 2020, retrospective, USA, peer-reviewed, 45 authors.
This PaperHCQAll
Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study
Donna R Rivera, Solange Peters, Orestis A Panagiotou, Dimpy P Shah, Nicole M Kuderer, Chih-Yuan Hsu, Samuel M Rubinstein, Brendan J Lee, Toni K Choueiri, Gilberto De Lima Lopes, Petros Grivas, Corrie A Painter, Brian I Rini, Michael A Thompson, Jonathan Arcobello, Ziad Bakouny, Deborah B Doroshow, Pamela C Egan, Dimitrios Farmakiotis, Leslie A Fecher, Christopher R Friese, Matthew D Galsky, Sanjay Goel, Shilpa Gupta, Thorvardur R Halfdanarson, Balazs Halmos, Jessica E Hawley, Ali Raza Khaki, Christopher A Lemmon, Sanjay Mishra, Adam J Olszewski, Nathan A Pennell, Matthew M Puc, Sanjay G Revankar, Lidia Schapira, Andrew Schmidt, Gary K Schwartz, Sumit A Shah, Julie T Wu, Zhuoer Xie, Albert C Yeh, Huili Zhu, Yu Shyr, Gary H Lyman, Jeremy L Warner
Cancer Discovery, doi:10.1158/2159-8290.cd-20-0941
Among 2,186 U.S. adults with invasive cancer and laboratory-confi rmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical signifi cance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our fi ndings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials. SIGnIfICAnCE: Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically signifi cant 30-day all-cause mortality benefi t with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefi t. Treatment receipt refl ects clinical decision-making and suggests disparities in medication access.
Authors' Contributions
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Logistic regression ' 'with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) ' 'was performed. Hydroxychloroquine with any other drug was associated with increased mortality ' 'versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated ' 'controls; this association was not present with hydroxychloroquine alone. Remdesivir had ' 'numerically reduced mortality versus untreated controls that did not reach statistical ' 'significance. Baseline COVID-19 severity was strongly associated with receipt of any ' 'treatment. Black patients were approximately half as likely to receive remdesivir as white ' 'patients. 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'given': 'Corrie A.', 'family': 'Painter', 'sequence': 'additional', 'affiliation': [{'name': '12Count Me In, Cambridge, Massachusetts.'}]}, { 'given': 'Brian I.', 'family': 'Rini', 'sequence': 'additional', 'affiliation': [ { 'name': '7Deparment of Medicine, Division of Hematology and Oncology, ' 'Vanderbilt University Medical Center, Nashville, Tennessee.'}]}, { 'given': 'Michael A.', 'family': 'Thompson', 'sequence': 'additional', 'affiliation': [{'name': '13Advocate Aurora Health, Milwaukee, Wisconsin.'}]}, { 'given': 'Jonathan', 'family': 'Arcobello', 'sequence': 'additional', 'affiliation': [{'name': '14Karmanos Cancer Institute, Detroit, Michigan.'}]}, { 'ORCID': 'http://orcid.org/0000-0003-1906-5704', 'authenticated-orcid': False, 'given': 'Ziad', 'family': 'Bakouny', 'sequence': 'additional', 'affiliation': [ { 'name': '8Department of Medical Oncology, Dana-Farber Cancer Institute, ' 'Boston, Massachusetts.'}]}, { 'given': 'Deborah B.', 'family': 'Doroshow', 'sequence': 'additional', 'affiliation': [ { 'name': '15Department of Medicine, Icahn School of Medicine at Mount ' 'Sinai, New York, New York.'}, { 'name': '16Tisch Cancer Institute, Icahn School of Medicine at Mount ' 'Sinai, New York, New York.'}]}, { 'given': 'Pamela C.', 'family': 'Egan', 'sequence': 'additional', 'affiliation': [ { 'name': '17Department of Medicine, Division of Hematology/Oncology, The ' 'Warren Alpert Medical School of Brown University, Providence, ' 'Rhode Island.'}]}, { 'given': 'Dimitrios', 'family': 'Farmakiotis', 'sequence': 'additional', 'affiliation': [ { 'name': '18Department of Medicine, Division of Infectious Diseases, The ' 'Warren Alpert Medical School of Brown University, Providence, ' 'Rhode Island.'}]}, { 'given': 'Leslie A.', 'family': 'Fecher', 'sequence': 'additional', 'affiliation': [ { 'name': '19Department of Internal Medicine, Rogel Cancer Center, ' 'University of Michigan, Ann Arbor, Michigan.'}]}, { 'given': 'Christopher R.', 'family': 'Friese', 'sequence': 'additional', 'affiliation': [ { 'name': '20School of Nursing, University of Michigan, Ann Arbor, ' 'Michigan.'}]}, { 'ORCID': 'http://orcid.org/0000-0001-7655-9378', 'authenticated-orcid': False, 'given': 'Matthew D.', 'family': 'Galsky', 'sequence': 'additional', 'affiliation': [ { 'name': '15Department of Medicine, Icahn School of Medicine at Mount ' 'Sinai, New York, New York.'}, { 'name': '16Tisch Cancer Institute, Icahn School of Medicine at Mount ' 'Sinai, New York, New York.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-2798-7568', 'authenticated-orcid': False, 'given': 'Sanjay', 'family': 'Goel', 'sequence': 'additional', 'affiliation': [ { 'name': '21Albert Einstein College of Medicine, Montefiore Medical ' 'Center, Bronx, New York.'}]}, { 'given': 'Shilpa', 'family': 'Gupta', 'sequence': 'additional', 'affiliation': [ { 'name': '22Department of Hematology and Medical Oncology, Cleveland ' 'Clinic, Cleveland, Ohio.'}]}, { 'ORCID': 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'Lemmon', 'sequence': 'additional', 'affiliation': [ { 'name': '22Department of Hematology and Medical Oncology, Cleveland ' 'Clinic, Cleveland, Ohio.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-7775-9600', 'authenticated-orcid': False, 'given': 'Sanjay', 'family': 'Mishra', 'sequence': 'additional', 'affiliation': [{'name': '25Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.'}]}, { 'given': 'Adam J.', 'family': 'Olszewski', 'sequence': 'additional', 'affiliation': [ { 'name': '17Department of Medicine, Division of Hematology/Oncology, The ' 'Warren Alpert Medical School of Brown University, Providence, ' 'Rhode Island.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-1458-0064', 'authenticated-orcid': False, 'given': 'Nathan A.', 'family': 'Pennell', 'sequence': 'additional', 'affiliation': [ { 'name': '22Department of Hematology and Medical Oncology, Cleveland ' 'Clinic, Cleveland, Ohio.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-9281-2262', 'authenticated-orcid': False, 'given': 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Medical Center, New York, New ' 'York.'}]}, { 'given': 'Sumit A.', 'family': 'Shah', 'sequence': 'additional', 'affiliation': [ { 'name': '27Department of Medicine, Division of Oncology, Stanford ' 'University, Palo Alto, California.'}]}, { 'ORCID': 'http://orcid.org/0000-0003-2388-1827', 'authenticated-orcid': False, 'given': 'Julie T.', 'family': 'Wu', 'sequence': 'additional', 'affiliation': [ { 'name': '27Department of Medicine, Division of Oncology, Stanford ' 'University, Palo Alto, California.'}]}, { 'given': 'Zhuoer', 'family': 'Xie', 'sequence': 'additional', 'affiliation': [ { 'name': '23Department of Medical Oncology, Mayo Clinic, Rochester, ' 'Minnesota.'}]}, { 'ORCID': 'http://orcid.org/0000-0003-3455-7360', 'authenticated-orcid': False, 'given': 'Albert C.', 'family': 'Yeh', 'sequence': 'additional', 'affiliation': [ { 'name': '10Department of Medicine, Division of Oncology, University of ' 'Washington, Seattle, Washington.'}]}, { 'given': 'Huili', 'family': 'Zhu', 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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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