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0 0.5 1 1.5 2+ 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 Rivera et al., Cancer Discovery, July 2020 Favors HCQ Favors control

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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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.
4,000+ studies for 60+ treatments.
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/
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.
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Late treatment
is less effective
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