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0 0.5 1 1.5 2+ Mortality 23% Improvement Relative Risk HCQ  Rodriguez-Gonzalez et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 1,208 patients in Spain Lower mortality with HCQ (not stat. sig., p=0.26) Rodriguez-Gonzalez et al., Int. J. Ant.., Nov 2020 Favors HCQ Favors control

COVID-19 in hospitalized patients in Spain: a cohort study in Madrid

Rodriguez-Gonzalez et al., International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106249
Nov 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 1255 patients in Spain showing lower mortality with HCQ. Subject to confounding by indication.
Although the 23% lower mortality is not statistically significant, it is consistent with the significant 25% lower mortality [20‑29%] from meta analysis of the 250 mortality results to date.
risk of death, 22.8% lower, RR 0.77, p = 0.26, treatment 251 of 1,148 (21.9%), control 17 of 60 (28.3%), NNT 15.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Rodriguez-Gonzalez et al., 28 Nov 2020, retrospective, Spain, peer-reviewed, 20 authors, average treatment delay 6.0 days.
This PaperHCQAll
COVID-19 in hospitalised patients in Spain: a cohort study in Madrid
Carmen Guadalupe Rodriguez-Gonzalez, Esther Chamorro-De-Vega, Maricela Valerio, Miguel Angel Amor-Garcia, Francisco Tejerina, Milagros Sancho-Gonzalez, Alvaro Narrillos-Moraza, Alvaro Gimenez-Manzorro, Silvia Manrique-Rodriguez, Marina Machado, Maria Olmedo, Vicente Escudero-Vilaplana, Cristina Villanueva-Bueno, Beatriz Torroba-Sanz, Alejandra Melgarejo-Ortuño, Juan Vicente-Valor, Ana Herranz, Emilio Bouza, Patricia Muñoz, Maria Sanjurjo
International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106249
Few large series describe the clinical characteristics, outcomes and costs of COVID-19 in Western countries. This cohort reports the first 1255 adult cases receiving anti-COVID-19 treatment at a Spanish hospital (1-24 March 2020). Treatment costs were calculated. A logistic regression model was used to explore risk factors on admission associated with ARDS. A bivariate Cox proportional hazard ratio (HR) model was employed to determine the HR between individual factors and death. We included 1255 patients (median age 65 years; 57.8% male), of which 92.3% required hospitalisation. The prevalence of hypertension, cardiovascular disease and diabetes mellitus (DM) was 45.1%, 31.4% and 19.9%, respectively. Lymphocytopenia (54.8%), elevated alanine aminotransferase (33.0%) and elevated lactate dehydrogenase (58.5%) were frequent. Overall, 36.7% of patients developed ARDS, 10.0% were admitted to an ICU and 21.3% died. The most frequent antiviral combinations were lopinavir/ritonavir plus hydroxychloroquine (44.2%), followed by triple therapy with interferon beta-1b (32.7%). Corticosteroids and tocilizumab were used in 25.3% and 12.9% of patients, respectively. Total cost of anti-COVID-19 agents was €511 825 ( €408/patient). By multivariate analysis, risk factors associated with ARDS included older age, obesity, DM, severe hypoxaemia, lymphocytopenia, increased creatine kinase and increased C-reactive protein. In multivariate Cox model, older age (HR 1.07, 95% CI 1.06-1.09), cardiovascular disease (HR 1.34, 95% CI 1.01-1.79), DM (HR 1.45, 95% CI 1.09-1.92), severe hypoxaemia (HR 2.01, 95% CI 1.49-2.72), lymphocytopenia (HR 1.62, 95% CI 1.20-2.20) and increased C-reactive protein (HR 1.04, 95% CI 1.02-1.06) were risk factors for mortality.
Supplementary materials Supplementary material associated with this article can be found, in the online version, at doi: 10.1016/j.ijantimicag.2020. 106249 .
Armstrong, Kane, Cook, Outcomes from intensive care in patients with COVID-19: a systematic review and meta-analysis of observational studies, Anaesthesia, doi:10.1111/anae.15201
Cao, Wang, Wen, Liu, Wang et al., A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19, N Engl J Med, doi:10.1056/NEJMoa2001282
Docherty, Harrison, Green, Hardwick, Pius et al., Features of 20 133 UK patients in hospital with COVID-19 using the IS-ARIC WHO Clinical Characterisation Protocol: prospective observational cohort study, BMJ, doi:10.1136/bmj.m1985
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Grasselli, Zangrillo, Zanella, Antonelli, Cabrini et al., Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region. Italy, JAMA, doi:10.1001/jama.2020.5394
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Late treatment
is less effective
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