Efficacy of hydroxychloroquine and tocilizumab in patients with COVID-19: A single-center retrospective chart review
Roomi et al.
, Efficacy of hydroxychloroquine and tocilizumab in patients with COVID-19: A single-center retrospective chart..
, J. Medical Internet Research, doi:10.2196/21758
Retrospective 176 hospitalized patients (144 HCQ, 32 control) showing no significant differences with HCQ or TCZ. Confounding by indication
This study is excluded in the after exclusion results of meta
substantial unadjusted confounding by indication
risk of death, 37.7% higher, RR 1.38, p = 0.54, treatment 13 of 144 (9.0%), control 6 of 32 (18.8%), adjusted per study, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Roomi et al., 13 Aug 2020, retrospective, USA, peer-reviewed, 11 authors.
Abstract: JOURNAL OF MEDICAL INTERNET RESEARCH
Roomi et al
Efficacy of Hydroxychloroquine and Tocilizumab in Patients With
COVID-19: Single-Center Retrospective Chart Review
Sohaib Roomi1, MD; Waqas Ullah1, MD; Faizan Ahmed1, MD; Soban Farooq2, MD; Usama Sadiq1, MD; Asad
Chohan3, MD; Munnam Jafar1, MD; Maryum Saddique4, MD; Shristi Khanal1, MD; Robert Watson1, MD; Margot
Jefferson Health Abington, Abington, PA, United States
King Edward Medical University, Lahore, Pakistan
Newark Beth Israel Medical Center, Newark, NJ, United States
Einstein Medical Center, Philadelphia, PA, United States
Sohaib Roomi, MD
Jefferson Health Abington
1200 Old York Rd
Phone: 1 2674666985
Background: During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of
hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial.
Objective: The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19.
We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to
intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis.
Methods: A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes
during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were
divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean
age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups.
Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds
ratios with 95% CIs, respectively.
Results: The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI
1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI
0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference
in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney
failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their
respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the
Conclusions: In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital
mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results
are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit
from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled
trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be
deduced to combat this global..
is less effective
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