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All Studies   Meta Analysis    Recent:   

Efficacy of hydroxychloroquine and tocilizumab in patients with COVID-19: A single-center retrospective chart review

Roomi et al., J. Medical Internet Research, doi:10.2196/21758
Aug 2020  
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Mortality -38% Improvement Relative Risk HCQ for COVID-19  Roomi et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 176 patients in the USA Higher mortality with HCQ (not stat. sig., p=0.54) c19hcq.org Roomi et al., J. Medical Internet Rese.., Aug 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 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 analysis: substantial unadjusted confounding by indication likely.
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.
This PaperHCQAll
Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review
MD Sohaib Roomi, MD Waqas Ullah, MD Faizan Ahmed, MD Soban Farooq, MD Usama Sadiq, MD Asad Chohan, Munnam Jafar, MD Maryum Saddique, MD Shristi Khanal, MD Robert Watson, MD Margot Boigon
Journal of Medical Internet Research, doi:10.2196/21758
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 unadjusted estimates. 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 pandemic.
Conflicts of Interest None declared. ©Sohaib Roomi, Waqas Ullah, Faizan Ahmed, Soban Farooq, Usama Sadiq, Asad Chohan, Munnam Jafar, Maryum Saddique, Shristi Khanal, Robert Watson, Margot Boigon. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.09.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. Abbreviations
References
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Carlucci, Ahuja, Petrilli, Rajagopalan, Jones et al., Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients, medRxiv, doi:10.1101/2020.05.02.20080036
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Gautret, Lagier, Parola, Hoang, Meddeb et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.105949
Guaraldi, Meschiari, Cozzi-Lepri, Milic, Tonelli et al., Tocilizumab in patients with severe COVID-19: a retrospective cohort study, The Lancet Rheumatology, doi:10.1016/s2665-9913(20)30173-9
Horby, Landray, Statement from the Chief Investigators of the Randomised Evaluation of COVid-19 thERapY (RECOVERY) Trial on hydroxychloroquine
Ison, Wolfe, Boucher, Emergency Use Authorization of Remdesivir: The Need for a Transparent Distribution Process, JAMA, doi:10.1001/jama.2020.8863
Luo, Liu, Qiu, Liu, Liu et al., Tocilizumab treatment in COVID-19: A single center experience, J Med Virol, doi:10.1002/jmv.25801
Magagnoli, Narendran, Pereira, Cummings, Hardin et al., Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Retrospective Cohort Study, medRxiv, doi:10.1016/j.medj.2020.06.001
Mahevas, Tran, Roumier, Chabrol, Paule et al., No evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COVID-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial, medRxiv, doi:10.1101/2020.04.10.20060699
Mehta, Mcauley, Brown, Sanchez, Tattersall et al., COVID-19: consider cytokine storm syndromes and immunosuppression, The Lancet, doi:10.1016/s0140-6736(20)30628-0
Peschken, Possible Consequences of a Shortage of Hydroxychloroquine for Patients with Systemic Lupus Erythematosus amid the COVID-19 Pandemic, J Rheumatol, doi:10.3899/jrheum.200395
Recovery Collaborative Group, Horby, Lim, Emberson, Mafham et al., Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report, N Engl J Med, doi:10.1056/NEJMoa2021436
Rosenberg, Dufort, Udo, Wilberschied, Kumar et al., Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State, JAMA, doi:10.1001/jama.2020.8630
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Xu, Han, Li, Sun, Wang et al., Effective treatment of severe COVID-19 patients with tocilizumab, Proc Natl Acad Sci U S A, doi:10.1073/pnas.2005615117
Yao, Ye, Zhang, Cui, Huang et al., Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clin Infect Dis, doi:10.1093/cid/ciaa237
Zhou, Dai, Tong, COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression, J Antimicrob Chemother, doi:10.1093/jac/dkaa114
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Late treatment
is less effective
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