Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State

Rosenberg et al., JAMA, May 11, 2020, doi:10.1001/jama.2020.8630

May 2020

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Restrospective observational late stage study showing no significant differences but calling for clinical trials.

Zervos et al. ijidonline.com point out serious limitations that they say should be corrected on the record: patients receiving HCQ with or without AZ were overall sicker on presentation and had multiple other risk factors including much higher risk based on ethnicity; patients receiving HCQ were more likely to be obese, diabetic, have chronic lung disease, and cardiovascular conditions; yet these sicker patients had approximately the same mortality rates compared to patients with a milder course of the disease and less risk factors. However, the authors conclude that "there are no significant benefits." It is noteworthy that HCQ was associated with a significant survival benefit in a larger cohort of patients from New York City as reported by Mikami.

See also worldtribune.com.

1. ijidonline.com, www.ijidonline.com/article/S1201-9712(20)30604-4/fulltext.www.ijidonline.com/article/S1201-9712(20)30604-4/fulltext.

2. Mikami et al., Risk Factors for Mortality in Patients with COVID-19 in New York City, J. Gen. Intern. Med., doi:10.1007/s11606-020-05983-z.springer.com, doi.org.

3. worldtribune.com, www.worldtribune.com/effectiveness-of-hydroxychloroquine-was-hiding-in-plain-sight/.www.worldtribune.com/effectiveness-of-hydroxychloroquine-was-hiding-in-plain-sight/.

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risk of death, 35.0% higher, HR 1.35, p = 0.31, treatment 189 of 735 (25.7%), control 28 of 221 (12.7%), adjusted per study.

risk of death, 8.0% higher, HR 1.08, p = 0.79, treatment 54 of 271 (19.9%), control 28 of 221 (12.7%), adjusted per study.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Rosenberg et al., 11 May 2020, retrospective, USA, peer-reviewed, 14 authors.

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Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State

PhD Eli S Rosenberg, MD Elizabeth M Dufort, PhD Tomoko Udo, MS Larissa A Wilberschied, DO; Jessica Kumar, PhD James Tesoriero, PA Patti Weinberg, MPH James Kirkwood, MPH Alison Muse, MD Jack Dehovitz, MD Debra S Blog, MPH Brad Hutton, PhD David R Holtgrave, MD Howard A Zucker

JAMA, doi:10.1001/jama.2020.8630

IMPORTANCE Hydroxychloroquine, with or without azithromycin, has been considered as a possible therapeutic agent for patients with coronavirus disease 2019 (COVID-19). However, there are limited data on efficacy and associated adverse events. OBJECTIVE To describe the association between use of hydroxychloroquine, with or without azithromycin, and clinical outcomes among hospital inpatients diagnosed with COVID-19. DESIGN, SETTING, AND PARTICIPANTS Retrospective multicenter cohort study of patients from a random sample of all admitted patients with laboratory-confirmed COVID-19 in 25 hospitals, representing 88.2% of patients with COVID-19 in the New York metropolitan region. Eligible patients were admitted for at least 24 hours between March 15 and 28, 2020. Medications, preexisting conditions, clinical measures on admission, outcomes, and adverse events were abstracted from medical records. The date of final follow-up was April 24, 2020.

Abbreviations: COVID-19, coronavirus disease 2019; ICU, intensive care unit; IQR, interquartile range. a Receipt of intensive care may not have been in a traditional critical care unit. b Based on open-text and ICD-10 fields for cause of death. Causes are not mutually exclusive. c Denominator is the total patient-days in the hospital experienced by the group. d Not applicable (NA) because there was only 1 patient in this group still admitted at analysis. ARTICLE INFORMATION

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Late treatment
is less effective

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