Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State
Rosenberg et al.,
Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With..,
JAMA, May 11, 2020, doi:10.1001/jama.2020.8630
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].
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.
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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.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Rosenberg et al., 11 May 2020, retrospective, USA, peer-reviewed, 14 authors.
Abstract: Research
JAMA | Original Investigation
Association of Treatment With Hydroxychloroquine or Azithromycin
With In-Hospital Mortality in Patients With COVID-19 in New York State
Eli S. Rosenberg, PhD; Elizabeth M. Dufort, MD; Tomoko Udo, PhD; Larissa A. Wilberschied, MS;
Jessica Kumar, DO; James Tesoriero, PhD; Patti Weinberg, PA; James Kirkwood, MPH; Alison Muse, MPH;
Jack DeHovitz, MD; Debra S. Blog, MD; Brad Hutton, MPH; David R. Holtgrave, PhD; Howard A. Zucker, MD
Related article page 2518
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.
Supplemental content
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.
EXPOSURES Receipt of both hydroxychloroquine and azithromycin, hydroxychloroquine
alone, azithromycin alone, or neither.
MAIN OUTCOMES AND MEASURES Primary outcome was in-hospital mortality. Secondary
outcomes were cardiac arrest and abnormal electrocardiogram findings (arrhythmia
or QT prolongation).
RESULTS Among 1438 hospitalized patients with a diagnosis of COVID-19 (858 [59.7%] male,
median age, 63 years), those receiving hydroxychloroquine, azithromycin, or both were more
likely than those not receiving either drug to have diabetes, respiratory rate >22/min,
abnormal chest imaging findings, O2 saturation lower than 90%, and aspartate
aminotransferase greater than 40 U/L. Overall in-hospital mortality was 20.3% (95% CI,
18.2%-22.4%). The probability of death for patients receiving hydroxychloroquine +
azithromycin was 189/735 (25.7% [95% CI, 22.3%-28.9%]), hydroxychloroquine alone,
54/271 (19.9% [95% CI, 15.2%-24.7%]), azithromycin alone, 21/211 (10.0% [95% CI,
5.9%-14.0%]), and neither drug, 28/221 (12.7% [95% CI, 8.3%-17.1%]). In adjusted Cox
proportional hazards models, compared with patients receiving neither drug, there were no
significant differences in mortality for patients receiving hydroxychloroquine + azithromycin
(HR, 1.35 [95% CI, 0.76-2.40]), hydroxychloroquine alone (HR, 1.08 [95% CI, 0.63-1.85]), or
azithromycin alone (HR, 0.56 [95% CI, 0.26-1.21]). In logistic models, compared with patients
receiving neither drug cardiac arrest was significantly more likely in patients receiving
hydroxychloroquine + azithromycin (adjusted OR, 2.13 [95% CI, 1.12-4.05]), but not
hydroxychloroquine alone (adjusted OR, 1.91 [95% CI, 0.96-3.81]) or azithromycin alone
(adjusted OR, 0.64 [95% CI, 0.27-1.56]), . In adjusted logistic regression models, there were
no significant differences in the relative likelihood of abnormal electrocardiogram findings.
CONCLUSIONS AND RELEVANCE Among patients hospitalized in metropolitan New York with
COVID-19, treatment with hydroxychloroquine,..
Late treatment
is less effective
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