“Efficacy and Safety of Fixed Combination of Hydroxychloroquine with Azithromycin Versus Hydroxychloroquine and Placebo in Patients with Mild COVID-19: Randomized, double blind, Placebo controlled trial”
Ivonne A Roy-García, Moises Moreno-Noguez, Rodolfo Rivas-Ruiz, Marta Zapata-Tarres, Marcela Perez-Rodriguez, Magaly A Ortiz-Zamora, Lourdes Gabriela Navarro-Susano, Lilia M Guzman-Rivas, Luis Rey Garcia-Cortes, Icela Palma-Lara, Pedro Gutierrez-Catrellón
doi:10.1101/2022.04.06.22273531
To determine the efficacy and safety of fixed combination of hydroxychloroquine/azithromycin (HCQ+AZT) compared to hydroxychloroquine (HCQ) alone or placebo in mild COVID-19 outpatients to avoid hospitalization.
Materials and methods This randomized, parallel, double-blind clinical trial included male and female patients aged 18 and 76 years non COVID vaccinated, who were diagnosed with mild COVID-19 infection. All patients underwent liver and kidney profile test, as well as a health questionnaire and clinical revision to document that they did not have uncontrolled comorbidities. They were randomly assigned to one of the three treatment arms: 1) hydroxychloroquine with azithromycin 200 mg/250 mg every 12 hours for five days followed by hydroxychloroquine 200 mg every 12 hours for 5 days; 2) hydroxychloroquine 200 mg every 12 hours for ten days; or 3) placebo every 12 hours for ten days. The primary outcome of the study was hospitalization, while the secondary outcomes were disease progression, pneumonia, use of supplemental oxygen, and adverse events. This study was registered in clinicaltrials.gov with the NCT number of 04964583.
Results A total of 92 participants were randomized. Of whom, 30 received HCQ+AZT, 31 received HCQ, and 31 received placebo. The median age was 37 years, 27.2% of the participants had comorbidities, and the global incidence of hospitalization was .
References
Albani, Fusina, Giovannini, Ferretti, Granato et al., Impact of Azithromycin and/or Hydroxychloroquine on Hospital Mortality in COVID-19, J Clin Med
Andreani, Le Bideau, Duflot, Jardot, Rolland et al., In vitro testing of combined hydroxychloroquine and azithromycin on SARS-CoV-2 shows synergistic effect, Microb Pathog
Andreani, Le Bideau, Duflot, Prolland, Boxberger et al., In vitro testing of combined hydroxychloroquine and azithromycin on SARS-CoV-2 shows synergistic effect, Microb Pathog
Cavalcanti, Zampieri, Rosa, Azevedo, Veiga et al., Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19
Chen, Liu, Liu, Liu, Xu et al., A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19
Echeverría-Esnal, Martin-Ontiyuelo, Navarrete-Rouco, Cuscó, Ferrández et al., Azithromycin in the treatment of COVID-19: a review, Expert Rev Anti Infect Ther
Garcia-Zamora, Lee, Haseeb, Bazoukis, Tse et al., Arrhythmias and electrocardiographic findings in Coronavirus disease 2019: A systematic review and meta-analysis, Pacing Clin Electrophysiol
Gautret, Lagier, Parola, Hoang, Meddeb et al., Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a sixday follow up: A pilot observational study, Travel Med Infect Dis
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, Int J Antimicrob Agents
Gautret, Million, Jarrot, Camoin-Jau, Colson et al., Natural history of COVID-19 and therapeutic options, Expert Rev Clin Immunol
Geleris, Sun, Platt, Zucker, Baldwin et al., Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19, N Engl J Med
Huang, Yang, Shang, Zheng, Zhao et al., Clinical Characteristics and Predictors of Disease Progression in Severe Patients with COVID-19 Infection in Jiangsu Province, China: A Descriptive Study, Am J Med Sci
Kelly, Connor, Townsend, Coghlan, Relihan et al., Clinical outcomes and adverse events in patients hospitalised with COVID-19, treated with off-label hydroxychloroquine and azithromycin, Br J Clin Pharmacol
Kim, Coppa, Hirsch, Abrahams, Johnson et al., Examination of patient characteristics and hydroxychloroquine use based on the US Food and Drug Administration's recommendation: a cross-sectional analysis in New York, BMJ Open
Kuderer, Choueiri, Shah, Shyr, Rubinstein et al., Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study, Lancet
Maisonnasse, Guedj, Contreras, Behillil, Solas et al., Hydroxychloroquine use against SARS-CoV-2 infection in non-human primates, Nature
Manolis, Manolis, Manolis, Apostolopoulos, Papatheou et al., COVID-19 infection and cardiac arrhythmias, Trends Cardiovasc Med
Morgenstern-Kaplan, Buitano-Tang, Martínez-Gil, Pavón, Talavera, U-shaped-aggressiveness of SARS-CoV-2: Period between initial symptoms and clinical progression to COVID-19 suspicion. A population-based cohort study, PLoS One
Ramadan, Bertolino, Zampino, Mangoni, Hospital et al., Study Group. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review, Clin Microbiol Infect
Reis, Silva, Silva, Thabane, Singh et al., Effect of Early Treatment With Hydroxychloroquine or Lopinavir and Ritonavir on Risk of Hospitalization Among Patients With COVID-19: The TOGETHER Randomized Clinical Trial, JAMA Netw Open
Rivas-Ruiz, Roy-García, Pérez-Rodríguez, Berea, Moreno-Palacios et al., The relevance and irrelevance of charts in clinical research, Rev Alerg Mex
Roques, Thiberville, Dupuis-Maguiraga, Lum, Labadie et al., Paradoxical Effect of Chloroquine Treatment in Enhancing Chikungunya Virus Infection, Viruses
Savarino, Boelaert, Cassone, Majori, Cauda, Effects of chloroquine on viral infections: an old drug against today's diseases?, Lancet Infect Dis
Schwartz, Boesen, Cerchiaro, Doram, Edwards et al., Assessing the efficacy and safety of hydroxychloroquine as outpatient treatment of COVID-19: a randomized controlled trial, CMAJ Open
Skipper, Da, Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 : A Randomized Trial, Ann Intern Med
Talavera, Rivas-Ruiz, Clinical research IV. Relevancy of the statistical test chosen, Rev Med Inst Mex Seguro Soc
Wang, Cao, Zhang, Yang, Liu et al., Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res
Álvarez-Maldonado, Hernández-Ríos, Ambríz-Mondragón, Gordillo-Mena, Morales-Serrano et al., Characteristics and mortality of Mexican patients with COVID-19 and mechanical ventilation, Gac Med Mex
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'abstract': '<jats:p>To determine the efficacy and safety of fixed combination of '
'hydroxychloroquine/azithromycin (HCQ+AZT) compared to hydroxychloroquine (HCQ) alone or '
'placebo in mild COVID-19 outpatients to avoid hospitalization.Materials and '
'methods\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0'
'This randomized, parallel, double-blind clinical trial included male and female patients aged '
'18 and 76 years non COVID vaccinated, who were diagnosed with mild COVID-19 infection. All '
'patients underwent liver and kidney profile test, as well as a health questionnaire and '
'clinical revision to document that they did not have uncontrolled comorbidities. They were '
'randomly assigned to one of the three treatment arms: 1) hydroxychloroquine with azithromycin '
'200 mg/250 mg every 12 hours for five days followed by hydroxychloroquine 200 mg every 12 '
'hours for 5 days; 2) hydroxychloroquine 200 mg every 12 hours for ten days; or 3) placebo '
'every 12 hours for ten days. The primary outcome of the study was hospitalization, while the '
'secondary outcomes were disease progression, pneumonia, use of supplemental oxygen, and '
'adverse events. This study was registered in clinicaltrials.gov with the NCT number of '
'04964583.ResultsA total of 92 participants were randomized. Of whom, 30 received HCQ+AZT, 31 '
'received HCQ, and 31 received placebo. The median age was 37 years, 27.2% of the participants '
'had comorbidities, and the global incidence of hospitalization was 2.2%. The incidence of '
'hospitalization was 6.7% (2/30) in the HCQ+AZT group compared to the HCQ or placebo groups, '
'in which there were no hospitalizations. Progression of disease was higher in the HCQ group '
'[RR=3.25 (95% CI, 1.19-8.87)] compared with placebo group. There was no statistical '
'difference between the HCQ+AZT group and the placebo group in progression of disease. The '
'incidence of pneumonia was 30% in the HCQ+AZT group, 32.2% in the HCQ group, and 9.6% in the '
'placebo group (HCQ + AZT vs Placebo; p=0.06). There was a significant risk of pneumonia '
'versus placebo only in the HCQ group [RR=3.33 (95% CI, 1.01-10.9)]. Supplemental oxygen was '
'required by 20% (6/30) of the patients in the HCQ+AZT group, 6.4 (2/31) of the patients in '
'the HCQ group, and 3.2% (1/31) of the patients in the placebo group,[(HCQ + AZT vs Placebo; '
'p=0.100), (HCQ vs Placebo, p=0.610)]. There was no statistical difference between groups for '
'negative test (PCR) on day 11. The most frequent adverse events were gastrointestinal '
'symptoms. No lengthening of the QT interval was observed in patients receiving HCQ+AZT or '
'HCQ.ConclusionThe use of HCQ+AZT does not decrease the risk of hospitalization in patients '
'with mild COVID-19. The use of HCQ increases the risk of progression and pneumonia.</jats:p>',
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{'given': 'Lilia', 'family': 'Guzman-Rivas', 'sequence': 'additional', 'affiliation': []},
{'given': 'Luis R', 'family': 'Garcia-Cortes', 'sequence': 'additional', 'affiliation': []},
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