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0 0.5 1 1.5 2+ Mortality 27% Improvement Relative Risk Mortality (b) 93% HCQ for COVID-19  Smith et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 255 patients in the USA Lower mortality with HCQ (p=0.0024) Smith et al., medRxiv, May 2021 Favors HCQ Favors control

Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic

Smith et al., medRxiv, doi:10.1101/2021.05.28.21258012
May 2021  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 421 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
Retrospective 255 mechanical ventilation patients in USA, showing that weight-adjusted HCQ+AZ improved survival by over 100%. QTc prolongation did not correlate with cumulative HCQ dose or HCQ serum level.
Although authors mention immortal time bias, full details on the timing of HCQ administration is not provided and this is not fully addressed. Survival curves indicate immortal time bias will significantly change results, although the observed benefit appears to exceed the potential bias.
This study is excluded in the after exclusion results of meta analysis: immortal time bias may significantly affect results.
risk of death, 27.2% lower, RR 0.73, p = 0.002, treatment 19 of 37 (51.4%), control 182 of 218 (83.5%), NNT 3.1, odds ratio converted to relative risk, >3g HCQ and >1g AZ, multivariable cox proportional hazard regression.
risk of death, 92.9% lower, OR 0.07, p < 0.001, inverted to make OR<1 favor treatment, ≥80mg/kg HCQ and >1g AZ, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Smith et al., 31 May 2021, retrospective, USA, preprint, 4 authors.
This PaperHCQAll
Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
Leon G Smith, Nicolas Mendoza, David Dobesh, Stephen M Smith
All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
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Late treatment
is less effective
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