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Dados de Vida Real sobre o Uso da Hidroxicloroquina ou da Cloroquina Combinadas ou Não à Azitromicina em Pacientes com Covid-19: Uma Análise Retrospectiva no Brasil

Souza-Silva et al., Arquivos Brasileiros de Cardiologia, doi:10.36660/abc.20220935
Sep 2023  
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Mortality -5% Improvement Relative Risk Ventilation -21% ICU admission -9% Hospitalization time -12% HCQ for COVID-19  Souza-Silva et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 1,346 patients in Brazil (March - September 2020) Longer hospitalization with HCQ (p=0.033) c19hcq.org Souza-Silva et al., Arquivos Brasileir.., Sep 2023 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.
4,400+ studies for 79 treatments. c19hcq.org
Retrospective 7,580 hospitalized patients in Brazil, showing longer hospitalization, and no significant difference in mortality, mechanical ventilation, and ICU admission with HCQ treatment.
Authors note confounding by indication due to selected use in a compassionate use context. Authors match only on age, sex, cardiovascular comorbidities, and in-hospital use of corticosteroid, and only 10% of patients received HCQ/CQ, therefore confounding by indication is likely to be significant. A different matching list is included in the text, but neither includes COVID-19 severity.
In the first line of the abstract authors falsely state that there is no evidence of benefit for HCQ treatment. While misrepresenting prior research is common, this is an extreme case and raises concern for validity of the analysis. In reality 145 controlled studies show statistically significant positive results for one or more outcomes (including 11 RCTs)1-143. Authors discussion of prior research shows similar bias.
This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication likely; authors discussion of prior research exhibits strong bias, raising concern for bias in analysis.
risk of death, 5.5% higher, RR 1.05, p = 0.68, treatment 135 of 673 (20.1%), control 128 of 673 (19.0%).
risk of mechanical ventilation, 21.1% higher, RR 1.21, p = 0.08, treatment 145 of 538 (27.0%), control 120 of 539 (22.3%).
risk of ICU admission, 9.5% higher, RR 1.09, p = 0.31, treatment 196 of 559 (35.1%), control 179 of 559 (32.0%).
hospitalization time, 12.5% higher, relative time 1.12, p = 0.03, treatment median 9.0 IQR 13.0 n=673, control median 8.0 IQR 10.0 n=673.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Souza-Silva et al., 30 Sep 2023, retrospective, Brazil, peer-reviewed, median age 60.0, 29 authors, study period March 2020 - September 2020. Contact: dani_nunesp@hotmail.com.
This PaperHCQAll
Dados de Vida Real sobre o Uso da Hidroxicloroquina ou da Cloroquina Combinadas ou Não à Azitromicina em Pacientes com Covid-19: Uma Análise Retrospectiva no Brasil
Maíra Viana Rego Souza-Silva, Daniella Nunes Pereira, Magda Carvalho Pires, Isabela Muzzi Vasconcelos, Alexandre Vargas Schwarzbold, Diego Henrique De Vasconcelos, Elayne Crestani Pereira, Euler Roberto Fernandes Manenti, Felício Roberto Costa, Filipe Carrilho De Aguiar, Fernando Anschau, Frederico Bartolazzi, Guilherme Fagundes Nascimento, Heloisa Reniers Vianna, Joanna D’arc Lyra Batista, Juliana Machado-Rugolo, Karen Brasil Ruschel, Maria Angélica Pires Ferreira, Leonardo Seixas De Oliveira, Luanna Silva Monteiro Menezes, Patricia Klarmann Ziegelmann, Marcela Gonçalves Trindade Tofani, Maria Aparecida Camargos Bicalho, Matheus Carvalho Alves Nogueira, Milton Henriques Guimarães-Júnior, Rúbia Laura Oliveira Aguiar, Danyelle Romana Alves Rios, Carisi Anne Polanczyk, Milena Soriano Marcolino
Arquivos Brasileiros de Cardiologia, doi:10.36660/abc.20220935
Background: Despite no evidence showing benefits of hydroxychloroquine and chloroquine with or without azithromycin for COVID-19 treatment, these medications have been largely prescribed in Brazil. Objectives: To assess outcomes, including in-hospital mortality, electrocardiographic abnormalities, hospital length-of-stay, admission to the intensive care unit, and need for dialysis and mechanical ventilation, in hospitalized COVID-19 patients who received chloroquine or hydroxychloroquine, and to compare outcomes between those patients and their matched controls. Methods: A retrospective multicenter cohort study that included consecutive laboratory-confirmed COVID-19 patients from 37 Brazilian hospitals from March to September 2020. Propensity score was used to select matching controls by age, sex, cardiovascular comorbidities, and in-hospital use of corticosteroid. A p-value <0.05 was considered statistically significant. Results: From 7,850 COVID-19 patients, 673 (8.6%) received hydroxychloroquine and 67 (0.9%) chloroquine. The median age in the study group was 60 years (46 -71) and 59.1% were women. During hospitalization, 3.2% of patients presented side effects and 2.2% required therapy discontinuation. Electrocardiographic abnormalities were more prevalent in the chloroquine/hydroxychloroquine group (13.2% vs. 8.2%, p=0.01), and the long corrected QT interval was the main difference (3.6% vs. 0.4%, p<0.001). The median hospital length of stay was longer in the HCQ/CQ + AZT group than in controls (9.0 [5.0, 18.0] vs. 8.0 [4.0, 14.0] days). There was no statistical differences between groups in intensive care unit admission (35.1% vs. 32.0%; p=0.282), invasive mechanical ventilation support (27.0% vs. 22.3%; p=0.074) or mortality (18.9% vs. 18.0%; p=0.682). Conclusion: COVID-19 patients treated with chloroquine or hydroxychloroquine had a longer hospital length of stay, when compared to matched controls. Intensive care unit admission, invasive mechanical ventilation, dialysis and inhospital mortality were similar.
Potential conflict of interest No potential conflict of interest relevant to this article was reported. Sources of funding Study association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This study was approved by the Comitê Nacional de Ética em Pesquisa under the protocol number CAAE 30350820.5.1001.0008. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013.
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Intensive Care Med. 2023;49(2):166-77. doi: ' '10.1007/s00134-022-06953-1.', 'journal-title': 'Intensive Care Med'}], 'container-title': 'Arquivos Brasileiros de Cardiologia', 'original-title': [], 'language': 'en', 'deposited': { 'date-parts': [[2023, 10, 4]], 'date-time': '2023-10-04T11:41:38Z', 'timestamp': 1696419698000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://abccardiol.org/article/dados-de-vida-real-sobre-o-uso-da-hidroxicloroquina-ou-da-cloroquina-combinadas-ou-nao-a-azitromicina-em-pacientes-com-covid-19-uma-analise-retrospectiva-no-brasil/'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 9]]}, 'references-count': 22, 'journal-issue': {'issue': '9', 'published-print': {'date-parts': [[2023, 10, 3]]}}, 'alternative-id': ['10.36660/abc.20220935'], 'URL': 'http://dx.doi.org/10.36660/abc.20220935', 'relation': {}, 'ISSN': ['0066-782X', '1678-4170'], 'subject': ['Cardiology and Cardiovascular Medicine'], 'published': {'date-parts': [[2023, 9]]}}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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