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0 0.5 1 1.5 2+ Mortality -17% Improvement Relative Risk Death/ICU -78% Hospitalization -45% HCQ for COVID-19  Trefond et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 262 patients in France Higher death/ICU (p=0.21) and hospitalization (p=0.12), not sig. Trefond et al., Revue du Rhumatisme, Jan 2021 Favors HCQ Favors control

Effet d’un traitement par hydroxychloroquine prescrit comme traitement de fond de rhumatismes inflammatoires chroniques ou maladies auto-immunes systémiques sur les tests diagnostiques et l’évolution de l’infection à SARS CoV-2: étude de 871 patients

Trefond et al., Revue du Rhumatisme, doi:10.1016/j.rhum.2021.09.004 (date from preprint)
Jan 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 71 chronic HCQ patients compared with 191 matched controls, analyzing only those with a highly suspected or confirmed diagnosis of COVID-19. No significant difference was found in outcomes, however matching failed with extreme confounding - 77.5% of HCQ patients with systemic autoimmune diseases vs. 21.5% of control patients.
Other research shows that the risk of COVID-19 for systemic autoimmune disease patients is much higher overall, Ferri et al. show OR 4.42, p<0.001 Ferri.
This study is excluded in the after exclusion results of meta analysis: not fully adjusting for the different baseline risk of systemic autoimmune patients; significant unadjusted confounding possible; excessive unadjusted differences between groups.
risk of death, 16.6% higher, RR 1.17, p = 0.80, treatment 4 of 68 (5.9%), control 12 of 183 (6.6%), adjusted per study, odds ratio converted to relative risk.
risk of death/ICU, 78.2% higher, RR 1.78, p = 0.21, treatment 8 of 71 (11.3%), control 18 of 191 (9.4%), adjusted per study, odds ratio converted to relative risk.
risk of hospitalization, 44.9% higher, RR 1.45, p = 0.12, treatment 24 of 71 (33.8%), control 53 of 191 (27.7%), adjusted per study, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Trefond et al., 27 Jan 2021, retrospective, France, peer-reviewed, 21 authors.
This PaperHCQAll
Effet d’un traitement par hydroxychloroquine prescrit comme traitement de fond de rhumatismes inflammatoires chroniques ou maladies auto-immunes systémiques sur les tests diagnostiques et l’évolution de l’infection à SARS CoV-2 : étude de 871 patients
Ludovic Trefond, Elodie Drumez, Marc Andre, Nathalie Costedoat-Chalumeau, Raphaèle Seror, Mathilde Devaux, Emmanuelle Dernis, Yannick Dieudonne, Soumaya El Mahou, Aurelia Lanteri, Isabelle Melki, Viviane Queyrel, Mathilde Roumier, Jean Schmidt, Thomas Barnetche, Thierry Thomas, Patrice Cacoub, Alexandre Belot, Olivier Aumaitre, Christophe Richez, Eric Hachulla
Revue du Rhumatisme, doi:10.1016/j.rhum.2021.09.004
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Nous remercions Elodie Drumez, Julien Labreuche (biostatisticien, CHU-Lille), et Thomas Barnetche (chef de projet, CHU-Bordeaux), pour l'analyse statistique et pour l'aide à la préparation de ce manuscrit. Nick Barton a aidé à la préparation de ce manuscrit, conformément aux Good Publication Practice (GPP3) guidelines. J o u r n a l P r e -p r o o f
Cohen, Hydroxychloroquine for the Prevention of Covid-19 -Searching for Evidence, N Engl J Med
Contributors, Sofremip/, CRI/IMIDIATE consortium and. Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients, Ann Rheum Dis
Gautret, Lagier, Parola, Hoang, Meddeb et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial, Int J Antimicrob Agents
Geleris, Sun, Platt, Zucker, Baldwin et al., Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19, N Engl J Med
Jallouli, Francès, Piette, Huong, Moguelet et al., Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus: a case-control study, JAMA Dermatol
Schrezenmeier, Dörner, Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology, Nat Rev Rheumatol
Skipper, Pastick, Engen, Bangdiwala, Abassi et al., Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 : A Randomized Trial, Ann Intern Med
Wang, Cao, Zhang, Yang, Liu et al., Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res
Williamson, Walker, Bhaskaran, Bacon, Bates et al., Factors associated with COVID-19-related death using OpenSAFELY, Nature
Yao, Ye, Zhang, Cui, Huang et al., In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clin Infect Dis Off Publ Infect Dis Soc Am
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