Published On May 27, 2020
Low Dose of Hydroxychloroquine Reduces Fatality of Critically Ill Patients With COVID-19 (15th March)
China Life Science
https://pubmed.ncbi.nlm.nih.gov/32418...
Does hydroxychloroquine reduce the death risk of critically ill COVID-19 patients.
Retrospective study
550 critically ill COVID-19 patients
Wuhan, from February 1, 2020 to April 4, 2020.
550 patients received comparable basic treatments including antiviral drugs and antibiotics
48 of them were treated with oral HCQ for 7-10 days
Primary endpoint is fatality of patients, and inflammatory cytokine levels
Compared between HCQ and non-hydroxychloroquine (NHCQ) groups
18.8% (9/48) deaths in HCQ group
47.4% (238/502) in the NHCQ group (P less than 0.001)
Inflammatory cytokine IL-6 significantly reduced in the HCL group
But there was no change in the NHCQ group
HCQ is highly effective in reducing deaths by reducing the cytokine storm
HCQ should be prescribed for critically ill COVID-19 patients
Hydroxychloroquine
Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. (NEJM 7th May)
https://www.nejm.org/doi/full/10.1056...
CONCLUSIONS
Hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of intubation or death
Findings do not support the use of hydroxychloroquine at present, outside randomized clinical trials testing its efficacy
Clinical guidance at our medical center has been updated to remove the suggestion that patients with Covid-19 be treated with hydroxychloroquine
Hydroxychloroquine or chloroquine, with or without a macrolide, for the treatment of COVID-19, a multinational registry analysis (22nd May)
https://www.thelancet.com/journals/la...
https://www.thelancet.com/journals/la...
Background
Azithromycin, clarithromycin, (erythromycin)
HC and C are generally safe when used for approved indications such as autoimmune disease or malaria
The safety and benefit of these treatment regimens are poorly evaluated in COVID-19.
Hydroxychloroquine has been shown to have in-vitro activity against the SARS-CoV-2
Recently published human trials, along with other unpublished data, suggest that it could decrease the duration of viral shedding and symptoms if given early.
Method
671 hospitals in six continents
Included patients hospitalised between Dec 20, 2019, and April 14, 2020
With a positive laboratory finding for SARS-CoV-2
Patients treated within 48 h of diagnosis
4 patient groups, total n = 14,888
Chloroquine alone, n = 1,868
Chloroquine with a macrolide, n = 3,783
Hydroxychloroquine alone n = 3,016
Hydroxychloroquine with a macrolide n = 6,221
Patients who received none of these treatments, n = 81,144
Excluded patients
Patients in whom treatments were started more than 48 hours after diagnosis
Patients on mechanical ventilation
Patients who received remdesivir
Findings
96 032 patients with COVID-19 were hospitalised during the study period and met the inclusion criteria.
Controlled for multiple confounding factors
Age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity
In hospital Mortality de-novo ventricular arrhythmia
Control group 9·3% 0.3%
Hydroxychloroquine 18·0% 6.1%
Hydroxychloroquine
with a macrolide 23·8% 8.1%
Chloroquine 16·4% 4.3%
Chloroquine
with a macrolide 22·2% 6.5%
Interpretation
Unable to confirm a benefit of hydroxychloroquine or chloroquine
Used alone or with a macrolide
Each of these drug regimens was associated with;
Decreased in-hospital survival, p less than 0·0001
Increased frequency of ventricular arrhythmias when used for treatment of COVID-19
Independent predictors of in-hospital mortality
Age
BMI
Black race or Hispanic ethnicity
Coronary artery disease
Congestive heart failure
History of arrhythmia
Diabetes
Hypertension
Hyperlipidaemia
COPD
Current smoker
Immunosuppressed condition
Associated with reduced in-hospital mortality risk
Female
Asian origin
ACE inhibitors (but not angiotensin receptor blockers)
Statins