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2020 ; 323
(24
): 2493-2502
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Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital
Mortality in Patients With COVID-19 in New York State
#MMPMID32392282
Rosenberg ES
; Dufort EM
; Udo T
; Wilberschied LA
; Kumar J
; Tesoriero J
; Weinberg P
; Kirkwood J
; Muse A
; DeHovitz J
; Blog DS
; Hutton B
; Holtgrave DR
; Zucker HA
JAMA
2020[Jun]; 323
(24
): 2493-2502
PMID32392282
show ga
IMPORTANCE: Hydroxychloroquine, with or without azithromycin, has been considered
as a possible therapeutic agent for patients with coronavirus disease 2019
(COVID-19). However, there are limited data on efficacy and associated adverse
events. OBJECTIVE: To describe the association between use of hydroxychloroquine,
with or without azithromycin, and clinical outcomes among hospital inpatients
diagnosed with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Retrospective
multicenter cohort study of patients from a random sample of all admitted
patients with laboratory-confirmed COVID-19 in 25 hospitals, representing 88.2%
of patients with COVID-19 in the New York metropolitan region. Eligible patients
were admitted for at least 24 hours between March 15 and 28, 2020. Medications,
preexisting conditions, clinical measures on admission, outcomes, and adverse
events were abstracted from medical records. The date of final follow-up was
April 24, 2020. EXPOSURES: Receipt of both hydroxychloroquine and azithromycin,
hydroxychloroquine alone, azithromycin alone, or neither. MAIN OUTCOMES AND
MEASURES: Primary outcome was in-hospital mortality. Secondary outcomes were
cardiac arrest and abnormal electrocardiogram findings (arrhythmia or QT
prolongation). RESULTS: Among 1438 hospitalized patients with a diagnosis of
COVID-19 (858 [59.7%] male, median age, 63 years), those receiving
hydroxychloroquine, azithromycin, or both were more likely than those not
receiving either drug to have diabetes, respiratory rate >22/min, abnormal chest
imaging findings, O2 saturation lower than 90%, and aspartate aminotransferase
greater than 40 U/L. Overall in-hospital mortality was 20.3% (95% CI,
18.2%-22.4%). The probability of death for patients receiving
hydroxychloroquine?+?azithromycin was 189/735 (25.7% [95% CI, 22.3%-28.9%]),
hydroxychloroquine alone, 54/271 (19.9% [95% CI, 15.2%-24.7%]), azithromycin
alone, 21/211 (10.0% [95% CI, 5.9%-14.0%]), and neither drug, 28/221 (12.7% [95%
CI, 8.3%-17.1%]). In adjusted Cox proportional hazards models, compared with
patients receiving neither drug, there were no significant differences in
mortality for patients receiving hydroxychloroquine?+?azithromycin (HR, 1.35 [95%
CI, 0.76-2.40]), hydroxychloroquine alone (HR, 1.08 [95% CI, 0.63-1.85]), or
azithromycin alone (HR, 0.56 [95% CI, 0.26-1.21]). In logistic models, compared
with patients receiving neither drug cardiac arrest was significantly more likely
in patients receiving hydroxychloroquine?+?azithromycin (adjusted OR, 2.13 [95%
CI, 1.12-4.05]), but not hydroxychloroquine alone (adjusted OR, 1.91 [95% CI,
0.96-3.81]) or azithromycin alone (adjusted OR, 0.64 [95% CI, 0.27-1.56]), . In
adjusted logistic regression models, there were no significant differences in the
relative likelihood of abnormal electrocardiogram findings. CONCLUSIONS AND
RELEVANCE: Among patients hospitalized in metropolitan New York with COVID-19,
treatment with hydroxychloroquine, azithromycin, or both, compared with neither
treatment, was not significantly associated with differences in in-hospital
mortality. However, the interpretation of these findings may be limited by the
observational design.
|*Hospital Mortality
[MESH]
|Adolescent
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Anti-Infective Agents/adverse effects/*therapeutic use
[MESH]
|Arrhythmias, Cardiac/chemically induced
[MESH]
|Azithromycin/adverse effects/*therapeutic use
[MESH]