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2020 ; 97
(ä): 396-403
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English Wikipedia
Treatment with hydroxychloroquine, azithromycin, and combination in patients
hospitalized with COVID-19
#MMPMID32623082
Arshad S
; Kilgore P
; Chaudhry ZS
; Jacobsen G
; Wang DD
; Huitsing K
; Brar I
; Alangaden GJ
; Ramesh MS
; McKinnon JE
; O'Neill W
; Zervos M
Int J Infect Dis
2020[Aug]; 97
(ä): 396-403
PMID32623082
show ga
SIGNIFICANCE: The United States is in an acceleration phase of the COVID-19
pandemic. Currently there is no known effective therapy or vaccine for treatment
of SARS-CoV-2, highlighting urgency around identifying effective therapies.
OBJECTIVE: The purpose of this study was to evaluate the role of
hydroxychloroquine therapy alone and in combination with azithromycin in
hospitalized patients positive for COVID-19. DESIGN: Multi-center retrospective
observational study. SETTING: The Henry Ford Health System (HFHS) in Southeast
Michigan: large six hospital integrated health system; the largest of hospitals
is an 802-bed quaternary academic teaching hospital in urban Detroit, Michigan.
PARTICIPANTS: Consecutive patients hospitalized with a COVID-related admission in
the health system from March 10, 2020 to May 2, 2020 were included. Only the
first admission was included for patients with multiple admissions. All patients
evaluated were 18 years of age and older and were treated as inpatients for at
least 48h unless expired within 24h. EXPOSURE: Receipt of hydroxychloroquine
alone, hydroxychloroquine in combination with azithromycin, azithromycin alone,
or neither. MAIN OUTCOME: The primary outcome was in-hospital mortality. RESULTS:
Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4-10
days), median age was 64 years (IQR:53-76 years), 51% male, 56% African American,
with median time to follow-up of 28.5 days (IQR:3-53). Overall in-hospital
mortality was 18.1% (95% CI:16.6%-19.7%); by treatment:
hydroxychloroquine+azithromycin, 157/783 (20.1% [95% CI: 17.3%-23.0%]),
hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%-15.5%]), azithromycin
alone, 33/147 (22.4% [95% CI: 16.0%-30.1%]), and neither drug, 108/409 (26.4%
[95% CI: 22.2%-31.0%]). Primary cause of mortality was respiratory failure (88%);
no patient had documented torsades de pointes. From Cox regression modeling,
predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9-3.3]), white race
(HR:1.7 [95% CI:1.4-2.1]), CKD (HR:1.7 [95%CI:1.4-2.1]), reduced O2 saturation
level on admission (HR:1.5 [95%CI:1.1-2.1]), and ventilator use during admission
(HR: 2.2 [95%CI:1.4-3.3]). Hydroxychloroquine provided a 66% hazard ratio
reduction, and hydroxychloroquine+azithromycin 71% compared to neither treatment
(p<0.001). CONCLUSIONS AND RELEVANCE: In this multi-hospital assessment, when
controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone
and in combination with azithromycin was associated with reduction in COVID-19
associated mortality. Prospective trials are needed to examine this impact.
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