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Real-Life Data on Hydroxychloroquine or Chloroquine with or Without Azithromycin in COVID-19 Patients: A
Maíra Viana Rego Souza-Silva1, Daniella Nunes Pereira1, Magda Carvalho Pires2
1Faculdade de Medicina - Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil.
Insights
Hydroxychloroquine and chloroquine treatment for COVID-19 did not improve outcomes but increased hospital stay. No significant differences were found in mortality or intensive care unit admission compared to controls.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Hydroxychloroquine (HCQ) and chloroquine (CQ) were widely prescribed for COVID-19 in Brazil despite lacking evidence of efficacy.
- This study investigated the real-world outcomes of HCQ/CQ use in hospitalized COVID-19 patients.
Purpose of the Study:
- To assess the impact of HCQ/CQ treatment on in-hospital mortality, adverse events, and resource utilization in COVID-19 patients.
- To compare outcomes between COVID-19 patients treated with HCQ/CQ and matched controls.
Main Methods:
- Retrospective multicenter cohort study of 7,850 COVID-19 patients from 37 Brazilian hospitals (March-September 2020).
- Propensity score matching was used to create a control group based on age, sex, comorbidities, and corticosteroid use.
- Outcomes included mortality, ICU admission, mechanical ventilation, dialysis, length of stay, and electrocardiographic abnormalities.
Main Results:
- 13.2% of patients receiving HCQ/CQ experienced electrocardiographic abnormalities, compared to 8.2% in controls (p=0.01).
- The median hospital length of stay was longer for patients treated with HCQ/CQ (9.0 days) versus controls (8.0 days).
- No significant differences were observed in in-hospital mortality (18.9% vs. 18.0%), ICU admission (35.1% vs. 32.0%), or need for mechanical ventilation (27.0% vs. 22.3%).
Conclusions:
- Treatment with chloroquine or hydroxychloroquine in hospitalized COVID-19 patients was associated with a longer hospital stay.
- HCQ/CQ treatment did not lead to significant differences in intensive care unit admission, mechanical ventilation, dialysis, or in-hospital mortality compared to matched controls.
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 in-hospital mortality were similar.
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