Abstract
Background: The global push for the use of hydroxychloroquine (HCQ) and chloroquine (CQ) against COVID-19 has resulted in an ongoing discussion about the effectivity and toxicity of these drugs. Recent studies report no effect of (H)CQ on 28-day mortality. We investigated the effect of HCQ and CQ in hospitalized patients on the non-ICU COVID-ward.
Methods: A nationwide, observational cohort study was performed in The Netherlands. Hospitals were given the opportunity to decide independently on the use of three different COVID-19 treatment strategies: HCQ, CQ, or no treatment. We compared the outcomes between these groups. The primary outcomes were 1) death on the COVID-19 ward, and 2) transfer to the intensive care unit (ICU).
Results: The analysis included 1064 patients from 14 hospitals: 566 patients received treatment with either HCQ (n = 189) or CQ (n = 377), and 498 patients received no treatment. In a multivariate propensity-matched weighted competing regression analysis, there was no significant effect of (H)CQ on mortality on the COVID ward. However, HCQ was associated with a significantly decreased risk of transfer to the ICU (hazard ratio (HR) = 0.47, 95% CI = 0.27-0.82, p = 0.008) when compared with controls. This effect was not found in the CQ group (HR = 0.80, 95% CI = 0.55-1.15, p = 0.207), and remained significant after competing risk analysis.
Conclusion: The results of this observational study demonstrate a lack of effect of (H)CQ on non-ICU mortality. However, we show that the use of HCQ – but not CQ – is associated with a 53% reduction in risk of transfer of COVID-19 patients from the regular ward to the ICU. Recent prospective studies have reported on 28-day, all-cause mortality only; therefore, additional prospective data on the early effects of HCQ in preventing transfer to the ICU are still needed.
Keywords: Azithromycin; COVID-19; Chloroquine; Clinical course; Hydroxychloroquine.
【저자키워드】 COVID-19, Chloroquine, Azithromycin, Hydroxychloroquine, Clinical course, 【초록키워드】 Treatment, Chloroquine, Azithromycin, Mortality, Hydroxychloroquine, intensive care, Prospective Study, intensive care unit, 28-day mortality, drugs, risk, Toxicity, outcome, hospitalized patients, observational study, ICU, COVID, clinical, Patient, death, HCQ, Analysis, COVID-19 patient, Netherlands, no effect, regression analysis, Observational cohort study, Primary outcome, 95% CI, no significant effect, hazard ratio, Primary outcomes, all-cause mortality, non-ICU, transfer, Effect, recent, controls, lack, significantly, reported, investigated, remained, was performed, were given, hospitalized patient, groups, reduction in, competing, use of hydroxychloroquine, 【제목키워드】 Chloroquine, ICU admission, COVID-19 patient, reduce,