Low-dose Hydroxychloroquine Therapy, Mortality in Hospitalized with COVID-19

LucyCatteauPharmD, PhD^afi#NicolasDaubyMD, PhD^bcdfi#MarionMontourcyMSc^afiEmmanuelBottieauMD, PhD^efiJorisHautekietMSc^agfiElsGoetghebeurPhD^figSabrinavan IersselMD, PhD^fihElsDuysburghMD, MPH, PhD^afiHermanVan OyenMD, DrPH^afhiChloéWyndham-ThomasMD, PhD^afiDominiqueVan BeckhovenMD, MSc^afiBelgian Collaborative Group on COVID-19 hospital surveillance

https://doi.org/10.1016/j.ijantimicag.2020.106144

PDF: https://www.sciencedirect.com/science/article/pii/S0924857920303423/pdfft?md5=40ccefd2e6665d5ddbbc7b2e4cf80990&pid=1-s2.0-S0924857920303423-main.pdf

Highlights

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Hydroxychloroquine (HCQ) 2400 mg during 5 days was used in Belgium for COVID-19•

Impact of HCQ on mortality among 8075 patients with COVID-19 was assessed•

Lower mortality in HCQ-treated patients as compared to supportive care•

Lower mortality is irrespective of symptoms duration

Abstract

Background

Hydroxychloroquine (HCQ) has been largely used and investigated as therapy of COVID-19 across various settings, at total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of low-dose HCQ (2400 mg in total over five days) was recommended for hospitalized patients with COVID-19.

Methods

We conducted a retrospective analysis of in-hospital mortality in the Belgian national COVID-19 hospital surveillance data. Patients treated either with HCQ alone and supportive care (HCQ group) were compared to patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors.

Results

Of 8075 patients with complete discharge data on 24^th of May and diagnosed before the 1^st of May, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable analysis, the mortality was lower in the HCQ group compared to the no-HCQ group (adjusted hazard ratio [HR] 0.684, 95% confidence interval [CI] 0.617–0.758). Compared to the no-HCQ group, mortality in the HCQ group was reduced both in patients diagnosed ≤ 5 days (n=3975) and > 5 days (n=3487) after symptom onset (adjusted HR 0.701, 95% CI 0.617–0.796 and adjusted HR 0.647, 95% CI 0.525–0.797, respectively).

Conclusions

Compared to supportive care only, low-dose HCQ monotherapy was independently associated with lower mortality in hospitalized patients with COVID-19 diagnosed and treated early or later after symptom onset.

https://www.sciencedirect.com/science/article/pii/S0924857920303423