LOS ANGELES - A surprising new study found that the controversial drug hydroxychloroquine was associated with a significant reduction in mortality among sick patients hospitalized with COVID-19.
A team at Henry Ford Health System in Detroit, Michigan studied 2,541 patients hospitalized with a COVID-related admission between March 10 to May 2.“Our analysis shows that using hydroxychloroquine helped saves lives,” said neurosurgeon Dr. Steven Kalkanis, CEO, Henry Ford Medical Group and Senior Vice President and Chief Academic Officer of Henry Ford Health System.“As doctors and scientists, we look to the data for insight. And the data here is clear that there was benefit to using the drug as a treatment for sick, hospitalized patients," Kalkanis said.The purpose of this study was to evaluate the role of hydroxychloroquine therapy alone and in combination with azithromycin in patients with the virus.The study found 13% of those treated with hydroxychloroquine alone died compared to 26.4% not treated with the drug.“Hydroxychloroquine, an antimalarial and immunomodulatory agent and a safer analogue of chloroquine, has demonstrated antiviral activity against SARS-CoV-2”, the study published in the International Journal of Infectious Diseases read.
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.
"All patients observed in the study were at least 18 years old and the majority of patients received the drug soon after admission. Ninety-one percent of said patients received the drug within 48 hours of admission to the hospital.The study describes how patients were given two 400 mg doses of hydroxychloroquine on the first day, followed by two doses of 200 mg on days 2-5. Patients received one 500 mg dose of azithromycin on the first day of the study, followed by another daily 250 mg dose for the next four days.The combination of the two drugs was reserved for patients with severe COVID-19 symptoms and minimal cardiac risk factors.“Considered in the context of current studies on the use of hydroxychloroquine for COVID-19, our results suggest that the drug may have an important role to play in reducing COVID-19 mortality,” Dr. Marcus Zervos, division head of Infectious Disease for Henry Ford Health System said.