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Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19.


ABSTRACT: Background: Hydroxychloroquine and azithromycin have been used to treat patients with coronavirus disease 2019 (Covid-19). However, evidence on the safety and efficacy of these therapies is limited.

Methods: We conducted a multicenter, randomized, open-label, three-group, controlled trial involving hospitalized patients with suspected or confirmed Covid-19 who were receiving either no supplemental oxygen or a maximum of 4 liters per minute of supplemental oxygen. Patients were randomly assigned in a 1:1:1 ratio to receive standard care, standard care plus hydroxychloroquine at a dose of 400 mg twice daily, or standard care plus hydroxychloroquine at a dose of 400 mg twice daily plus azithromycin at a dose of 500 mg once daily for 7 days. The primary outcome was clinical status at 15 days as assessed with the use of a seven-level ordinal scale (with levels ranging from one to seven and higher scores indicating a worse condition) in the modified intention-to-treat population (patients with a confirmed diagnosis of Covid-19). Safety was also assessed.

Results: A total of 667 patients underwent randomization; 504 patients had confirmed Covid-19 and were included in the modified intention-to-treat analysis. As compared with standard care, the proportional odds of having a higher score on the seven-point ordinal scale at 15 days was not affected by either hydroxychloroquine alone (odds ratio, 1.21; 95% confidence interval [CI], 0.69 to 2.11; P?=?1.00) or hydroxychloroquine plus azithromycin (odds ratio, 0.99; 95% CI, 0.57 to 1.73; P?=?1.00). Prolongation of the corrected QT interval and elevation of liver-enzyme levels were more frequent in patients receiving hydroxychloroquine, alone or with azithromycin, than in those who were not receiving either agent.

Conclusions: Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care. (Funded by the Coalition Covid-19 Brazil and EMS Pharma; ClinicalTrials.gov number, NCT04322123.).

SUBMITTER: Cavalcanti AB 

PROVIDER: S-EPMC7397242 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19.

Cavalcanti Alexandre B AB   Zampieri Fernando G FG   Rosa Regis G RG   Azevedo Luciano C P LCP   Veiga Viviane C VC   Avezum Alvaro A   Damiani Lucas P LP   Marcadenti Aline A   Kawano-Dourado Letícia L   Lisboa Thiago T   Junqueira Debora L M DLM   de Barros E Silva Pedro G M PGM   Tramujas Lucas L   Abreu-Silva Erlon O EO   Laranjeira Ligia N LN   Soares Aline T AT   Echenique Leandro S LS   Pereira Adriano J AJ   Freitas Flávio G R FGR   Gebara Otávio C E OCE   Dantas Vicente C S VCS   Furtado Remo H M RHM   Milan Eveline P EP   Golin Nicole A NA   Cardoso Fábio F FF   Maia Israel S IS   Hoffmann Filho Conrado R CR   Kormann Adrian P M APM   Amazonas Roberto B RB   Bocchi de Oliveira Monalisa F MF   Serpa-Neto Ary A   Falavigna Maicon M   Lopes Renato D RD   Machado Flávia R FR   Berwanger Otavio O  

The New England journal of medicine 20200723 21


<h4>Background</h4>Hydroxychloroquine and azithromycin have been used to treat patients with coronavirus disease 2019 (Covid-19). However, evidence on the safety and efficacy of these therapies is limited.<h4>Methods</h4>We conducted a multicenter, randomized, open-label, three-group, controlled trial involving hospitalized patients with suspected or confirmed Covid-19 who were receiving either no supplemental oxygen or a maximum of 4 liters per minute of supplemental oxygen. Patients were rando  ...[more]

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