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ABSTRACT: Objective
To compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine.Methods
We analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (hydroxy)chloroquine, two hospitals did not. Primary outcome was 21-day all-cause mortality. We performed a survival analysis using log-rank test and Cox regression with adjustment for age, sex and covariates based on premorbid health, disease severity and the use of steroids for adult respiratory distress syndrome, including dexamethasone.Results
Among 1949 individuals, 21-day mortality was 21.5% in 1596 patients treated in hospitals that routinely prescribed (hydroxy)chloroquine, and 15.0% in 353 patients treated in hospitals that did not. In the adjusted Cox regression models this difference disappeared, with an adjusted hazard ratio of 1.09 (95% CI 0.81-1.47). When stratified by treatment actually received in individual patients, the use of (hydroxy)chloroquine was associated with an increased 21-day mortality (HR 1.58; 95% CI 1.24-2.02) in the full model.Conclusions
After adjustment for confounders, mortality was not significantly different in hospitals that routinely treated patients with (hydroxy)chloroquine compared with hospitals that did not. We compared outcomes of hospital strategies rather than outcomes of individual patients to reduce the chance of indication bias. This study adds evidence against the use of (hydroxy)chloroquine in hospitalised patients with COVID-19.
SUBMITTER: Peters EJ
PROVIDER: S-EPMC7554450 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
Peters Edgar Jg EJ Collard Didier D Van Assen Sander S Beudel Martijn M Bomers Marije K MK Buijs Jacqueline J De Haan Lianne R LR De Ruijter Wouter W Douma Renée A RA Elbers Paul Wg PW Goorhuis Abraham A Gritters van den Oever Niels C NC Knarren Lieve Ghh LG Moeniralam Hazra S HS Mostard Remy Lm RL Quanjel Marian Jr MJ Reidinga Auke C AC Renckens Roos R Van Den Bergh Joop Pw JP Vlasveld Imro N IN Sikkens Jonne J JJ
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 20201014 2
<h4>Objective</h4>To compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine.<h4>Methods</h4>We analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (h ...[more]