International Journal of Infectious Diseases (Dec 2020)

Early hydroxychloroquine but not chloroquine use reduces ICU admission in COVID-19 patients

  • A.J.J. Lammers,
  • R.M. Brohet,
  • R.E.P. Theunissen,
  • C. Koster,
  • R. Rood,
  • D.W.M. Verhagen,
  • K. Brinkman,
  • R.J. Hassing,
  • A. Dofferhoff,
  • R. el Moussaoui,
  • G. Hermanides,
  • J. Ellerbroek,
  • N. Bokhizzou,
  • H. Visser,
  • M. van den Berge,
  • H. Bax,
  • D.F. Postma,
  • P.H.P. Groeneveld

Journal volume & issue
Vol. 101
pp. 283 – 289

Abstract

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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.

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