1. Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine
- Author
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Sander van Assen, Hazra S. Moeniralam, Jacqueline Buijs, Renée A. Douma, Joop P. W. van den Bergh, Abraham Goorhuis, Wouter de Ruijter, Edgar J G Peters, R. Renckens, Didier Collard, Martijn Beudel, Paul W. G. Elbers, Lieve G. Hh. Knarren, Lianne de Haan, Rémy L M Mostard, Niels C. Gritters van den Oever, Auke C Reidinga, Imro N. Vlasveld, Marije K. Bomers, Marian J. R. Quanjel, Jonne J. Sikkens, Graduate School, Vascular Medicine, Neurology, ANS - Neurodegeneration, Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life, APH - Global Health, ACS - Atherosclerosis & ischemic syndromes, Amsterdam Movement Sciences, Amsterdam Movement Sciences - Rehabilitation & Development, Internal medicine, ACS - Diabetes & metabolism, Intensive care medicine, and AMS - Rehabilitation & Development
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,03 medical and health sciences ,0302 clinical medicine ,Chloroquine ,Internal medicine ,medicine ,Severe acute respiratory syndrome coronavirus 2 ,030212 general & internal medicine ,Mortality ,Survival analysis ,Respiratory distress ,Coronavirus disease 2019 ,business.industry ,Proportional hazards model ,Standard treatment ,Hazard ratio ,Confounding ,Hydroxychloroquine ,General Medicine ,Infectious Diseases ,business ,medicine.drug - 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.
- Published
- 2021