Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate
Background: During the first wave of COVID-19, hydroxychloroquine (HCQ) was used off-label despite the absence of evidence documenting its clinical benefits. Since then, a meta-analysis of randomised trials showed that HCQ use was associated with an 11% increase in the mortality rate. We aimed to es...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Biomedicine & Pharmacotherapy |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S075333222301853X |
| _version_ | 1797324420449042432 |
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| author | Alexiane PRADELLE Sabine MAINBOURG Steeve PROVENCHER Emmanuel MASSY Guillaume GRENET Jean-Christophe LEGA |
| author_facet | Alexiane PRADELLE Sabine MAINBOURG Steeve PROVENCHER Emmanuel MASSY Guillaume GRENET Jean-Christophe LEGA |
| author_sort | Alexiane PRADELLE |
| collection | DOAJ |
| description | Background: During the first wave of COVID-19, hydroxychloroquine (HCQ) was used off-label despite the absence of evidence documenting its clinical benefits. Since then, a meta-analysis of randomised trials showed that HCQ use was associated with an 11% increase in the mortality rate. We aimed to estimate the number of HCQ-related deaths worldwide. Methods and findings: We estimated the worldwide in-hospital mortality attributable to HCQ use by combining the mortality rate, HCQ exposure, number of hospitalised patients, and the increased relative risk of death with HCQ. The mortality rate in hospitalised patients for each country was calculated using pooled prevalence estimated by a meta-analysis of published cohorts. The HCQ exposure was estimated using median and extreme estimates from the same systematic review. The number of hospitalised patients during the first wave was extracted from dedicated databases. The systematic review included 44 cohort studies (Belgium: k = 1, France: k = 2, Italy: k = 12, Spain: k = 6, Turkey: k = 3, USA: k = 20). HCQ prescription rates varied greatly from one country to another (range 16–84%). Overall, using median estimates of HCQ use in each country, we estimated that 16,990 HCQ-related in-hospital deaths (range 6267–19256) occurred in the countries with available data. The median number of HCQ-related deaths in Belgium, Turkey, France, Italy, Spain, and the USA was 240 (range not estimable), 95 (range 92–128), 199 (range not estimable), 1822 (range 1170–2063), 1895 (range 1475–2094) and 12739 (3244− 15570), respectively. Conclusions: Although our estimates are limited by their imprecision, these findings illustrate the hazard of drug repurposing with low-level evidence. |
| first_indexed | 2024-03-08T05:55:54Z |
| format | Article |
| id | doaj.art-add263c9c8a84cae961bd1487eab1c63 |
| institution | Directory Open Access Journal |
| issn | 0753-3322 |
| language | English |
| last_indexed | 2024-03-08T05:55:54Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Biomedicine & Pharmacotherapy |
| spelling | doaj.art-add263c9c8a84cae961bd1487eab1c632024-02-05T04:30:58ZengElsevierBiomedicine & Pharmacotherapy0753-33222024-02-01171116055Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimateAlexiane PRADELLE0Sabine MAINBOURG1Steeve PROVENCHER2Emmanuel MASSY3Guillaume GRENET4Jean-Christophe LEGA5Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, FranceUniv Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Unité bases de données cliniques et épidémiologiques, Hospices Civils de Lyon, Lyon F-69310, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, FrancePulmonary Hypertension Research Group (http://phrg.ca), Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Department of medicine, Université Laval, Québec City, CanadaLyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, FranceUniv Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, FranceUniv Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France; Correspondence to: Department of rheumatology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, F-69310 Pierre-Bénite, France.Background: During the first wave of COVID-19, hydroxychloroquine (HCQ) was used off-label despite the absence of evidence documenting its clinical benefits. Since then, a meta-analysis of randomised trials showed that HCQ use was associated with an 11% increase in the mortality rate. We aimed to estimate the number of HCQ-related deaths worldwide. Methods and findings: We estimated the worldwide in-hospital mortality attributable to HCQ use by combining the mortality rate, HCQ exposure, number of hospitalised patients, and the increased relative risk of death with HCQ. The mortality rate in hospitalised patients for each country was calculated using pooled prevalence estimated by a meta-analysis of published cohorts. The HCQ exposure was estimated using median and extreme estimates from the same systematic review. The number of hospitalised patients during the first wave was extracted from dedicated databases. The systematic review included 44 cohort studies (Belgium: k = 1, France: k = 2, Italy: k = 12, Spain: k = 6, Turkey: k = 3, USA: k = 20). HCQ prescription rates varied greatly from one country to another (range 16–84%). Overall, using median estimates of HCQ use in each country, we estimated that 16,990 HCQ-related in-hospital deaths (range 6267–19256) occurred in the countries with available data. The median number of HCQ-related deaths in Belgium, Turkey, France, Italy, Spain, and the USA was 240 (range not estimable), 95 (range 92–128), 199 (range not estimable), 1822 (range 1170–2063), 1895 (range 1475–2094) and 12739 (3244− 15570), respectively. Conclusions: Although our estimates are limited by their imprecision, these findings illustrate the hazard of drug repurposing with low-level evidence.http://www.sciencedirect.com/science/article/pii/S075333222301853XCovid-19Off-label treatmentSafetyRepurposing |
| spellingShingle | Alexiane PRADELLE Sabine MAINBOURG Steeve PROVENCHER Emmanuel MASSY Guillaume GRENET Jean-Christophe LEGA Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate Biomedicine & Pharmacotherapy Covid-19 Off-label treatment Safety Repurposing |
| title | Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate |
| title_full | Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate |
| title_fullStr | Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate |
| title_full_unstemmed | Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate |
| title_short | Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate |
| title_sort | deaths induced by compassionate use of hydroxychloroquine during the first covid 19 wave an estimate |
| topic | Covid-19 Off-label treatment Safety Repurposing |
| url | http://www.sciencedirect.com/science/article/pii/S075333222301853X |
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