Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19
Significance: The United States is in an acceleration phase of the COVID-19 pandemic. Currently there is no known effective therapy or vaccine for treatment of SARS-CoV-2, highlighting urgency around identifying effective therapies. Objective: The purpose of this study was to evaluate the role of hy...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-08-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971220305348 |
| _version_ | 1818201170336808960 |
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| author | Samia Arshad Paul Kilgore Zohra S. Chaudhry Gordon Jacobsen Dee Dee Wang Kylie Huitsing Indira Brar George J. Alangaden Mayur S. Ramesh John E. McKinnon William O’Neill Marcus Zervos Varidhi Nauriyal Asif Abdul Hamed Owais Nadeem Jennifer Swiderek Amanda Godfrey Jeffrey Jennings Jayna Gardner-Gray Adam M. Ackerman Jonathan Lezotte Joseph Ruhala Raef Fadel Amit Vahia Smitha Gudipati Tommy Parraga Anita Shallal Gina Maki Zain Tariq Geehan Suleyman Nicholas Yared Erica Herc Johnathan Williams Odaliz Abreu Lanfranco Pallavi Bhargava Katherine Reyes |
| author_facet | Samia Arshad Paul Kilgore Zohra S. Chaudhry Gordon Jacobsen Dee Dee Wang Kylie Huitsing Indira Brar George J. Alangaden Mayur S. Ramesh John E. McKinnon William O’Neill Marcus Zervos Varidhi Nauriyal Asif Abdul Hamed Owais Nadeem Jennifer Swiderek Amanda Godfrey Jeffrey Jennings Jayna Gardner-Gray Adam M. Ackerman Jonathan Lezotte Joseph Ruhala Raef Fadel Amit Vahia Smitha Gudipati Tommy Parraga Anita Shallal Gina Maki Zain Tariq Geehan Suleyman Nicholas Yared Erica Herc Johnathan Williams Odaliz Abreu Lanfranco Pallavi Bhargava Katherine Reyes |
| author_sort | Samia Arshad |
| collection | DOAJ |
| description | Significance: The United States is in an acceleration phase of the COVID-19 pandemic. Currently there is no known effective therapy or vaccine for treatment of SARS-CoV-2, highlighting urgency around identifying effective therapies. Objective: The purpose of this study was to evaluate the role of hydroxychloroquine therapy alone and in combination with azithromycin in hospitalized patients positive for COVID-19. Design: Multi-center retrospective observational study. Setting: The Henry Ford Health System (HFHS) in Southeast Michigan: large six hospital integrated health system; the largest of hospitals is an 802-bed quaternary academic teaching hospital in urban Detroit, Michigan. Participants: Consecutive patients hospitalized with a COVID-related admission in the health system from March 10, 2020 to May 2, 2020 were included. Only the first admission was included for patients with multiple admissions. All patients evaluated were 18 years of age and older and were treated as inpatients for at least 48 h unless expired within 24 h. Exposure: Receipt of hydroxychloroquine alone, hydroxychloroquine in combination with azithromycin, azithromycin alone, or neither. Main outcome: The primary outcome was in-hospital mortality. Results: Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4–10 days), median age was 64 years (IQR:53–76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3–53). Overall in-hospital mortality was 18.1% (95% CI:16.6%–19.7%); by treatment: hydroxychloroquine + azithromycin, 157/783 (20.1% [95% CI: 17.3%–23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%–15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%–30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%–31.0%]). Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes. From Cox regression modeling, predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9–3.3]), white race (HR:1.7 [95% CI:1.4–2.1]), CKD (HR:1.7 [95%CI:1.4–2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1–2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4–3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p < 0.001). Conclusions and relevance: In this multi-hospital assessment, when controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin was associated with reduction in COVID-19 associated mortality. Prospective trials are needed to examine this impact. |
| first_indexed | 2024-12-12T02:49:18Z |
| format | Article |
| id | doaj.art-f63e94b59bf1451cb9ceace2ebd92ec1 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-12T02:49:18Z |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-f63e94b59bf1451cb9ceace2ebd92ec12022-12-22T00:40:56ZengElsevierInternational Journal of Infectious Diseases1201-97122020-08-0197396403Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19Samia Arshad0Paul Kilgore1Zohra S. Chaudhry2Gordon Jacobsen3Dee Dee Wang4Kylie Huitsing5Indira Brar6George J. Alangaden7Mayur S. Ramesh8John E. McKinnon9William O’Neill10Marcus Zervos11Varidhi NauriyalAsif Abdul HamedOwais NadeemJennifer SwiderekAmanda GodfreyJeffrey JenningsJayna Gardner-GrayAdam M. AckermanJonathan LezotteJoseph RuhalaRaef FadelAmit VahiaSmitha GudipatiTommy ParragaAnita ShallalGina MakiZain TariqGeehan SuleymanNicholas YaredErica HercJohnathan WilliamsOdaliz Abreu LanfrancoPallavi BhargavaKatherine ReyesInfectious Diseases, Henry Ford Hospital, Detroit, MI, United StatesEugene Applebaum College of Pharmacy, Wayne State University, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United StatesInfectious Diseases, Henry Ford Hospital, Detroit, MI, United StatesPublic Health Sciences, Henry Ford Hospital, Detroit, MI, United StatesDivision of Cardiovascular Disease & Structural Heart, Henry Ford Hospital, Detroit, MI, United StatesInfectious Diseases, Henry Ford Hospital, Detroit, MI, United StatesInfectious Diseases, Henry Ford Hospital, Detroit, MI, United StatesInfectious Diseases, Henry Ford Hospital, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United StatesInfectious Diseases, Henry Ford Hospital, Detroit, MI, United StatesInfectious Diseases, Henry Ford Hospital, Detroit, MI, United StatesDivision of Cardiovascular Disease & Structural Heart, Henry Ford Hospital, Detroit, MI, United StatesInfectious Diseases, Henry Ford Hospital, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United States; Corresponding author at: Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI 48202, United States.Significance: The United States is in an acceleration phase of the COVID-19 pandemic. Currently there is no known effective therapy or vaccine for treatment of SARS-CoV-2, highlighting urgency around identifying effective therapies. Objective: The purpose of this study was to evaluate the role of hydroxychloroquine therapy alone and in combination with azithromycin in hospitalized patients positive for COVID-19. Design: Multi-center retrospective observational study. Setting: The Henry Ford Health System (HFHS) in Southeast Michigan: large six hospital integrated health system; the largest of hospitals is an 802-bed quaternary academic teaching hospital in urban Detroit, Michigan. Participants: Consecutive patients hospitalized with a COVID-related admission in the health system from March 10, 2020 to May 2, 2020 were included. Only the first admission was included for patients with multiple admissions. All patients evaluated were 18 years of age and older and were treated as inpatients for at least 48 h unless expired within 24 h. Exposure: Receipt of hydroxychloroquine alone, hydroxychloroquine in combination with azithromycin, azithromycin alone, or neither. Main outcome: The primary outcome was in-hospital mortality. Results: Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4–10 days), median age was 64 years (IQR:53–76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3–53). Overall in-hospital mortality was 18.1% (95% CI:16.6%–19.7%); by treatment: hydroxychloroquine + azithromycin, 157/783 (20.1% [95% CI: 17.3%–23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%–15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%–30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%–31.0%]). Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes. From Cox regression modeling, predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9–3.3]), white race (HR:1.7 [95% CI:1.4–2.1]), CKD (HR:1.7 [95%CI:1.4–2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1–2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4–3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p < 0.001). Conclusions and relevance: In this multi-hospital assessment, when controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin was associated with reduction in COVID-19 associated mortality. Prospective trials are needed to examine this impact.http://www.sciencedirect.com/science/article/pii/S1201971220305348HydroxychloroquineMortalityCOVID-19SARS-COV-2CoronavirusTherapy |
| spellingShingle | Samia Arshad Paul Kilgore Zohra S. Chaudhry Gordon Jacobsen Dee Dee Wang Kylie Huitsing Indira Brar George J. Alangaden Mayur S. Ramesh John E. McKinnon William O’Neill Marcus Zervos Varidhi Nauriyal Asif Abdul Hamed Owais Nadeem Jennifer Swiderek Amanda Godfrey Jeffrey Jennings Jayna Gardner-Gray Adam M. Ackerman Jonathan Lezotte Joseph Ruhala Raef Fadel Amit Vahia Smitha Gudipati Tommy Parraga Anita Shallal Gina Maki Zain Tariq Geehan Suleyman Nicholas Yared Erica Herc Johnathan Williams Odaliz Abreu Lanfranco Pallavi Bhargava Katherine Reyes Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 International Journal of Infectious Diseases Hydroxychloroquine Mortality COVID-19 SARS-COV-2 Coronavirus Therapy |
| title | Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 |
| title_full | Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 |
| title_fullStr | Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 |
| title_full_unstemmed | Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 |
| title_short | Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 |
| title_sort | treatment with hydroxychloroquine azithromycin and combination in patients hospitalized with covid 19 |
| topic | Hydroxychloroquine Mortality COVID-19 SARS-COV-2 Coronavirus Therapy |
| url | http://www.sciencedirect.com/science/article/pii/S1201971220305348 |
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