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Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France.
Travel Med Infect Dis. 2020 May - Jun; 35:101738.TM

Abstract

BACKGROUND

In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19.

METHODS

We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days).

RESULTS

A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14-95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74-95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision).

CONCLUSION

Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.

Authors+Show Affiliations

IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France.Aix Marseille Univ., Laboratoire de Pharmacie Clinique, Marseille, France; AP-HM, hôpital Timone, service Pharmacie, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France; Centre d'Epidémiologie et de Santé Publique des Armées (CESPA), Marseille, France; AP-HM, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France.IHU-Méditerranée Infection, Marseille, France.Aix Marseille Univ., Laboratoire de Pharmacie Clinique, Marseille, France; AP-HM, hôpital Timone, service Pharmacie, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.Department of Radiology and Cardiovascular Imaging, Aix-Marseille Univ., UMR 7339, CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale-Centre d'Exploration Métaboliques par Résonance Magnétique), Marseille, France.AP-HM, Aix Marseille Univ., hôpital Timone, Cardiologie, Rythmologie, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France.IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France. Electronic address: didier.raoult@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32387409

Citation

Million, Matthieu, et al. "Early Treatment of COVID-19 Patients With Hydroxychloroquine and Azithromycin: a Retrospective Analysis of 1061 Cases in Marseille, France." Travel Medicine and Infectious Disease, vol. 35, 2020, p. 101738.
Million M, Lagier JC, Gautret P, et al. Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. Travel Med Infect Dis. 2020;35:101738.
Million, M., Lagier, J. C., Gautret, P., Colson, P., Fournier, P. E., Amrane, S., Hocquart, M., Mailhe, M., Esteves-Vieira, V., Doudier, B., Aubry, C., Correard, F., Giraud-Gatineau, A., Roussel, Y., Berenger, C., Cassir, N., Seng, P., Zandotti, C., Dhiver, C., ... Raoult, D. (2020). Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. Travel Medicine and Infectious Disease, 35, 101738. https://doi.org/10.1016/j.tmaid.2020.101738
Million M, et al. Early Treatment of COVID-19 Patients With Hydroxychloroquine and Azithromycin: a Retrospective Analysis of 1061 Cases in Marseille, France. Travel Med Infect Dis. 2020 May - Jun;35:101738. PubMed PMID: 32387409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. AU - Million,Matthieu, AU - Lagier,Jean-Christophe, AU - Gautret,Philippe, AU - Colson,Philippe, AU - Fournier,Pierre-Edouard, AU - Amrane,Sophie, AU - Hocquart,Marie, AU - Mailhe,Morgane, AU - Esteves-Vieira,Vera, AU - Doudier,Barbara, AU - Aubry,Camille, AU - Correard,Florian, AU - Giraud-Gatineau,Audrey, AU - Roussel,Yanis, AU - Berenger,Cyril, AU - Cassir,Nadim, AU - Seng,Piseth, AU - Zandotti,Christine, AU - Dhiver,Catherine, AU - Ravaux,Isabelle, AU - Tomei,Christelle, AU - Eldin,Carole, AU - Tissot-Dupont,Hervé, AU - Honoré,Stéphane, AU - Stein,Andreas, AU - Jacquier,Alexis, AU - Deharo,Jean-Claude, AU - Chabrière,Eric, AU - Levasseur,Anthony, AU - Fenollar,Florence, AU - Rolain,Jean-Marc, AU - Obadia,Yolande, AU - Brouqui,Philippe, AU - Drancourt,Michel, AU - La Scola,Bernard, AU - Parola,Philippe, AU - Raoult,Didier, Y1 - 2020/05/05/ PY - 2020/04/20/received PY - 2020/04/30/revised PY - 2020/05/01/accepted PY - 2020/5/11/pubmed PY - 2020/7/11/medline PY - 2020/5/11/entrez KW - Azithromycin KW - COVID-19 KW - Hydroxychloroquine KW - SARS-CoV-2 SP - 101738 EP - 101738 JF - Travel medicine and infectious disease JO - Travel Med Infect Dis VL - 35 N2 - BACKGROUND: In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19. METHODS: We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days). RESULTS: A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14-95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74-95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision). CONCLUSION: Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients. SN - 1873-0442 UR - https://www.unboundmedicine.com/medline/citation/32387409/Early_treatment_of_COVID_19_patients_with_hydroxychloroquine_and_azithromycin:_A_retrospective_analysis_of_1061_cases_in_Marseille_France_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-8939(20)30217-9 DB - PRIME DP - Unbound Medicine ER -