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Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data.
BMJ. 2020 May 14; 369:m1844.BMJ

Abstract

OBJECTIVE

To assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen.

DESIGN

Comparative observational study using data collected from routine care.

SETTING

Four French tertiary care centres providing care to patients with covid-19 pneumonia between 12 March and 31 March 2020.

PARTICIPANTS

181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care.

INTERVENTIONS

Hydroxychloroquine at a dose of 600 mg/day within 48 hours of admission to hospital (treatment group) versus standard care without hydroxychloroquine (control group).

MAIN OUTCOME MEASURES

The primary outcome was survival without transfer to the intensive care unit at day 21. Secondary outcomes were overall survival, survival without acute respiratory distress syndrome, weaning from oxygen, and discharge from hospital to home or rehabilitation (all at day 21). Analyses were adjusted for confounding factors by inverse probability of treatment weighting.

RESULTS

In the main analysis, 84 patients who received hydroxychloroquine within 48 hours of admission to hospital (treatment group) were compared with 89 patients who did not receive hydroxychloroquine (control group). Eight additional patients received hydroxychloroquine more than 48 hours after admission. In the weighted analyses, the survival rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and 75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, 0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of patients in the treatment group had been weaned from oxygen compared with 76% in the control group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the treatment group (10%) experienced electrocardiographic modifications that required discontinuation of treatment.

CONCLUSIONS

Hydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen.

Authors+Show Affiliations

Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France matthieu.mahevas@gmail.com.Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.Department of Internal Medicine, Foch Hospital, Suresnes, France.Department of Infectious Diseases, Sud Francilien Hospital, Corbeil-Essonnes, France.Department of Internal Medicine, Foch Hospital, Suresnes, France.Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.Transversal Infections Treatment Unit, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Department of Infectious Diseases, Hôpital Bichat Hospital, Paris, France.Pulmonology Unit, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.Department of Nephrology, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.Department of Internal Medicine, Foch Hospital, Suresnes, France.Department of Virology, Bacteriology-Hygiene, and Mycology-Parasitology Centre, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.Department of Pulmonology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Department of Pulmonology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Department of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Pharmacy, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.Mobile Infectious Disease Team, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Pulmonology Unit, Sud Francilien Hospital, Corbeil-Essonnes, France.Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.Clinical Epidemiology and Aging Team, Mondor Institute for Biomedical Research (INSERM U955), Public Health Services, Henri-Mondor Hosptial, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.Department of Infectious Diseases, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Pari, Paris-Est Créteil University, Créteil, France.Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France. Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32409486

Citation

Mahévas, Matthieu, et al. "Clinical Efficacy of Hydroxychloroquine in Patients With Covid-19 Pneumonia Who Require Oxygen: Observational Comparative Study Using Routine Care Data." BMJ (Clinical Research Ed.), vol. 369, 2020, pp. m1844.
Mahévas M, Tran VT, Roumier M, et al. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ. 2020;369:m1844.
Mahévas, M., Tran, V. T., Roumier, M., Chabrol, A., Paule, R., Guillaud, C., Fois, E., Lepeule, R., Szwebel, T. A., Lescure, F. X., Schlemmer, F., Matignon, M., Khellaf, M., Crickx, E., Terrier, B., Morbieu, C., Legendre, P., Dang, J., Schoindre, Y., ... Costedoat-Chalumeau, N. (2020). Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ (Clinical Research Ed.), 369, m1844. https://doi.org/10.1136/bmj.m1844
Mahévas M, et al. Clinical Efficacy of Hydroxychloroquine in Patients With Covid-19 Pneumonia Who Require Oxygen: Observational Comparative Study Using Routine Care Data. BMJ. 2020 May 14;369:m1844. PubMed PMID: 32409486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. AU - Mahévas,Matthieu, AU - Tran,Viet-Thi, AU - Roumier,Mathilde, AU - Chabrol,Amélie, AU - Paule,Romain, AU - Guillaud,Constance, AU - Fois,Elena, AU - Lepeule,Raphael, AU - Szwebel,Tali-Anne, AU - Lescure,François-Xavier, AU - Schlemmer,Frédéric, AU - Matignon,Marie, AU - Khellaf,Mehdi, AU - Crickx,Etienne, AU - Terrier,Benjamin, AU - Morbieu,Caroline, AU - Legendre,Paul, AU - Dang,Julien, AU - Schoindre,Yoland, AU - Pawlotsky,Jean-Michel, AU - Michel,Marc, AU - Perrodeau,Elodie, AU - Carlier,Nicolas, AU - Roche,Nicolas, AU - de Lastours,Victoire, AU - Ourghanlian,Clément, AU - Kerneis,Solen, AU - Ménager,Philippe, AU - Mouthon,Luc, AU - Audureau,Etienne, AU - Ravaud,Philippe, AU - Godeau,Bertrand, AU - Gallien,Sébastien, AU - Costedoat-Chalumeau,Nathalie, Y1 - 2020/05/14/ PY - 2020/5/16/entrez PY - 2020/5/16/pubmed PY - 2020/5/20/medline SP - m1844 EP - m1844 JF - BMJ (Clinical research ed.) JO - BMJ VL - 369 N2 - OBJECTIVE: To assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen. DESIGN: Comparative observational study using data collected from routine care. SETTING: Four French tertiary care centres providing care to patients with covid-19 pneumonia between 12 March and 31 March 2020. PARTICIPANTS: 181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care. INTERVENTIONS: Hydroxychloroquine at a dose of 600 mg/day within 48 hours of admission to hospital (treatment group) versus standard care without hydroxychloroquine (control group). MAIN OUTCOME MEASURES: The primary outcome was survival without transfer to the intensive care unit at day 21. Secondary outcomes were overall survival, survival without acute respiratory distress syndrome, weaning from oxygen, and discharge from hospital to home or rehabilitation (all at day 21). Analyses were adjusted for confounding factors by inverse probability of treatment weighting. RESULTS: In the main analysis, 84 patients who received hydroxychloroquine within 48 hours of admission to hospital (treatment group) were compared with 89 patients who did not receive hydroxychloroquine (control group). Eight additional patients received hydroxychloroquine more than 48 hours after admission. In the weighted analyses, the survival rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and 75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, 0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of patients in the treatment group had been weaned from oxygen compared with 76% in the control group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the treatment group (10%) experienced electrocardiographic modifications that required discontinuation of treatment. CONCLUSIONS: Hydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/32409486/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=32409486 DB - PRIME DP - Unbound Medicine ER -