Effect of combination therapy of hydroxychloroquine and azithromycin on mortality in COVID-19 patients

Clin Transl Sci. 2020 Sep 14. doi: 10.1111/cts.12860. Online ahead of print.

Abstract

Conflicting evidence regarding the use of hydroxychloroquine and azithromycin for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection do exist. We performed a retrospective single-center cohort study including 377 consecutive patients admitted for pneumonia related to coronavirus disease (COVID-19). Of these 297 were in combination treatment, 17 were on hydroxychloroquine alone and 63 did not receive any of these two drugs because of contraindications. The primary endpoint was in-hospital death. Mean age was 71.8±13.4 years and 34.2% were women. We recorded 146 deaths: 35 in no treatment, 7 in hydroxychloroquine and 102 in hydroxychloroquine + azithromycin group (log-rank test for Kaplan-Meier curve p<0.001). At multivariable Cox proportional hazard regression analysis, age (hazard ratio [HR] 1.057, 95% confidence interval [CI] 1.035-1.079, p<0.001), mechanical ventilation/CPAP (HR 2.726, 95%CI 1.823-4.074, p<0.001), C Reactive Protein above the median (HR 2.191, 95%CI 1.479-3.246, p<0.001) were directly associated with death, whilst use of hydroxychloroquine + azithromycin (vs. no treatment) (HR 0.265, 95%CI 0.171-0.412, p<0.001) was inversely associated. In this study, we found a reduced in-hospital mortality in patients treated with a combination of hydroxychloroquine and azithromycin after adjustment for comorbidities. A large randomized trial is necessary to confirm these findings.

Keywords: COVID-19; SARS-CoV-2; azithromycin; hydroxychloroquine; mortality.