Hydroxychloroquine in hospitalized COVID-19 patients: Real world experience assessing mortality

Pharmacotherapy. 2020 Oct 12. doi: 10.1002/phar.2467. Online ahead of print.


Introduction: Hydroxychloroquine (HCQ) for COVID-19 is presently being used off-label or within a clinical trial.

Objectives: We investigated a multinational COVID-19 patient database of real world data containing outcomes and their relationship to HCQ use. The primary outcome was all-cause mortality within 30 days follow-up.

Methods: Retrospective cohort study of patients receiving HCQ within 48 hours of hospital admission. Medications, preexisting conditions, clinical measures on admission, and outcomes were recorded.

Results: Among patients with a diagnosis of COVID-19 in our propensity matched cohort, the mean ages±SD were 62.3±15.9 years (53.7% male) and 61.9±16.0 years (53.0% male) in the HCQ and no-HCQ groups, respectively. There was no difference in overall 30-day mortality between the HCQ and no-HCQ groups (HCQ 13.1%, n=367; No-HCQ 13.6%, n=367; OR 0.95; 95% CI 0.62-1.46) after propensity-matching. Although statistically insignificant, the HCQ/azithromycin (AZ) group had an overall mortality rate of 14.6% (n=199) compared with propensity matched no HCQ/+AZ cohort's rate of 12.1% (n=199) (OR 1.24; 95% CI 0.70-2.22). Importantly, however, there was no trend in this cohort's overall mortality/arrhythmogenesis outcome (HCQ/AZ 17.1%, No-HCQ/No AZ 17.1%; OR 1.0; 95% CI 0.6-1.7).

Conclusions: We report from a large retrospective multinational database analysis of COVID-19 outcomes with HCQ and overall mortality in hospitalized patients. There was no statistically significant increase in mortality and mortality/arrhythmia with HCQ or HCQ/AZ.

Keywords: COVID-19; SARS-CoV-2; antimalarial; azithromycin; coronavirus; hydroxychloroquine; macrolide; severe acute respiratory syndrome coronavirus 2.