Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19.
Identifieur interne : 000E00 ( Main/Corpus ); précédent : 000D99; suivant : 000E01Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19.
Auteurs : Joseph Magagnoli ; Siddharth Narendran ; Felipe Pereira ; Tammy H. Cummings ; James W. Hardin ; S Scott Sutton ; Jayakrishna AmbatiSource :
- Med (New York, N.Y.) [ 2666-6340 ] ; 2020.
Abstract
Background
Despite limited and conflicting evidence, hydroxychloroquine, alone or in combination with azithromycin, is widely used in COVID-19 therapy.
Methods
We performed a retrospective study of electronic health records of patients hospitalized with confirmed SARS-CoV-2 infection in US Veterans Health Administration medical centers between March 9, 2020 and April 29, 2020. Patients hospitalized within 24 h of diagnosis were classified based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) or no HC as treatments. The primary outcomes were mortality and use of mechanical ventilation.
Findings
A total of 807 patients were evaluated. Compared to the no HC group, after propensity score adjustment for clinical characteristics, the risk of death from any cause was higher in the HC group (adjusted hazard ratio [aHR], 1.83; 95% confidence interval [CI], 1.16-2.89; p = 0.009), but not in the HC+AZ group (aHR, 1.31; 95% CI, 0.80-2.15; p = 0.28). Both the propensity-score-adjusted risks of mechanical ventilation and death after mechanical ventilation were not significantly different in the HC group (aHR, 1.19; 95% CI, 0.78-1.82; p = 0.42 and aHR, 2.11; 95% CI, 0.96-4.62; p = 0.06, respectively) or in the HC+AZ group (aHR, 1.09; 95% CI, 0.72-1.66; p = 0.69 and aHR, 1.25; 95% CI, 0.59-2.68; p = 0.56, respectively) compared to the no HC group.
Conclusions
Among patients hospitalized with COVID-19, this retrospective study did not identify any significant reduction in mortality or in the need for mechanical ventilation with hydroxychloroquine treatment with or without azithromycin.
Funding
University of Virginia Strategic Investment Fund.
DOI: 10.1016/j.medj.2020.06.001
PubMed: 32838355
PubMed Central: PMC7274588
Links to Exploration step
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Hardin</name><affiliation><nlm:affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Sutton, S Scott" sort="Sutton, S Scott" uniqKey="Sutton S" first="S Scott" last="Sutton">S Scott Sutton</name><affiliation><nlm:affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Ambati, Jayakrishna" sort="Ambati, Jayakrishna" uniqKey="Ambati J" first="Jayakrishna" last="Ambati">Jayakrishna Ambati</name><affiliation><nlm:affiliation>Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32838355</idno><idno type="pmid">32838355</idno><idno type="doi">10.1016/j.medj.2020.06.001</idno><idno type="pmc">PMC7274588</idno><idno type="wicri:Area/Main/Corpus">000E00</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000E00</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19.</title><author><name sortKey="Magagnoli, Joseph" sort="Magagnoli, Joseph" uniqKey="Magagnoli J" first="Joseph" last="Magagnoli">Joseph Magagnoli</name><affiliation><nlm:affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Narendran, Siddharth" sort="Narendran, Siddharth" uniqKey="Narendran S" first="Siddharth" last="Narendran">Siddharth Narendran</name><affiliation><nlm:affiliation>Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Pereira, Felipe" sort="Pereira, Felipe" uniqKey="Pereira F" first="Felipe" last="Pereira">Felipe Pereira</name><affiliation><nlm:affiliation>Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Cummings, Tammy H" sort="Cummings, Tammy H" uniqKey="Cummings T" first="Tammy H" last="Cummings">Tammy H. Cummings</name><affiliation><nlm:affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Hardin, James W" sort="Hardin, James W" uniqKey="Hardin J" first="James W" last="Hardin">James W. Hardin</name><affiliation><nlm:affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Sutton, S Scott" sort="Sutton, S Scott" uniqKey="Sutton S" first="S Scott" last="Sutton">S Scott Sutton</name><affiliation><nlm:affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Ambati, Jayakrishna" sort="Ambati, Jayakrishna" uniqKey="Ambati J" first="Jayakrishna" last="Ambati">Jayakrishna Ambati</name><affiliation><nlm:affiliation>Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, USA.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Med (New York, N.Y.)</title><idno type="eISSN">2666-6340</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Background</b></p><p>Despite limited and conflicting evidence, hydroxychloroquine, alone or in combination with azithromycin, is widely used in COVID-19 therapy.</p></div><div type="abstract" xml:lang="en"><p><b>Methods</b></p><p>We performed a retrospective study of electronic health records of patients hospitalized with confirmed SARS-CoV-2 infection in US Veterans Health Administration medical centers between March 9, 2020 and April 29, 2020. Patients hospitalized within 24 h of diagnosis were classified based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) or no HC as treatments. The primary outcomes were mortality and use of mechanical ventilation.</p></div><div type="abstract" xml:lang="en"><p><b>Findings</b></p><p>A total of 807 patients were evaluated. Compared to the no HC group, after propensity score adjustment for clinical characteristics, the risk of death from any cause was higher in the HC group (adjusted hazard ratio [aHR], 1.83; 95% confidence interval [CI], 1.16-2.89; p = 0.009), but not in the HC+AZ group (aHR, 1.31; 95% CI, 0.80-2.15; p = 0.28). Both the propensity-score-adjusted risks of mechanical ventilation and death after mechanical ventilation were not significantly different in the HC group (aHR, 1.19; 95% CI, 0.78-1.82; p = 0.42 and aHR, 2.11; 95% CI, 0.96-4.62; p = 0.06, respectively) or in the HC+AZ group (aHR, 1.09; 95% CI, 0.72-1.66; p = 0.69 and aHR, 1.25; 95% CI, 0.59-2.68; p = 0.56, respectively) compared to the no HC group.</p></div><div type="abstract" xml:lang="en"><p><b>Conclusions</b></p><p>Among patients hospitalized with COVID-19, this retrospective study did not identify any significant reduction in mortality or in the need for mechanical ventilation with hydroxychloroquine treatment with or without azithromycin.</p></div><div type="abstract" xml:lang="en"><p><b>Funding</b></p><p>University of Virginia Strategic Investment Fund.</p></div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">32838355</PMID><DateRevised><Year>2021</Year><Month>04</Month><Day>09</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2666-6340</ISSN><JournalIssue CitedMedium="Internet"><Volume>1</Volume><Issue>1</Issue><PubDate><Year>2020</Year><Month>Dec</Month><Day>18</Day></PubDate></JournalIssue><Title>Med (New York, N.Y.)</Title><ISOAbbreviation>Med (N Y)</ISOAbbreviation></Journal><ArticleTitle>Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19.</ArticleTitle><Pagination><MedlinePgn>114-127.e3</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.medj.2020.06.001</ELocationID><Abstract><AbstractText Label="Background" NlmCategory="UNASSIGNED">Despite limited and conflicting evidence, hydroxychloroquine, alone or in combination with azithromycin, is widely used in COVID-19 therapy.</AbstractText><AbstractText Label="Methods" NlmCategory="UNASSIGNED">We performed a retrospective study of electronic health records of patients hospitalized with confirmed SARS-CoV-2 infection in US Veterans Health Administration medical centers between March 9, 2020 and April 29, 2020. Patients hospitalized within 24 h of diagnosis were classified based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) or no HC as treatments. The primary outcomes were mortality and use of mechanical ventilation.</AbstractText><AbstractText Label="Findings" NlmCategory="UNASSIGNED">A total of 807 patients were evaluated. Compared to the no HC group, after propensity score adjustment for clinical characteristics, the risk of death from any cause was higher in the HC group (adjusted hazard ratio [aHR], 1.83; 95% confidence interval [CI], 1.16-2.89; p = 0.009), but not in the HC+AZ group (aHR, 1.31; 95% CI, 0.80-2.15; p = 0.28). Both the propensity-score-adjusted risks of mechanical ventilation and death after mechanical ventilation were not significantly different in the HC group (aHR, 1.19; 95% CI, 0.78-1.82; p = 0.42 and aHR, 2.11; 95% CI, 0.96-4.62; p = 0.06, respectively) or in the HC+AZ group (aHR, 1.09; 95% CI, 0.72-1.66; p = 0.69 and aHR, 1.25; 95% CI, 0.59-2.68; p = 0.56, respectively) compared to the no HC group.</AbstractText><AbstractText Label="Conclusions" NlmCategory="UNASSIGNED">Among patients hospitalized with COVID-19, this retrospective study did not identify any significant reduction in mortality or in the need for mechanical ventilation with hydroxychloroquine treatment with or without azithromycin.</AbstractText><AbstractText Label="Funding" NlmCategory="UNASSIGNED">University of Virginia Strategic Investment Fund.</AbstractText><CopyrightInformation>© 2020 Elsevier Inc.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Magagnoli</LastName><ForeName>Joseph</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Narendran</LastName><ForeName>Siddharth</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pereira</LastName><ForeName>Felipe</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cummings</LastName><ForeName>Tammy H</ForeName><Initials>TH</Initials><AffiliationInfo><Affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hardin</LastName><ForeName>James W</ForeName><Initials>JW</Initials><AffiliationInfo><Affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sutton</LastName><ForeName>S Scott</ForeName><Initials>SS</Initials><AffiliationInfo><Affiliation>Dorn Research Institute, Columbia VA Health Care System, Columbia, SC, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ambati</LastName><ForeName>Jayakrishna</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>R01 EY028027</GrantID><Acronym>EY</Acronym><Agency>NEI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01 EY029799</GrantID><Acronym>EY</Acronym><Agency>NEI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01 EY031039</GrantID><Acronym>EY</Acronym><Agency>NEI NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>06</Month><Day>05</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Med (N Y)</MedlineTA><NlmUniqueID>101769215</NlmUniqueID><ISSNLinking>2666-6340</ISSNLinking></MedlineJournalInfo><CommentsCorrectionsList><CommentsCorrections RefType="UpdateOf"><RefSource>medRxiv. 2020 Apr 21;:</RefSource><PMID Version="1">32511622</PMID></CommentsCorrections></CommentsCorrectionsList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2</Keyword><Keyword MajorTopicYN="N">azithromycin</Keyword><Keyword MajorTopicYN="N">hazard ratio</Keyword><Keyword MajorTopicYN="N">hydroxychloroquine</Keyword><Keyword MajorTopicYN="N">mortality</Keyword><Keyword MajorTopicYN="N">retrospective cohort</Keyword><Keyword MajorTopicYN="N">ventilation</Keyword></KeywordList><CoiStatement>J.A. is a co-founder of iVeena Holdings, iVeena Delivery Systems, and Inflammasome Therapeutics; he has received consultancy fees from Allergan, Biogen, Boehringer Ingelheim, Immunovant, Janssen, Olix Pharmaceuticals, Retinal Solutions, and Saksin LifeSciences, all for ophthalmic topics unrelated to COVID-19. J.A. is named as an inventor on a patent application filed by the University of Virginia relating to COVID-19 but unrelated to this work or to any ongoing COVID-19 clinical trials. S.S.S. has received research grants from Boehringer Ingelheim, Gilead Sciences, Portola Pharmaceuticals, and United Therapeutics, all for projects unrelated to COVID-19. J.W.H. has received consulting fees from Celgene Corporation unrelated to this work. The other authors declare no competing interests.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>05</Month><Day>15</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>05</Month><Day>26</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>05</Month><Day>26</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>8</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>8</Month><Day>25</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>8</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32838355</ArticleId><ArticleId IdType="doi">10.1016/j.medj.2020.06.001</ArticleId><ArticleId IdType="pii">S2666-6340(20)30006-4</ArticleId><ArticleId IdType="pmc">PMC7274588</ArticleId></ArticleIdList><pmc-dir>pmcsd</pmc-dir>
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