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Low Dose of Hydroxychloroquine Reduces Fatality of Critically Ill Patients With COVID-19 (15th March) China Life Science https://pubmed.ncbi.nlm.nih.gov/32418114/ Does hydroxychloroquine reduce the death risk of critically ill COVID-19 patients. Retrospective study 550 critically ill COVID-19 patients Wuhan, from February 1, 2020 to April 4, 2020. 550 patients received comparable basic treatments including antiviral drugs and antibiotics 48 of them were treated with oral HCQ for 7-10 days Primary endpoint is fatality of patients, and inflammatory cytokine levels Compared between HCQ and non-hydroxychloroquine (NHCQ) groups 18.8% (9/48) deaths in HCQ group 47.4% (238/502) in the NHCQ group (P less than 0.001) Inflammatory cytokine IL-6 significantly reduced in the HCL group But there was no change in the NHCQ group HCQ is highly effective in reducing deaths by reducing the cytokine storm HCQ should be prescribed for critically ill COVID-19 patients Hydroxychloroquine Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. (NEJM 7th May) https://www.nejm.org/doi/full/10.1056/NEJMoa2012410?query=C19&cid=DM91569_NEJM_Registered_Users_and_InActive&bid=193180241 CONCLUSIONS Hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of intubation or death Findings do not support the use of hydroxychloroquine at present, outside randomized clinical trials testing its efficacy Clinical guidance at our medical center has been updated to remove the suggestion that patients with Covid-19 be treated with hydroxychloroquine Hydroxychloroquine or chloroquine, with or without a macrolide, for the treatment of COVID-19, a multinational registry analysis (22nd May) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30430-8/fulltext Background Azithromycin, clarithromycin, (erythromycin) HC and C are generally safe when used for approved indications such as autoimmune disease or malaria The safety and benefit of these treatment regimens are poorly evaluated in COVID-19. Hydroxychloroquine has been shown to have in-vitro activity against the SARS-CoV-2 Recently published human trials, along with other unpublished data, suggest that it could decrease the duration of viral shedding and symptoms if given early. Method 671 hospitals in six continents Included patients hospitalised between Dec 20, 2019, and April 14, 2020 With a positive laboratory finding for SARS-CoV-2 Patients treated within 48 h of diagnosis 4 patient groups, total n = 14,888 Chloroquine alone, n = 1,868 Chloroquine with a macrolide, n = 3,783 Hydroxychloroquine alone n = 3,016 Hydroxychloroquine with a macrolide n = 6,221 Patients who received none of these treatments, n = 81,144 Excluded patients Patients in whom treatments were started more than 48 hours after diagnosis Patients on mechanical ventilation Patients who received remdesivir Findings 96 032 patients with COVID-19 were hospitalised during the study period and met the inclusion criteria. Controlled for multiple confounding factors Age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity In hospital Mortality de-novo ventricular arrhythmia Control group 9·3% 0.3% Hydroxychloroquine 18·0% 6.1% Hydroxychloroquine with a macrolide 23·8% 8.1% Chloroquine 16·4% 4.3% Chloroquine with a macrolide 22·2% 6.5% Interpretation Unable to confirm a benefit of hydroxychloroquine or chloroquine Used alone or with a macrolide Each of these drug regimens was associated with; Decreased in-hospital survival, p less than 0·0001 Increased frequency of ventricular arrhythmias when used for treatment of COVID-19 Independent predictors of in-hospital mortality Age BMI Black race or Hispanic ethnicity Coronary artery disease Congestive heart failure History of arrhythmia Diabetes Hypertension Hyperlipidaemia COPD Current smoker Immunosuppressed condition Associated with reduced in-hospital mortality risk Female Asian origin ACE inhibitors (but not angiotensin receptor blockers) Statins

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