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Belgium, not Dutch. Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients with COVID-19: A Nationwide Observational Study of 8075 Participants (International Journal of Antimicrobial Agents, 24 August) https://www.sciencedirect.com/science/article/pii/S0924857920303423 Background Hydroxychloroquine (HCQ) has been largely used and investigated as therapy of COVID-19 , at total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of low-dose HCQ (2400 mg in total over five days) was recommended for hospitalized patients with COVID-19. “low-dose” regimen of HCQ sulphate in monotherapy 400mg twice on day 1 200mg twice a day from day 2 to 5 i.e. a total dose of 2400 mg Methods Multi-centric design Vast majority of Belgian hospitals Retrospective analysis In-hospital mortality in Belgium 40 day follow up No difference in the baseline characteristics Groups HCQ alone and supportive care Supportive care only Adjusted for demographic and clinical features Results 8075 patients with complete discharge data HCQ group, n = 4,542 Deaths, 804, (17.7%) no-HCQ group, n = 3,533 Deaths, 957 (27.1%) Multivariable analysis Mortality was lower in the HCQ group compared to the no-HCQ group Hazard ratio = 0.684 Estimated direct-adjusted mortality at 40 days 19.1% with HCQ alone 26.5% with supportive care only Mortality in the HCQ group was reduced Both in patients diagnosed in less than 5 days and more than 5 days Conclusions Compared to supportive care only, low-dose HCQ monotherapy was independently associated with lower mortality in hospitalized patients with COVID-19 diagnosed and treated early or later after symptom onset. Other positive studies https://www.sciencedirect.com/science/article/pii/S1477893920302817?via%3Dihub Risk Factors for Mortality in Patients with COVID-19 in New York City https://link.springer.com/article/10.1007/s11606-020-05983-z Hydroxychloroquine use was associated with decreased in-hospital mortality Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext treatment with hydroxychloroquine alone and in combination with azithromycin was associated with reduction in COVID-19 associated mortality Recovery Trial Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19: Preliminary results from a multi-centre, randomized, controlled trial. 15 July 2020 https://www.recoverytrial.net/results/hydroxychloroquine-results https://www.medrxiv.org/content/10.1101/2020.07.15.20151852v1.full.pdf Hydroxychloroquine group, n = 1,561 Usual care group, n = 3,155 Patients allocated to hydroxychloroquine sulfate (200mg) received a loading dose of 4 tablets (800 mg) at zero and 6 hours, followed by 2 tablets (400 mg) starting at 12 hours after the initial dose and then every 12 hours for the next 9 days 9,200 mg over 10 days Conclusion In patients hospitalized with COVID-19, hydroxychloroquine was not associated with reductions in 28-day mortality Was associated with an increased length of hospital stay and increased risk of progressing to invasive mechanical ventilation or death WHO-led SOLIDARITY https://www.who.int/news-room/detail/04-07-2020-who-discontinues-hydroxychloroquine-and-lopinavir-ritonavir-treatment-arms-for-covid-19 9600 mg over 10 days Provided no benefit in hospitalized patients with COVID-19 Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19 (NEJM23 July) Brazil https://www.nejm.org/doi/full/10.1056/NEJMoa2019014?query=C19&cid=DM95777_NEJM_Registered_Users_and_InActive&bid=234281688 METHODS 55 hospitals, Brazil Randomized Open label Three-group Controlled Patients 667 patients, 504 confirmed Covid-19 Receiving no supplemental oxygen Or a maximum of 4 liters per minute 1:1:1 Standard care n = 229 Standard care plus hydroxychloroquine (400 mg twice daily) n = 221 Standard care plus hydroxychloroquine (400 mg twice daily) plus azithromycin (500 mg once daily for 7 days) n = 277 RESULTS No difference in need for ventilation, deaths, thromboembolic complications, AKI Clinical status at 15 days As compared with standard care = 1 Hydroxychloroquine alone, odds ratio, 1.21 Hydroxychloroquine plus azithromycin, odds ratio, 0.99 HCQ Group Prolongation of the corrected QT interval and Elevation of liver-enzyme levels CONCLUSIONS Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care.

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