Clinical Outcomes of Hydroxychloroquine in Hospitalized Patients with COVID-19

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Salient Points

The following article focuses on the clinical outcomes of HCQ used in the management of COVID-19 patients. There is empirical evidence to show the efficacy of HCQ, thus the article is based on a study that compared patients on HCQ and those on supportive care alone to test this claim. The test however showed that there were no benefits of HCQ on mortality, lymphopenia or neutrophil:lymphocyte ratio, it instead increased the need for escalation of respiratory support.

A total of 63 patients were included with 32 in the HCQ arm. HCQ administration was associated with a need for escalation of respiratory support level compared to those that did not receive HCQ at 5 days (p=0.013). The same findings were observed in a baseline-matched subgroup analysis.

Absolute lymphocyte change in the hydroxychloroquine group was no different than supportive care alone (p=0.413). HCQ use tends towards worsening neutrophil-to-lymphocyte ratio compared to supportive care alone (+9.59 vs +1.58, p=0.51) as well as a higher risk for intubation (p=0.051).

  • Mortality Rates
  1. 11.76% in HCQ group
  2. 4.77% in Supportive Care Group
  • Rate of Intubation
  1. 41.18% in in HCQ group
  2. 9.52% in Supportive Care Group
  • Change in Absolute Lymphocyte Count (K/μL)
  1. 0.8 +/- 0.46 in HCQ group
  2. 1.0 +/- 0.49 in Supportive Care Group
  • Change in Neutrophil:Lymphocyte Ratio
  1. 15.34+/- 20.00 in HCQ group
  2. 6.33 +/- 4.77  in Supportive Care Group

Detailed Summary   

The use of HCQ in the SARS-CoV-2 positive population has become widespread with only empirical evidence on its efficacy. This study addresses the efficacy of hydroxychloroquine on serological and supportive care measures in a hospitalized population.

Consecutive adult subjects admitted for viral pneumonia secondary to SARS-CoV-2 (by polymerase chain reaction) during the last two weeks of March, 2020 were included. Those that were started on HCQ and supportive care were compared to supportive care alone.

The primary endpoints were the effect of hydroxychloroquine usage on the need to escalate respiratory support, change in lymphocyte count, and change in neutrophil-to-lymphocyte ratio.

A retrospective review of patients was obtained. Consecutive charts with a diagnosis of SARS-CoV-2 by nasal swab PCR from March 19th to March 26th 2020 were reviewed for off-label hydroxychloroquine treatment, age, sex, comorbid conditions, absolute lymphocyte and neutrophil count both on admission and at 24 hours, and respiratory supportive care level on admission, at 24 hours and at 5 day follow-up.

Comorbid conditions considered high risk throughout analysis included asthma, chronic obstructive pulmonary disease, heart failure of any variety, diabetes, a hematological malignancy, or immunocompromised state in which the patient was taking a prednisone equivalent of 20mg by mouth daily.

An independent, two-tailed t-test was used to compare change in absolute lymphocyte count, NLR, and respiratory support requirement level between subjects administered HCQ and those in which treatment was withheld.

Fisher’s exact test was used to compare mortality rates between the groups. A logistic regression was used to analyze the effect of treatment, age, sex, comorbid conditions, baseline absolute lymphocyte count, baseline neutrophil count, and baseline supportive care needs on whether respiratory supportive care need increased throughout a 5 day hopital course or shorter in the event of a death.

Result

  • Out of the 63 individuals in the study, 32 were subject to HCQ therapy and 32 in the standard supportive care group.
  • 26 (41.3%) were female
  • Median age of subjects – 62.7 +/- 15.1 y/o.
  • Mortality Rates
  1. 11.76% in HCQ group
  2. 4.77% in Supportive Care Group
  • Rate of Intubation
  1. 41.18% in in HCQ group
  2. 9.52% in Supportive Care Group
  • Change in Absolute Lymphocyte Count (K/μL)
  1. 0.8 +/- 0.46 in HCQ group
  2. 1.0 +/- 0.49 in Supportive Care Group
  • Change in Neutrophil:Lymphocyte Ratio
  1. 15.34+/- 20.00 in HCQ group
  2. 6.33 +/- 4.77  in Supportive Care Group

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