Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis
Fecha
2020Autor
Lagier, Jean-Christophe
Million, Matthieu
Gautret, Philippe
Colson, Philippe
Cortaredona, Sébastien
Giraud-Gatineau, Audrey
Honoré, Stéphane
Gaubert, Jean-Yves
Fournier, Pierre-Edouard
Tissot-Dupont, Hervé
Chabrière, Eric
Stein, Andreas
Deharo, Jean-Claude
Fenollar, Florence
Rolain, Jean-Marc
Obadia, Yolande
Jacquier, Alexis
La Scola, Bernard
Brouqui, Philippe
Drancourt, Michel
Parola, Philippe
Raoult, Didier
Documentos PDF
Resumen
Background:
In our institute in Marseille, France, we initiated early and massive screening for
coronavirus disease 2019 (COVID-19). Hospitalization and early treatment with
hydroxychloroquine and azithromycin (HCQ-AZ) was proposed for the positive cases.
Methods:
We retrospectively report the clinical management of 3,737 screened patients,
including 3,119 (83.5%) treated with HCQ-AZ (200 mg of oral HCQ, three times daily for ten
days and 500 mg of oral AZ on day 1 followed by 250 mg daily for the next four days,
respectively) for at least three days and 618 (16.5%) patients treated with other regimen
(“others”). Outcomes were death, transfer to the intensive care unit (ICU), ≥ 10 days of
hospitalization and viral shedding.
Results:
The patients’ mean age was 45 (sd 17) years, 45% were male, and the case fatality rate
was 0.9%. We performed 2,065 low-dose computed tomography (CT) scans highlighting lung
lesions in 592 of the 991 (59.7%) patients with minimal clinical symptoms (NEWS score =
0). A discrepancy between spontaneous dyspnoea, hypoxemia and lung lesions was observed.
Clinical factors (age, comorbidities, NEWS-2 score), biological factors (lymphocytopenia;
eosinopenia; decrease in blood zinc; and increase in D-dimers, lactate dehydrogenase,
creatinine phosphokinase, and C-reactive protein) and moderate and severe lesions detected in
low-dose CT scans were associated with poor clinical outcome. Treatment with HCQ-AZ was
associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11-
0.27), decreased risk of hospitalization ≥10 days (odds ratios 95% CI 0.38 0.27-0.54) and
shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17-1.42). QTc
prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 12 cases including 3 cases with QTc> 500ms. No cases of torsade de pointe or
sudden death were observed.
Conclusion
Although this is a retrospective analysis, results suggest that early diagnosis, early
isolation and early treatment of COVID-19 patients, with at least 3 days of HCQ-AZ lead to a
significantly better clinical outcome and a faster viral load reduction than other treatments.
Palabras clave
SARS-CoV-2; COVID-19; Hydroxychloroquine; AzithromycinEnlace al recurso
https://doi.org/10.1016/j.tmaid.2020.101791Colecciones
- Año 2020 [153]
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