Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19

11 mai 2020

Source : The NEJM

Auteurs : Joshua Geleris and al.


ANALYSE

Commentateur : Dr Marie MOITRY

Ce qu’elle apporte :

  • Dans cette étude, aucune association significative n’a été retrouvée entre l’administration d’HQ et la survenue du décès/intubation chez les patients hospitalisés pour un diagnostic confirmé de COVID-19.
  • Malgré le caractère observationnel rétrospectif de l’étude et les biais qu’elle peut comporter (pas de recueil spécifique à l’étude, pas de randomisation, risque de confusion résiduelle, étude unicentrique…), la taille de l’échantillon (+ de 1300) et les analyses statistiques poussées apportent des informations pertinentes.
  • Les résultats ne sont pas en faveur du recours à l’HQ chez les patients COVID.
  • Des essais randomisés sont indispensables pour confirmer ou infirmer l’intérêt de cette molécule dans l’arsenal thérapeutique.
  • Il est à noter que ces résultats ont conduit au retrait des suggestions de prescription d’HQ pour les patients COVID souffrant de difficultés respiratoires dans l’établissement d’étude (New-York).

Vous trouverez l’analyse détaillée ICI.

ABSTRACT

BACKGROUND

Hydroxychloroquine has been widely administered to patients with Covid-19 without robust evidence supporting its use.

METHODS

We examined the association between hydroxychloroquine use and intubation or death at a large medical center in New York City. Data were obtained regarding consecutive patients hospitalized with Covid-19, excluding those who were intubated, died, or discharged within 24 hours after presentation to the emergency department (study baseline). The primary end point was a composite of intubation or death in a time-to-event analysis. We compared outcomes in patients who received hydroxychloroquine with those in patients who did not, using a multivariable Cox model with inverse probability weighting according to the propensity score.

RESULTS

Of 1446 consecutive patients, 70 patients were intubated, died, or discharged within 24 hours after presentation and were excluded from the analysis. Of the remaining 1376 patients, during a median follow-up of 22.5 days, 811 (58.9%) received hydroxychloroquine (600 mg twice on day 1, then 400 mg daily for a median of 5 days); 45.8% of the patients were treated within 24 hours after presentation to the emergency department, and 85.9% within 48 hours. Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine (median ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, 223 vs. 360). Overall, 346 patients (25.1%) had a primary end-point event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses.

CONCLUSIONS

In this observational study involving patients with Covid-19 who had been admitted to the hospital, hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death. Randomized, controlled trials of hydroxychloroquine in patients with Covid-19 are needed. (Funded by the National Institutes of Health.)


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