Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France.

Adolescent Adult Aged Aged, 80 and over Antiviral Agents / administration & dosage Azithromycin / administration & dosage Betacoronavirus / genetics COVID-19 Coronavirus Infections / drug therapy Drug Therapy, Combination Female Follow-Up Studies France Humans Hydroxychloroquine / administration & dosage Male Middle Aged Pandemics Pneumonia, Viral / drug therapy Polymerase Chain Reaction Retrospective Studies SARS-CoV-2 Time Factors Treatment Outcome Viral Load Young Adult COVID-19 Drug Treatment

Azithromycin COVID-19 Hydroxychloroquine SARS-CoV-2

Journal

Travel medicine and infectious disease

ISSN: 1873-0442

Titre abrégé: Travel Med Infect Dis

Pays: Netherlands

ID NLM: 101230758

Informations de publication

Date de publication:

Historique:

received: 20 04 2020

revised: 30 04 2020

accepted: 01 05 2020

pubmed: 11 5 2020

medline: 11 7 2020

entrez: 11 5 2020

Statut: ppublish

Résumé

In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19. We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days). A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14-95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74-95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision). Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.

Sections du résumé

BACKGROUND

In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19.

METHODS

We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days).

RESULTS

A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14-95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74-95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision).

CONCLUSION

Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.

Identifiants

DOI: 10.1016/j.tmaid.2020.101738 PMID: 32387409 PMC: PMC7199729

pubmed: 32387409

pii: S1477-8939(20)30217-9

doi: 10.1016/j.tmaid.2020.101738

pmc: PMC7199729

pii:

doi:

Substances chimiques

Antiviral Agents 0

Hydroxychloroquine 4QWG6N8QKH

Azithromycin 83905-01-5

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

101738

Commentaires et corrections

Type : CommentIn

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare no competing interests. Funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Our group used widely available generic drugs distributed by many pharmaceutical companies (Supplementary data).

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