Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19

By P. Horby, M. Mafham, L. Linsell, Jennifer L. Bell, N. Staplin, J. Emberson, M. Wiselka, A. Ustianowski, E. Elmahi, B. Prudon and 20 more. New England Journal of Medicine, 2020

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Background Hydroxychloroquine and chloroquine have been proposed as treatments for coronavirus disease 2019 (COVID-19) on the basis of in vitro activity, uncontrolled data, and small randomized studies. Methods The Randomised Evaluation of COVID-19 therapy (RECOVERY) trial is a randomized, controlled, open-label, platform trial comparing a range of possible treatments with usual care in patients hospitalized with COVID-19. We report the preliminary results for the comparison of hydroxychloroquine vs. usual care alone. The primary outcome was 28-day mortality. Results 1561 patients randomly allocated to receive hydroxychloroquine were compared with 3155 patients concurrently allocated to usual care. Overall, 421 (27.0%) patients allocated hydroxychloroquine and 790 (25.0%) patients allocated usual care died within 28 days (rate ratio 1.09; 95% confidence interval [CI] 0.97 to 1.23; P=0.15). Consistent results were seen in all pre-specified subgroups of patients. The results suggest that patients allocated to hydroxychloroquine may be less likely to be discharged from hospital alive within 28 days (59.9% vs. 63.0%; rate ratio 0.90; 95% CI 0.84-0.98) and that those not on invasive mechanical ventilation at baseline may be more likely to reach the composite endpoint of invasive mechanical ventilation or death (30.2% vs. 26.8%; risk ratio 1.13; 95% CI 1.02-1.25). There was no excess of new major cardiac arrhythmia. Conclusions In patients hospitalized with COVID-19, hydroxychloroquine was not associated with reductions in 28-day mortality but was associated with an increased length of hospital stay and increased risk of progressing to invasive mechanical ventilation or death. Funding Medical Research Council and NIHR (Grant ref: MC_PC_19056). Trial registrations The trial is registered with ISRCTN (50189673) and clinicaltrials.gov (NCT04381936).

Subfields: Infectious Diseases, Neurology

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