Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France : A retrospective analysis
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved..
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, troponin 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> 500 ms. 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Travel medicine and infectious disease - 36(2020) vom: 24. Juli, Seite 101791 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lagier, Jean-Christophe [VerfasserIn] |
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| Themen: |
4QWG6N8QKH |
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| Anmerkungen: |
Date Completed 24.09.2020 Date Revised 29.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.tmaid.2020.101791 |
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| PPN (Katalog-ID): |
NLM311720153 |
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| 100 | 1 | |a Lagier, Jean-Christophe |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France |b A retrospective analysis |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 24.09.2020 | ||
| 500 | |a Date Revised 29.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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, troponin 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> 500 ms. No cases of torsade de pointe or sudden death were observed | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Evaluation Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Azithromycin | |
| 650 | 4 | |a COVID-19 | |
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| 700 | 1 | |a Honoré, Stéphane |e verfasserin |4 aut | |
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| 700 | 1 | |a Obadia, Yolande |e verfasserin |4 aut | |
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| 700 | 1 | |a La Scola, Bernard |e verfasserin |4 aut | |
| 700 | 1 | |a Brouqui, Philippe |e verfasserin |4 aut | |
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| 700 | 1 | |a Berenger, Cyril |e investigator |4 oth | |
| 700 | 1 | |a Camoin-Jau, Laurence |e investigator |4 oth | |
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| 700 | 1 | |a Decoster, Claire |e investigator |4 oth | |
| 700 | 1 | |a Dhiver, Catherine |e investigator |4 oth | |
| 700 | 1 | |a Doudier, Barbara |e investigator |4 oth | |
| 700 | 1 | |a Edouard, Sophie |e investigator |4 oth | |
| 700 | 1 | |a Gentile, Stéphanie |e investigator |4 oth | |
| 700 | 1 | |a Guillon-Lorvellec, Katell |e investigator |4 oth | |
| 700 | 1 | |a Hocquart, Marie |e investigator |4 oth | |
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| 700 | 1 | |a Mailhe, Morgane |e investigator |4 oth | |
| 700 | 1 | |a Ravaux, Isabelle |e investigator |4 oth | |
| 700 | 1 | |a Richez, Magali |e investigator |4 oth | |
| 700 | 1 | |a Roussel, Yanis |e investigator |4 oth | |
| 700 | 1 | |a Seng, Piseth |e investigator |4 oth | |
| 700 | 1 | |a Tomei, Christelle |e investigator |4 oth | |
| 700 | 1 | |a Zandotti, Christine |e investigator |4 oth | |
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