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Comparative Study
. 2021 Feb;27(2):264-268.
doi: 10.1016/j.cmi.2020.10.004. Epub 2020 Oct 14.

Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine

Edgar Jg Peters  1 , Didier Collard  2 , Sander Van Assen  3 , Martijn Beudel  4 , Marije K Bomers  5 , Jacqueline Buijs  6 , Lianne R De Haan  7 , Wouter De Ruijter  8 , Renée A Douma  7 , Paul Wg Elbers  9 , Abraham Goorhuis  10 , Niels C Gritters van den Oever  11 , Lieve Ghh Knarren  12 , Hazra S Moeniralam  13 , Remy Lm Mostard  14 , Marian Jr Quanjel  15 , Auke C Reidinga  16 , Roos Renckens  17 , Joop Pw Van Den Bergh  12 , Imro N Vlasveld  18 , Jonne J Sikkens  5 ; CovidPredict Study Group
Affiliations
Comparative Study

Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine

Edgar Jg Peters et al. Clin Microbiol Infect. 2021 Feb.

Abstract

Objective: To compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine.

Methods: We analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (hydroxy)chloroquine, two hospitals did not. Primary outcome was 21-day all-cause mortality. We performed a survival analysis using log-rank test and Cox regression with adjustment for age, sex and covariates based on premorbid health, disease severity and the use of steroids for adult respiratory distress syndrome, including dexamethasone.

Results: Among 1949 individuals, 21-day mortality was 21.5% in 1596 patients treated in hospitals that routinely prescribed (hydroxy)chloroquine, and 15.0% in 353 patients treated in hospitals that did not. In the adjusted Cox regression models this difference disappeared, with an adjusted hazard ratio of 1.09 (95% CI 0.81-1.47). When stratified by treatment actually received in individual patients, the use of (hydroxy)chloroquine was associated with an increased 21-day mortality (HR 1.58; 95% CI 1.24-2.02) in the full model.

Conclusions: After adjustment for confounders, mortality was not significantly different in hospitals that routinely treated patients with (hydroxy)chloroquine compared with hospitals that did not. We compared outcomes of hospital strategies rather than outcomes of individual patients to reduce the chance of indication bias. This study adds evidence against the use of (hydroxy)chloroquine in hospitalised patients with COVID-19.

Keywords: Chloroquine; Coronavirus disease 2019; Hydroxychloroquine; Mortality; Severe acute respiratory syndrome coronavirus 2.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of 21-day mortality of patients in the (hydroxyl)chloroquine ((H)CQ) hospitals (blue) versus non-(H)CQ hospitals (black), showing a significantly higher 21-day mortality in (H)CQ hospitals, p 0.004. This was attenuated towards a hazard ratio of 1.09 (95% CI 0.81–1.47) in the full regression model (see Table 2). Shaded areas indicate 95% CI.
See this image and copyright information in PMC

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