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Observational Study
. 2021 Jun 9;16(6):e0252388.
doi: 10.1371/journal.pone.0252388. eCollection 2021.

Lack of efficacy of hydroxychloroquine and azithromycin in patients hospitalized for COVID-19 pneumonia: A retrospective study

Anis Saib  1 , Walid Amara  1 , Pascal Wang  2 , Simon Cattan  1 , Azeddine Dellal  3 , Kais Regaieg  4 , Stephane Nahon  5 , Olivier Nallet  1 , Lee S Nguyen  6
Affiliations
Observational Study

Lack of efficacy of hydroxychloroquine and azithromycin in patients hospitalized for COVID-19 pneumonia: A retrospective study

Anis Saib et al. PLoS One. .

Abstract

Background: Hydroxychloroquine combined with azithromycin (HCQ/AZI) has initially been used against coronavirus disease-2019 (COVID-19). In this retrospective study, we assessed the clinical effects of HCQ/AZI, with a 28-days follow-up.

Methods: In a registry-study which included patients hospitalized for COVID-19 between March 15 and April 2, 2020, we compared patients who received HCQ/AZI to those who did not, regarding a composite outcome of mortality and mechanical ventilation with a 28-days follow-up. QT was monitored for patients treated with HCQ/AZI. Were excluded patients in intensive care units, palliative care and ventilated within 24 hours of admission. Three analyses were performed to adjust for selection bias: propensity score matching, multivariable survival, and inverse probability score weighting (IPSW) analyses.

Results: Overall, 203 patients were included: 60 patients treated by HCQ/AZI and 143 control patients. During the 28-days follow-up, 32 (16.3%) patients presented the primary outcome and 23 (12.3%) patients died. Propensity-score matching identified 52 unique pairs of patients with similar characteristics. In the matched cohort (n = 104), HCQ/AZI was not associated with the primary composite outcome (log-rank p-value = 0.16). In the overall cohort (n = 203), survival and IPSW analyses also found no benefit from HCQ/AZI. In the HCQ/AZI group, 11 (18.3%) patients prolonged QT interval duration, requiring treatment cessation.

Conclusions: HCQ/AZI combination therapy was not associated with lower in-hospital mortality and mechanical ventilation rate, with a 28-days follow-up. In the HCQ/AZI group, 18.3% of patients presented a prolonged QT interval requiring treatment cessation, however, control group was not monitored for this adverse event, making comparison impossible.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow-chart.
Abbreviations: HCQ/AZI: Hydroxychloroquine combined with azithromycin; IPSW: Inverse probability score weighted.
Fig 2
Fig 2
Standardized differences between HCQ/AZI and control group, before (A) and after (B) propensity-score matching.
Fig 3
Fig 3. Survival curves, regarding the primary outcome, comparing HCQ/AZI and control group.
In the propensity-score matched cohort (n = 203), HCQ/AZI was not associated with the primary outcome (p = 0.16). In the overall cohort (n = 104), there was no association in univariate survival comparison, nor in inverse probability score weighted analysis (p = 0.79 for both).
See this image and copyright information in PMC

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