Hydroxychloroquine/azithromycin: no mortality benefit, cardiac arrest a concern in COVID-19

  • Rosenberg ES & al.
  • JAMA
  • 11 May 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Hydroxychloroquine, azithromycin, or the combination is not significantly associated with lower in-hospital mortality vs no treatment among hospitalized patients with COVID-19.

Why this matters

  • Patients with COVID-19 being administered hydroxychloroquine/azithromycin should be monitored for cardiac arrest.

Key results

  • 1438 cases.
    • 51.1% hydroxychloroquine+azithromycin.
    • 18.8% hydroxychloroquine.
    • 14.7% azithromycin.
    • 15.4% neither.
  • Overall in-hospital mortality: 20.3% (95% CI, 18.2%-22.4%).
  • No significant mortality differences observed (adjusted HRs; 95% CIs):
    • Hydroxychloroquine/azithromycin: 1.35 (0.76-2.40).
    • Hydroxychloroquine: 1.08 (0.63-18.5).
    • Azithromycin: 0.56 (0.26-1.21).
  • Estimated 21-day direct-adjusted mortality (adjusted HRs; 95% CIs):
    • Hydroxychloroquine/azithromycin: 22.5% (19.7%-25.1%). 
    • Hydroxychloroquine: 18.9% (14.3%-23.2%). 
    • Azithromycin: 10.9% (5.8%-15.6%). 
    • Neither drug: 17.8% (11.1%-23.9%).
  • Vs having neither drug:
    • Cardiac arrest was more likely (aORs; 95% CIs) with:
      • Hydroxychloroquine+azithromycin: 2.13 (1.12-4.05). 
    • It was not more likely with:
      • Hydroxychloroquine: 1.91 (0.96-3.81); or
      • Azithromycin: 0.64 (0.27-1.56).
  • Cardiac arrest risk was significantly increased among patients not receiving mechanical ventilation but receiving hydroxychloroquine alone vs azithromycin alone: aOR, 3.01 (95% CI, 1.07-8.51).

Study design

  • Retrospective, multicenter analysis, patients in New York hospitals.
  • Funding: None disclosed.

Limitations

  • Observational.
  • Uncaptured sampling data.
  • Mortality data limited to in-hospital deaths.
  • Unmeasured, residual confounding.
  • Limited power.