Examination of patient characteristics and hydroxychloroquine use based on the US Food and Drug Administration's recommendation: a cross-sectional analysis in New York

A Box-Behnken design-based chemometric approach to optimize the sono-photodegradation of hydroxychloroquine in water media using the Fe(0)/S2O82-/UV system

The huge utilization of hydroxychloroquine in autoimmune infections led to an abnormal increment in its concentration in wastewater, which can pose a real risk to the environment, necessitating the development of a pretreatment technique. To do this, we are interested in researching how hydroxychloroquine degrades in contaminated water. The main goal of this investigation is to optimize the operating conditions for the sono-photodegradation of hydroxychloroquine in water using an ultrasound-assisted Fe(0)/S 2 O 8 2 - /UV system. To get adequate removal of HCQ, a chemometric method based on the Box-Behnken design was applied to optimize the influence of the empirical parameters selected, including Fe(0) dose,S 2 O 8 2 - concentration, pH, and initial HCQ concentration. The quadratic regression model representing the HCQ removal rate (η(%)) was evolved and validated by ANOVA. The optimal conditions as a result of the above-mentioned trade-off between the four input variables, with η(%) as the dependent output variable, were captured using RSM methodology and the composite desirability function approach. For HCQ full decomposition, the optimal values of the operating factors are as follows:S 2 O 8 2 - dose, 194.309 mg/L; Fe(0) quantity, 198.83 mg/L; pH = 2.017, and HCQ initial dose of 296.406 mg/L. Under these conditions, the HCQ removal rate, achieved after 60 min of reaction, attained 98.95%.

Efficacy of chloroquine and hydroxychloroquine for the treatment of hospitalized COVID-19 patients: a meta-analysis

Aims: To evaluate the efficacy and safety of hydroxychloroquine/chloroquine, with or without azithromycin, in treating hospitalized COVID-19 patients. Materials & methods: Data from randomized and observational studies were included in a random-effects meta-analysis. Primary outcomes included time to negative conversion of SARS-CoV-2 tests, length of stay, mortality, incidence of mechanical ventilation, time to normalization of body temperature, incidence of adverse events and incidence of QT prolongations. Results: Fifty-one studies (n = 61,221) were included. Hydroxychloroquine/chloroquine showed no efficacy in all primary efficacy outcomes, but was associated with increased odds of QT prolongations. Conclusion: Due to a lack of efficacy and increased odds of cardiac adverse events, hydroxychloroquine/chloroquine should not be used for treating hospitalized COVID-19 patients.

Hydroxychloroquine and mortality in COVID-19 patients: a systematic review and a meta-analysis of observational studies and randomized controlled trials

Background: Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19, but its association with mortality is unclear. We reviewed published literature for evidence of an association between HCQ (with or without azithromycin (AZM)) and total mortality in COVID-19 patients.Methods: Articles were retrieved until April 29th, 2021 by searching in seven databases. Data were combined using the general-variance-based method.Results: A total of 25 cohort studies (N=41,339 patients) and 11 randomized clinical trials (RCTs; N=8,709) were found. The use of HCQ was not associated with mortality in meta-analysis of RCTs (pooled risk ratio (PRR): 1.08, 95%CI: 0.97-1.20; I2=0%), but it was associated with 20% lower mortality risk (PRR=0.80, 95%CI: 0.69-0.93; I2=80%) in pooling of cohort studies. The negative association with mortality was mainly apparent by pooling cohort studies that used lower doses of HCQ (≤400 mg/day; PRR=0.69, 95%CI: 0.57-0.87). Use of HCQ+AZM (11 studies) was associated with 25% non-statistically significant lower mortality risk (PPR=0.75; 0.51-1.10; P=0.15). Use of HCQ was not associated with severe adverse events (PRR=1.12, 95%CI: 0.88-1.44; I2=0%).Conclusions: HCQ use was not associated with mortality in COVID-19 patients in pooling results from RCTs (high level of certainty of evidence), but it was associated with 20% mortality reduction when findings from observational studies were combined (low level of certainty of evidence). The reduction of mortality was mainly apparent in observational studies where lower doses of HCQ were used. These findings might help disentangling the debate on HCQ use in COVID-19.

Willingness to Treat with Therapies of Unknown Effectiveness in Severe COVID-19: A Survey of Intensivist Physicians

RATIONALE

Little is known about how physicians develop their beliefs about new treatments or update their beliefs in the face of new clinical evidence. These issues are particularly salient in the context of the COVID-19 pandemic, which created rapid demand for novel therapies in the absence of robust evidence.

OBJECTIVE

To identify psychological traits associated with physicians' willingness to treat with unproven therapies and willingness to update their treatment preferences in the setting of new evidence in the context of COVID-19.

METHODS

We administered a longitudinal e-mail survey to United States physicians board-certified in intensive care medicine in April and May, 2020 (phase one); and October and November, 2020 (phase two). We assessed five psychological traits potentially related to evidence-uptake: need for cognition, evidence skepticism, need for closure, risk tolerance, and research engagement. We then examined the relationship between these traits and physician preferences for pharmacological treatment for a hypothetical patient with severe COVID-19 pneumonia.

RESULTS

There were 592 responses to the phase one survey, conducted prior to publication of trial data. At this time physicians were most willing to treat with macrolide antibiotics (50.5%), followed by antimalaria agents (36.1%), corticosteroids (24.5%), antiretroviral agents (22.6%), and angiotensin inhibitors (4.4%). Greater evidence skepticism (relative risk, RR=1.40, 95% CI: 1.30 - 1.52, p<0.001), greater need for closure (RR=1.19, 95% CI: 1.06 - 1.34, p=0.003), and greater risk tolerance (RR=1.17, 95% CI: 1.08 - 1.26, p<0.001) were associated with an increased willingness to treat; while greater need for cognition (RR: 0.85, 95% CI: 0.75 - 0.96, p=0.010) and greater research engagement (RR=0.91, 95% CI: 0.88 - 0.95, p<.0001) were associated with decreased willingness to treat. In phase two, most physicians updated their beliefs after publication of trial data about antimalarial agents and corticosteroids. Physicians with greater evidence skepticism more likely to persist in their beliefs.

CONCLUSIONS

Psychological traits associated with clinical decisions in the setting of uncertain evidence may provide insight into strategies to better align clinical practice with published evidence.