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Peters EJ, Collard D, Van Assen S, Beudel M, Bomers MK, Buijs J, De Haan LR, De Ruijter W, Douma RA, Elbers PW, Goorhuis A, Gritters van den Oever NC, Knarren LG, Moeniralam HS, Mostard RL, Quanjel MJ, Reidinga AC, Renckens R, Van Den Bergh JP, Vlasveld IN, Sikkens JJ. Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine. Clin Microbiol Infect 2020; 27:264-268. [PMID: 33068758 PMCID: PMC7554450 DOI: 10.1016/j.cmi.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Edgar Jg Peters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands.
| | - Didier Collard
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Sander Van Assen
- Treant Zorggroep, Department of Internal Medicine/Infectious Diseases, Emmen, the Netherlands
| | - Martijn Beudel
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam, the Netherlands
| | - Marije K Bomers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - Jacqueline Buijs
- Zuyderland Medical Center, Department of Internal Medicine, Heerlen/Sittard, the Netherlands
| | - Lianne R De Haan
- Flevoziekenhuis, Department of Internal Medicine, Almere, the Netherlands
| | - Wouter De Ruijter
- Noordwest Ziekenhuisgroep, Intensive Care Unit, Alkmaar, the Netherlands
| | - Renée A Douma
- Flevoziekenhuis, Department of Internal Medicine, Almere, the Netherlands
| | - Paul Wg Elbers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - Abraham Goorhuis
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam, the Netherlands
| | | | - Lieve Ghh Knarren
- Viecuri MC Noord-Limburg, Department of Internal Medicine, Venlo, the Netherlands
| | - Hazra S Moeniralam
- St Antonius Ziekenhuis, Department of Internal Medicine and Intensive Care Unit, Nieuwegein, the Netherlands
| | - Remy Lm Mostard
- Zuyderland Medical Center, Department of Pulmonology, Heerlen/Sittard, the Netherlands
| | - Marian Jr Quanjel
- St Antonius Ziekenhuis, Department of Pulmonology, Nieuwegein, the Netherlands
| | - Auke C Reidinga
- Martini Hospital, Intensive Care Unit, Groningen, the Netherlands
| | - Roos Renckens
- Noordwest Ziekenhuisgroep, Department of Internal Medicine, Alkmaar, the Netherlands
| | | | - Imro N Vlasveld
- Martini Hospital, Intensive Care Unit, Groningen, the Netherlands; Martini Hospital, Department of Internal Medicine, Groningen, the Netherlands
| | - Jonne J Sikkens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
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