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Treatment with hydroxychloroquine vs nitazoxanide in patients with COVID-19: brief report

Calderón et al., PAMJ - Clinical Medicine, doi:10.11604/pamj-cm.2021.7.15.30981
Nov 2021  
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Mortality 68% Improvement Relative Risk Ventilation 87% ICU admission 59% Hospitalization time 52% Nitazoxanide  Calderón et al.  LATE TREATMENT Is late treatment with nitazoxanide beneficial for COVID-19? Retrospective 44 patients in Mexico Study compares with HCQ, results vs. placebo may differ Lower ICU admission (p<0.0001) and shorter hospitalization (p=0.0065) Calderón et al., PAMJ - Clinical Medic.., Nov 2021 Favorsnitazoxanide FavorsHCQ 0 0.5 1 1.5 2+
Planned RCT of HCQ vs. HCQ+nitazoxanide which was aborted due to the retracted Surgisphere paper. Authors retrospectively analyze a small set of HCQ vs. nitazoxanide patients (which were protocol deviations in the planned RCT), showing reduced hospitalization time and ICU admission with nitazoxanide.
Study covers HCQ and nitazoxanide.
risk of death, 68.2% lower, RR 0.32, p = 0.38, treatment 1 of 17 (5.9%), control 5 of 27 (18.5%), NNT 7.9.
risk of mechanical ventilation, 86.7% lower, RR 0.13, p = 0.15, treatment 0 of 17 (0.0%), control 4 of 27 (14.8%), NNT 6.8, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of ICU admission, 59.3% lower, RR 0.41, p < 0.001, treatment 0 of 17 (0.0%), control 16 of 27 (59.3%), NNT 1.7, adjusted per study.
hospitalization time, 51.8% lower, relative time 0.48, p = 0.006, treatment 17, control 27.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Calderón et al., 23 Nov 2021, retrospective, Mexico, peer-reviewed, 7 authors, this trial compares with another treatment - results may be better when compared to placebo.
This PaperNitazoxanideAll
Treatment with hydroxychloroquine vs nitazoxanide in patients with COVID-19: brief report
José Meneses Calderón, Srivatsan Padmanabhan, Fernando Manuel, Carranza Salazar, David Californias Hernández, Alfredo Israel Díaz Martínez, César Humberto, Botello Ortiz, Hugo Mendieta Zerón, Fernando Manuel Carranza Salazar, César Humberto Botello Ortiz, Hugo Mendieta Zéron
Introduction: coronavirus pandemic has led to 1.8 million deaths worldwide as of May 1 st , 2021. Nitazoxanide (NTZ) is currently being studied in several ambulatory clinical trials to control viral infections including SARS-CoV-2. This study evaluates the effect of treatment with NTZ compared to Hydroxychloroquine (HCQ) in hospitalized patients. Methods: in this clinical study performed from May to August 2020, two groups of COVID-19 patients were compared: A) a control group treated with HCQ 200 mg PO twice a day for seven days and B) an experimental group treated with NTZ 500 mg PO every 6 hours for seven days. Student's t-test between the two groups and Relative Risk (RR) with a 95% confidence interval (CI), were calculated. In all cases a P<0.05 was considered statistically significant. Results: twenty-seven ( 27 ) patients (females 17, males 10) treated with HCQ and 17 patients (females 8, males 9) administered NTZ were included in the study (mean age 44.6 ± 14.4 years old). At the moment of hospital admission, the following variables were statistically significant: BMI (P=0.0225) and leucocyte counts (P=0.069). In the follow-up period, the statistically significant variables were hospital length of stay (P=0.003257) and Intensive Care Units (ICU) admission with a lower RR in the group taking NTZ vs HCQ of 0.4074 (95% CI: 0.2451 to 0.5927, attributable risk (P1 -P2): 0.5926, P≤0.0001, NNT: 1.688). Conclusion: in comparison to HCQ, NTZ significantly reduces the risk to be hospitalized in the ICU and this approach could be replicated easily in any hospital.
Competing interests The authors declare no competing interests. Authors' contributions
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Late treatment
is less effective
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