Use of Hydroxychloroquine in Patients with COVID-19: A Retrospective Observational Study

Lotfy et al., Turk. Thorac. J., doi:10.5152/TurkThoracJ.2021.20180, Jan 2021
Mortality -25% improvement lower risk ← → higher risk Ventilation -41% ICU admission -17% HCQ for COVID-19  Lotfy et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 202 patients in Saudi Arabia Higher ventilation (p=0.34) and ICU admission (p=0.53), not sig. c19early.org Lotfy et al., Turk. Thorac. J., January 2021 0 0.5 1 1.5 2+ RR
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 424 studies, used in 59 countries.
Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.
No treatment is 100% effective. Protocols combine treatments.
6,300+ studies for 210+ treatments. c19early.org
Meta Analysis
Retrospective 202 patients in Saudi Arabia not showing significant differences with treatment. No information is provided on how patients were selected for treatment, there may be significant confounding by indication. Time varying confounding is also likely as HCQ became controversial during the period studied, therefore HCQ use was likely more frequent toward the beginning of the period, a time when overall treatment protocols were significantly worse.
This study is excluded in the after exclusion results of meta analysis: substantial confounding by time likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically; substantial unadjusted confounding by indication likely.
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risk of death, 24.8% higher, RR 1.25, p = 0.76, treatment 6 of 99 (6.1%), control 5 of 103 (4.9%).
risk of mechanical ventilation, 41.2% higher, RR 1.41, p = 0.34, treatment 19 of 99 (19.2%), control 14 of 103 (13.6%).
risk of ICU admission, 16.5% higher, RR 1.17, p = 0.53, treatment 28 of 99 (28.3%), control 25 of 103 (24.3%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lotfy et al., 1 Jan 2021, retrospective, Saudi Arabia, peer-reviewed, mean age 55.0, 3 authors.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org December 2025 Saudi Arabia United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Pakistan Argentina Vietnam Peru Philippines Spain Brazil Italy France Japan China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Iceland New Zealand Mongolia Hong Kong Belarus Qatar Panama Serbia CAR Saudi Arabia favored high-profit treatments.The average efficacy of treatments was moderate.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org December 2025 Saudi Arabia United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Pakistan Argentina Vietnam Peru Philippines Spain Brazil Italy France Japan China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Algeria Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore Iceland Malawi Czechia Hong Kong North Macedonia Belarus Qatar Panama Serbia Syria Saudi Arabia favored high-profit treatments.The average efficacy was moderate.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Use of Hydroxychloroquine in Patients with COVID-19: A Retrospective Observational Study
Samah Mohamad Lotfy, Ahmad Abbas, Waheed Shouman
Turkish Thoracic Journal, doi:10.5152/turkthoracj.2021.20180
INTRODUCTION Corona viruses are important human and animal pathogens. Towards the end of 2019, a novel corona virus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread, resulting in a global pandemic. The disease is termed as COVID-19, which stands for the corona virus disease 2019 [1] . There is no consensus on a certain drug therapy for COVID-19 infection as yet. A lot of drugs are under trial or are empirically included in treatment protocols for COVID-19. Drug re-purposing is the most widely used method for rapid response in the face of this epidemic. Trials to invent de novo medicines may not be the perfect rationale, while the death and infection toll is on the rise by the hour. Hydroxychloroquine (HCQ) is an antimalarial and antirheumatic immunomodulating agent that has been suggested as an effective treatment for COVID-19 because of its anti-inflammatory and antiviral effects [2] [3] [4] [5] . Growing reports argue about the potential benefits of HCQ in reducing morbidity and mortality in patients hospitalized with COVID-19, but with inconsistent results [6] . So, the current work was conducted to test the potential benefits of HCQ on viral conversion, reducing the need for ICU, mechanical ventilation, and its impact on mortality. MATERIAL AND METHODS This is a retrospective observational study. It was carried out at the Saudi National Hospital, Mecca, KSA, after obtaining the approval of the administrative manager and the hospital ethical committee. Patients with full files with document-
Ethics Committee Approval: Ethics Committee approval for the study was obtained from the Hospital Ethical Committee Saudi National Hospital (SNH1352020). Informed Consent: As it was a retrospective study, informed consent was not required. Peer-review: Externally peer-reviewed. Author Contributions: Concept -A.A., W.S.; Design-A.A., W.S.; Supervision -W.S.; Materials -W.S.; Data Collection and/or Processing -S.M.L.; Analysis and/or Interpretation -S.M.L., A.A., W.S.; Literature Review -A.A.; Writing -A.A., W.S.; Critical Review -S.M.L., A.A., W.S. Conflict of Interest: The authors have no conflicts of interest to declare. Financial Disclosure: The authors declared that this study has received no financial support.
References
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Fantini, Scala, Chahinian, Yahi, Structural and molecular modeling studies reveal a new mechanism of action of chloroquine and hydroxychloroquine against SARS-CoV-2 infection, Int J Antimicrob Agents, doi:10.1016/j.ijantimicag.2020.105960
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Gautret, Lagier, Parola, Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an openlabel non-randomized clinical trial, Int J Antimicrob Agents, doi:10.1016/j.ijantimicag.2020.105949
Geleris, Sun, Platt, Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2012410
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Magagnoli, Narendran, Pereira, Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19, medRxiv, doi:10.1101/2020.04.16.20065920
Rosenberg, Dufort, Udo, Association of Treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State, JAMA, doi:10.1001/jama.2020.8630
Tang, Cao, Han, Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: Open label, randomised controlled trial, BMJ, doi:10.1136/bmj.m1849
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Yao, Ye, Zhang, In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clin Infect Dis, doi:10.1093/cid/ciaa237
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Late treatment
is less effective
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