Time to negative PCR from symptom onset in COVID-19 patients on Hydroxychloroquine and Azithromycin - A real-world experience
Sarfraz Saleemi, Abdulrahman Alrajhi, Mohammed Alhajji, Areej Alfattani, Faisal Albaiz
doi:10.1101/2020.08.05.20151027
Background: The role of hydroxychloroquine (HCQ) and azithromycin in the treatment of COVID-19 and its effect on SARS-CoV-2 viral clearance is not known. Methods: This is a retrospective observational study to assess the effect of HCQ and Azithromycin on duration from symptom onset to negative SARS-CoV-2 PCR using nasopharyngeal swab in hospitalized patient with COVID-19. Eighty-five patients were included in the study, 65 in HCQ (Hydroxychloroquine + Azithromycin) and 20 in non-HCQ group. Measurement of duration from symptom onset to negative PCR and effect of gender, age and disease severity on time to viral clearance was measured. NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. Results: Median time to negative PCR in HCQ group was 23 days (IQR: 9, Mean 24+8, N=65) compared with non-HCQ group, 19 days (IQR: 8, Mean 18+6, N=20), (p <0.05). Forty-one (63%) patients in HCQ group and all patients (100%) in non-HCQ group had mild disease. Multivariate regression model (F=6.8, P<0.002, R 2 =0.20) shows that being in HCQ group would delay the time to negative PCR by 7 days (95%CI: 2-12) and with every year increase in the age, the time to negative PCR would be delayed by 0.12 days (95%CI: 0.017-0.22). Among HCQ sub-groups, gender and disease severity had no effect on duration (p 0.142 and 0.156 respectively) but older patients >60 year had longer duration compared to patients <60 year of age although p value did not reach significance (p 0.073). Median time to negative PCR in mild-HCQ group (23 days, IQR: 9, Mean 23+8, N=41) was longer when compared with non-HCQ group (p <0.05). On day 28, all patients in non-HCQ group had negative PCR while only 50/65 (77%) were negative in HCQ group.
Conclusion: Hydroxychloroquine (HCQ) and azithromycin delay SARS-CoV-2 virus clearance in hospitalized patients with COVID-19 and it is correlated with older age. Larger studies are needed to confirm this finding.
References
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'abstract': '<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The '
'role of hydroxychloroquine (HCQ) and azithromycin in the treatment of COVID-19 and its effect '
'on SARS-CoV-2 viral clearance is not '
'known.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is a '
'retrospective observational study to assess the effect of HCQ and Azithromycin on duration '
'from symptom onset to negative SARS-CoV-2 PCR using nasopharyngeal swab in hospitalized '
'patient with COVID-19. Eighty-five patients were included in the study, 65 in HCQ '
'(Hydroxychloroquine + Azithromycin) and 20 in non-HCQ group. Measurement of duration from '
'symptom onset to negative PCR and effect of gender, age and disease severity on time to viral '
'clearance was '
'measured.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Median time to '
'negative PCR in HCQ group was 23 days (IQR: 9, Mean 24+8, N=65) compared with non-HCQ group, '
'19 days (IQR: 8, Mean 18±6, N=20), <jats:italic>(p</jats:italic> <0.05). Forty-one (63%) '
'patients in HCQ group and all patients (100%) in non-HCQ group had mild disease. Multivariate '
'regression model (F=6.8, <jats:italic>P</jats:italic><0.002, R<jats:sup>2</jats:sup>=0.20) '
'shows that being in HCQ group would delay the time to negative PCR by 7 days (95%CI: 2-12) '
'and with every year increase in the age, the time to negative PCR would be delayed by 0.12 '
'days (95%CI: 0.017-0.22). Among HCQ sub-groups, gender and disease severity had no effect on '
'duration (<jats:italic>p</jats:italic> 0.142 and 0.156 respectively) but older patients ≥60 '
'year had longer duration compared to patients <60 year of age although '
'<jats:italic>p</jats:italic> value did not reach significance (<jats:italic>p</jats:italic> '
'0.073). Median time to negative PCR in mild- HCQ group (23 days, IQR: 9, Mean 23+8, N=41) was '
'longer when compared with non-HCQ group <jats:italic>(p</jats:italic> <0.05). On day 28, '
'all patients in non-HCQ group had negative PCR while only 50/65 (77%) were negative in HCQ '
'group.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Hydroxychloroquine '
'(HCQ) and azithromycin delay SARS-CoV-2 virus clearance in hospitalized patients with '
'COVID-19 and it is correlated with older age. Larger studies are needed to confirm this '
'finding.</jats:p></jats:sec>',
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