Efficacy of early hydroxychloroquine treatment in preventing COVID-19 pneumonia aggravation, the experience from Shanghai, China

Su et al., BioScience Trends, doi:10.5582/bst.2020.03340, Dec 2020

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Vitamin C for COVID-19

6th treatment shown to reduce risk in September 2020, now with p = 0.00000004 from 74 studies, recognized in 22 countries.

Lower risk for mortality, ICU, hospitalization, and recovery.

No treatment is 100% effective. Protocols combine treatments.

5,700+ studies for 141 treatments. c19early.org

Retrospective 616 patients in China showing increased risk of disease progression with vitamin C treatment.

This is the 10th of 74 COVID-19 controlled studies for vitamin C, which collectively show efficacy with p=0.00000004 (1 in 25 million).

21 studies are RCTs, which show efficacy with p=0.0012.

Standard of Care (SOC) for COVID-19 in the study country, China, is poor with low average efficacy for approved treatments1.

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Study covers vitamin C and HCQ.

risk of progression, 135.3% higher, HR 2.35, p = 0.18, adjusted per study, binary logistic regression.

improvement time, 34.2% worse, relative time 1.34, p = 0.04, adjusted per study, inverted to make RR<1 favor treatment, Cox proportional hazards.

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1. c19early.org, c19early.org/soc/china.html.c19early.org/soc/china.html.

Su et al., 23 Dec 2020, retrospective, China, peer-reviewed, 9 authors, study period 20 January, 2020 - 30 April, 2020, dosage 10000mg days 1-3, 5-15g per day for at least 3 days.

This Paper Vitamin C All

Abstract: P1 BioScience Trends Advance Publication Original Article Advance Publication DOI: 10.5582/bst.2020.03340 Efficacy of early hydroxychloroquine treatment in preventing COVID-19 pneumonia aggravation, the experience from Shanghai, China § § § Yi Su1, , Yun Ling2, , Yuyan Ma1, , Lili Tao3, Qing Miao1, Qingfeng Shi4, Jue Pan1, Hongzhou Lu2,*, Bijie Hu1,* 1 Department of Infectious Diseases, Zhongshan Hospital Fudan University, Shanghai, China; Department of Infectious Diseases, Shanghai Public Health Clinical Center, China; 3 UT Southwestern Medical Center, Department of Immunology, Texas, USA; 4 Department of Infectious Control, Zhongshan Hospital Fudan University, Shanghai, China. 2 SUMMARY The aim of this study is to assess the efficacy of multiple treatments, especially hydroxychloroquine, used in different disease stages of coronavirus disease 2019 (COVID-19). All consecutive patients with COVID-19 admitted to Shanghai Public Health Clinical Center (Shanghai, China) between January 20, 2020, and April 30, 2020, were enrolled, and their clinical data were retrospectively collected. Binary logistic regression was used to screen the factors associated with disease aggravation, and multivariable analyses with the Cox proportional hazards model were used to estimate the effects of prognostic factors on the improvement time and PCR conversion days in throat swabs and stool swabs. A total of 616 patients, including 50 (8.11%) severe and 18 (2.92%) critical patients, were enrolled in our retrospective cohort study. The early use of hydroxychloroquine was a protective factor associated with disease aggravation (95% CI: 0.040-0.575, p = 0.006). Clinical improvement by 20 days was significantly different between patients with hydroxychloroquine used early and those with hydroxychloroquine not used (p = 0.016, 95% CI: 1.052-1.647). The median time to clinical improvement was 6 days in the hydroxychloroquine used early group, compared with 9 days in the without hydroxychloroquine used group and 8 days in the with hydroxychloroquine not used early group (p < 0.001). Hydroxychloroquine used early was associated with earlier PCR conversion in both throat swabs (HR = 1.558, p = 0.001) and stool swabs (HR = 1.400, p = 0.028). The use of hydroxychloroquine at an early stage is a potential therapeutic strategy for treating patients before irreversible severe respiratory complications occur. The early use of hydroxychloroquine decreased the improvement time and the duration of COVID-19 detection in throat and stool swabs. Keywords clinical management, treatment, hydroxychloroquine, COVID-19, SARS-CoV-2, coronavirus

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Philippe G, Jean-Christophe L, Philippe P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020; 56:105949." }, { "DOI": "10.1016/S0140-6736(20)30566-3", "doi-asserted-by": "crossref", "key": "2", "unstructured": "2. Fei Z, Ting Y, Ronghui D, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395:1054-1062." }, { "DOI": "10.1093/cid/ciaa443", "doi-asserted-by": "crossref", "key": "3", "unstructured": "3. Jiao G, Jingyi O, Xueping Q, Yusheng J, Yaqiong C, Lianxiong Y, Jing C, Mingkai T, Wengxiong X, Fang Z, Yaling S, Bo H. A tool to early predict severe corona virus disease 2019 (COVID-19): A multicenter study using the risk Nomogram in Wuhan and Guangdong, China. Clin Infect Dis. 2020; 71:833-840." }, { "DOI": "10.1016/j.jinf.2020.04.021", "doi-asserted-by": "crossref", "key": "4", "unstructured": "4. Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, Li Q, Jiang C, Zhou Y, Liu S, Ye C, Zhang P, Xing Y, Guo H, Tang W. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020; 81:e16-e25." }, { "DOI": "10.1128/mSphere.00317-20", "doi-asserted-by": "crossref", "key": "5", "unstructured": "5. Triggle CR, Bansal D, Farag EABA, Ding H, Sultan AA. COVID-19: Learning from lessons to guide treatment and prevention interventions. mSphere. 2020; 5:e00317-20." }, { "DOI": "10.1093/ofid/ofaa130", "doi-asserted-by": "crossref", "key": "6", "unstructured": "6. Pastick KA, Okafor EC, Wang F, et al. Review: Hydroxychloroquine and chloroquine for treatment of SARS-CoV-2 (COVID-19). Open Forum Infect Dis. 2020; 7:ofaa130." }, { "key": "7", "unstructured": "7. National Health Commission. Interpretation of the Seventh Edition of the Guidance for COVID-19: Prevention, Control, Diagnosis, and Management. Guideline for COVID-19 (version 7.0). http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf (accessed Mar 3, 2020). (in Chinese)" }, { "DOI": "10.5582/ddt.2020.01012", "doi-asserted-by": "crossref", "key": "8", "unstructured": "8. Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther. 2020; 14:58-60." }, { "DOI": "10.4103/atm.ATM_99_20", "doi-asserted-by": "crossref", "key": "9", "unstructured": "9. Arabi YM, Asseri A, Webb S, Marshall J, Al Moamary MS. Clinical trials for coronavirus disease 2019: what is being evaluated and what is not. Ann Thorac Med. 2020; 15:49-51." }, { "DOI": "10.1016/j.ijantimicag.2020.105960", "doi-asserted-by": "crossref", "key": "10", "unstructured": "10. Fantini J, Scala CD, Chahinian H, Yahi N. Structural and molecular modeling studies reveal a new mechanism of action of chloroquine and hydroxychloroquine against SARS-CoV-2 infection. Int J Antimicrob Agents. 2020; 55:105960." }, { "DOI": "10.1093/cid/ciaa237", "doi-asserted-by": "crossref", "key": "11", "unstructured": "11. Yao X, Ye F, Zhang M, Cui C, Huang BY, Niu PH, Liu X, Zhao L, Dong E, Song CL, Zhan SY, Lu RJ, Li HY, Tan WJ, Liu DY. 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. 2020; 71:732-739." }, { "DOI": "10.1038/s41421-020-0156-0", "doi-asserted-by": "crossref", "key": "12", "unstructured": "12. Liu J, Cao RY, Xu MY, Wang X, Zhang HY, Hu HR, Li YF, Hu ZH, Zhong W, Wang ML. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020; 6:16." }, { "DOI": "10.1007/s11427-020-1732-2", "doi-asserted-by": "crossref", "key": "13", "unstructured": "13. Yu B, Li C, Chen P, Zhou N, Wang L, Li J, Jiang H, Wang DW. Low dose of hydroxychloroquine reduces fatality of critically ill patients with COVID-19. Sci China Life Sci. 2020; 63:1515-1521." }, { "DOI": "10.1002/jmv.25898", "doi-asserted-by": "crossref", "key": "14", "unstructured": "14. Sarma P, Kaur H, Kumar H, Mahendru D, Avti P, Bhattacharyya A, Prajapat M, Shekhar N, Kumar S, Singh R, Singh A, Dhibar DP, Prakash A, Medhi B. Virological and clinical cure in COVID-19 patients treated with hydroxychloroquine: A systematic review and meta-analysis. J Med Virol. 2020; 92:776-785." }, { "key": "15", "unstructured": "15. Xing Li, Ying Wang, Patrizia Agostinis, Arnold Rabson, Gerry Melino, Ernesto Carafoli, Yufang Shi, Erwei Sun. Is hydroxychloroquine beneficial for COVID-19 patients? Cell Death Dis. 2020; 11:512" }, { "key": "16", "unstructured": "16. Multicenter Collaboration Group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia. Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 43:185-188. (in Chinese)" }, { "DOI": "10.1136/bmj.m1849", "doi-asserted-by": "crossref", "key": "17", "unstructured": "17. Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with mainly mild to moderate Coronavirus Disease 2019: Open label, randomised controlled trial. BMJ. 2020; 369:m1849." }, { "DOI": "10.1001/jama.2020.8630", "doi-asserted-by": "crossref", "key": "18", "unstructured": "18. Rosenberg ES, Dufort EM, Udo T, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State. JAMA. 2020; 323:2493-502." }, { "DOI": "10.1016/j.tmaid.2020.101738", "doi-asserted-by": "crossref", "key": "19", "unstructured": "19. Million M, Lagier JC, Gautret P, et al. Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. Travel Med Infect Dis. 2020; 35:101738." }, { "DOI": "10.1093/cid/ciaa630", "doi-asserted-by": "crossref", "key": "20", "unstructured": "20. Liu YP, Pang Y, Hu ZH, et al. Thymosin alpha 1 (Tα1) reduces the mortality of severe COVID-19 by restoration of lymphocytopenia and reversion of exhausted T cells. Clin Infect Dis. 2020; 71:2150-2157." }, { "DOI": "10.3390/nu11040708", "doi-asserted-by": "crossref", "key": "21", "unstructured": "21. Hemilä H, Chalker E. Vitamin C can shorten the length of stay in the ICU: a meta- analysis. Nutrients. 2019; 11:708." }, { "DOI": "10.1056/NEJMoa2001282", "doi-asserted-by": "crossref", "key": "22", "unstructured": "22. Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020; 382:1787-1799." } ], "reference-count": 22, "references-count": 22, "relation": {}, "resource": { "primary": { "URL": "https://www.jstage.jst.go.jp/article/bst/14/6/14_2020.03340/_article" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [ "General Biochemistry, Genetics and Molecular Biology", "General Medicine", "Health (social science)" ], "subtitle": [], "title": "Efficacy of early hydroxychloroquine treatment in preventing COVID-19 pneumonia aggravation, the experience from Shanghai, China", "type": "journal-article", "volume": "14" }

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