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Reviews of "Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: A multi-center observational study"

Reviewers: Jonas Ranstam (Lund University) | 📒📒📒◻️◻️ • Emanuela Scarpi (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori Sr) | 📕◻️◻️◻️◻️

Published onOct 22, 2020
Reviews of "Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: A multi-center observational study"
key-enterThis Pub is a Review of
Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: A multi-center observational study
Description

Background: Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. Methods: We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. Results: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. Conclusions: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.

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Summary of Reviews: This observational study is potentially informative. It suggests an association between outpatient hydroxychloroquine use decreased hospitalization rate. However, both RR:C19 reviewers expressed concern about the study design, variable definitions, and generalizability.

Reviewer 1 (Jonas Ranstam) | 📒📒📒 ◻️◻️

Reviewer 2 (Emanuela Scarpi) | 📕◻️◻️◻️◻️

RR:C19 Strength of Evidence Scale Key

📕 ◻️◻️◻️◻️ = Misleading

📙📙 ◻️◻️◻️ = Not Informative

📒📒📒 ◻️◻️ = Potentially Informative

📗📗📗📗◻️ = Reliable

📘📘📘📘📘 = Strong

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