Early combination therapy with hydroxychloroquine and azithromycin reduces mortality in 10,429 COVID-19 outpatients
Early combination therapy with hydroxychloroquine and azithromycin reduces mortality in 10,429 COVID-19 outpatients
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DOI：
10.31083/j.rcm2203116
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发表时间：
2021-09-24
影响因子：
2.7
通讯作者：
Raoult, Didier
中科院分区：
文献类型：
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作者：
Million, Matthieu;Lagier, Jean-Christophe;Raoult, Didier
我们评估了在专门的 COVID-19 日间医院早期治疗的未经选择的感染 SARS-CoV-2 的成人门诊患者的年龄特异性死亡率，并评估了使用羟氯喹 (HCQ) + 阿奇霉素 (AZ) 是否与该队列中生存率的改善相关。 2020 年 3 月至 12 月，我们中心的日间医院对经 PCR 证实感染的成年人进行了一项回顾性单中心队列研究，这些成年人按照标准化方案接受门诊治疗。主要终点是 6 周死亡率，次要终点是转入重症监护室和住院率。在 10,429 名患者（中位年龄 45 [IQR 32-57] 岁；5597 名 [53.7%] 女性）中，有 16 名患者死亡 (0.15%)。在接受HCQ+AZ治疗的8315例患者中，感染死亡率为0.06%。 8414名60岁以下患者中，无死亡病例。年龄较大和男性与较高的死亡、ICU 转移和住院风险相关。 HCQ+AZ (0.17 [0.06-0.48]) 治疗与较低的死亡风险相关，与年龄、性别和流行时期无关。荟萃分析证明与之前的 4 项门诊研究一致（32,124 名患者，比值比 0.31 [0.20-0.47]，I-2 = 0%）。以 HCQ+AZ 作为护理标准的 COVID-19 早期门诊治疗与非常低的死亡率相关，并且与其他方案相比，HCQ+AZ 可以提高 COVID-19 的生存率。
We evaluated the age-specific mortality of unselected adult outpatients infected with SARS-CoV-2 treated early in a dedicated COVID-19 day hospital and we assessed whether the use of hydroxychloroquine (HCQ) + azithromycin (AZ) was associated with improved survival in this cohort. A retrospective monocentric cohort study was conducted in the day hospital of our center from March to December 2020 in adults with PCR-proven infection who were treated as outpatients with a standardized protocol. The primary endpoint was 6-week mortality, and secondary endpoints were transfer to the intensive care unit and hospitalization rate. Among 10,429 patients (median age, 45 [IQR 32-57] years; 5597 [53.7%] women), 16 died (0.15%). The infection fatality rate was 0.06% among the 8315 patients treated with HCQ+AZ. No deaths occurred among the 8414 patients younger than 60 years. Older age and male sex were associated with a higher risk of death, ICU transfer, and hospitalization. Treatment with HCQ+AZ (0.17 [0.06-0.48]) was associated with a lower risk of death, independently of age, sex and epidemic period. Meta-analysis evidenced consistency with 4 previous outpatient studies (32,124 patients-Odds ratio 0.31 [0.20-0.47], I-2 = 0%). Early ambulatory treatment of COVID-19 with HCQ+AZ as a standard of care is associated with very low mortality, and HCQ+AZ improve COVID-19 survival compared to other regimens.