Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France
Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France
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DOI：
10.1016/j.tmaid.2020.101738
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发表时间：
2020-05-01
影响因子：
12
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
背景：在法国，羟氯喹（HCQ）和阿奇霉素（AZ）联合用于治疗COVID-19。方法：我们回顾性报告了1061例SARS-CoV-2阳性患者，他们接受了至少3天的治疗方案：HCQ （200mg，每日3次，连续10天）+ AZ（第1天500mg，随后连续4天每天250mg）。结果为死亡、临床恶化（转入ICU，住院10天）和病毒持续脱落（> 10天）。结果：共纳入1061例患者，其中46.4%为男性，平均年龄43.6岁（14 -95岁）。973例患者在10天内获得了良好的临床疗效和病毒学治愈（91.7%）。47例患者（4.4%）观察到长时间的病毒携带，并与诊断时较高的病毒载量相关（p < 0.001），但第10天病毒培养为阴性。除一人外，其余都在第15天被pcr清除。临床预后差（PClinO） 46例（4.3%），死亡8例（0.75%）（74 ~ 95岁）。所有死亡都是由于呼吸衰竭，而不是心脏中毒。目前仍有5例患者住院治疗（98.7%）。PClinO与年龄较大（OR为1.11）、入院时疾病严重程度（OR为10.05）和低HCQ血清浓度相关。PClinO与选择性β -阻滞剂和血管紧张素II受体阻滞剂的使用独立相关（p < 0.05）。总共有2.3%的患者报告轻度不良事件（胃肠道或皮肤症状、头痛、失眠和短暂性视力模糊）。结论：在COVID-19并发症发生前使用HCQ+AZ是安全的，并且与患者的病死率非常低相关。
Background: In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19.Methods: We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and 10 day hospitalization) and viral shedding persistence (> 10 days).Results: A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14 -95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74 -95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta - blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision).Conclusion: Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.