Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: a multi-center observational study.
Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: a multi-center observational study.
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DOI：
10.1186/s12879-021-05773-w
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发表时间：
2021-01-14
影响因子：
3.7
通讯作者：
Goldberg SL
中科院分区：
文献类型：
--
作者：
Ip A;Ahn J;Zhou Y;Goy AH;Hansen E;Pecora AL;Sinclaire BA;Bednarz U;Marafelias M;Sawczuk IS;Underwood JP 3rd;Walker DM;Prasad R;Sweeney RL;Ponce MG;La Capra S;Cunningham FJ;Calise AG;Pulver BL;Ruocco D;Mojares GE;Eagan MP;Ziontz KL;Mastrokyriakos P;Goldberg SL
在大多数观察性研究中，羟氯喹与住院 COVID-19 患者的生存率改善无关，同样，在一项前瞻性随机试验中，羟氯喹也没有被确定为暴露后的有效预防方法。我们的目的是探讨羟氯喹治疗对门诊诊断的轻度症状患者的作用。我们检查了门诊羟氯喹暴露与记录在案的 SARS-CoV-2 感染的轻度症状非住院患者中随后疾病进展之间的关联。评估的主要结果是住院的需要。数据来自对美国新泽西州多医院网络内电子健康记录的回顾性审查。我们比较了接受羟氯喹的患者与未应用倾向匹配多变量逻辑模型的患者的结果。在 1274 名有 SARS-CoV-2 感染记录的门诊患者中，7.6% 服用了羟氯喹。在 1067 名患者倾向匹配队列中，门诊接触过羟氯喹的患者住院治疗率为 21.6%，未接触过羟氯喹治疗的患者住院治疗率为 31.4%。在采用倾向匹配的主要多变量逻辑回归分析中，羟氯喹暴露与 COVID-19 住院率下降之间存在关联（OR 0.53；95% CI，0.29，0.95）。敏感性分析揭示了类似的关联。在服用羟氯喹的患者中，有 2% 发生 QTc 延长事件，而在有数据的患者中，没有报告出现心律失常事件。在这项针对 SARS-CoV-2 感染的非住院患者的回顾性观察研究中，羟氯喹暴露与随后住院率的降低相关。有必要对这种轻度症状的门诊患者群体进行羟氯喹的进一步探索。在线版本包含可在 10.1186/s12879-021-05773-w 获取的补充材料。
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. 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. 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. 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. The online version contains supplementary material available at 10.1186/s12879-021-05773-w.
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作者：
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