Abstract
BackgroundHydroxychloroquine 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.MethodsWe 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.ResultsAmong 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.ConclusionsIn 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.
Highlights
Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and was not identified as an effective prophylaxis following exposure in a prospective randomized trial
Ip et al BMC Infectious Diseases (2021) 21:72 (Continued from previous page). In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization
Understanding the limitations of observational studies, but with the urgency for evaluating potential therapeutic approaches during the current COVID-19 pandemic, our hospital spanning New Jersey USA established an observational database utilizing an integrated electronic health record (EHR) system (EPIC; Verona, WI) [17,18,19,20]. In this multi-center observational cohort study we report progression from mildly symptomatic SARSCoV-2 infection diagnosed as an outpatient progressing to subsequent need for inpatient hospitalization according to outpatient exposure to hydroxychloroquine
Summary
Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and was not identified as an effective prophylaxis following exposure in a prospective randomized trial. The majority of infections with SARS-CoV-2 result in mildly symptomatic or asymptomatic illnesses that can be managed in outpatient settings. Among hospitalized COVID-19 patients, observational studies have noted that hydroxychloroquine exposure has not been associated with a reduction in the risk of death [6,7,8,9]. When used as post-exposure prophylaxis within 4 days after moderate or high risk exposure, a prospective randomized trial found that hydroxychloroquine failed to prevent illness compatible with Covid-19 or confirmed infection [11]
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