No Evidence of Clinical Efficacy of Hydroxychloroquine in Patients Hospitalized for COVID-19 Infection with Oxygen Requirement: Results of a Study Using Routinely Collected Data to Emulate a Target Trial

Mahevas M,  Tran V, Roumier M, et al. medRxiv. April 14, 2020. [CrossRef]

Treatments are urgently needed to prevent respiratory failure and deaths from coronavirus disease 2019 (COVID-19). Hydroxychloroquine (HCQ) has received worldwide attention because of positive results from small studies. The authors used data collected from routine care of all adults in 4 French hospitals with documented COVID-19 pneumonia and requiring oxygen ≥ 2 L/min to emulate a target trial aimed at assessing the effectiveness of HCQ at 600 mg/day. The composite primary endpoint was transfer to intensive care unit (ICU) within 7 days from inclusion and/or death from any cause. Analyses were adjusted for confounding factors by inverse probability of treatment weighting. The study included 181 patients with COVID-19 pneumonia; 84 received HCQ within 48 hours of admission (HCQ group) and 97 did not (no-HCQ group). Initial severity was well balanced between the groups. In the weighted analysis, 20.2% patients in the HCQ group were transferred to the ICU or died within 7 days vs 22.1% in the no-HCQ group; 2.8% of the patients died within 7 days vs 4.6% in the no-HCQ group, and 27.4% and 24.1%, developed acute respiratory distress syndrome within 7 days. Eight patients receiving HCQ (9.5%) experienced electrocardiogram modifications requiring HCQ discontinuation. The authors state that the results do not support the use of HCQ in patients hospitalized for documented COVID-19 hypoxic pneumonia.