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Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19
Open accessAbstract
BACKGROUND: Hydroxychloroquine has been widely administered to patients with Covid-19 without robust evidence supporting its use. METHODS: We examined the association between hydroxychloroquine use and intubation or death at a large medical center in New York City. Data were obtained regarding consecutive patients hospitalized with Covid-19, excluding those who were intubated, died, or discharged within 24 hours after presentation to the emergency department (study baseline). The primary end point was a composite of intubation or death in a time-to-event analysis. We compared outcomes in patients who received hydroxychloroquine with those in patients who did not, using a multivariable Cox model with inverse probability weighting according to the propensity score. RESULTS: Of 1446 consecutive patients, 70 patients were intubated, died, or discharged within 24 hours after presentation and were excluded from the analysis. Of the remaining 1376 patients, during a median follow-up of 22.5 days, 811 (58.9%) received hydroxychloroquine (600 mg twice on day 1, then 400 mg daily for a median of 5 days); 45.8% of the patients were treated within 24 hours after presentation to the emergency department, and 85.9% within 48 hours. Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine (median ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, 223 vs. 360). Overall, 346 patients (25.1%) had a primary end-point event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses. CONCLUSIONS: In this observational study involving patients with Covid-19 who had been admitted to the hospital, hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death. Randomized, controlled trials of hydroxychloroquine in patients with Covid-19 are needed. (Funded by the National Institutes of Health.).
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“First, we used multivariable regression models with inverse probability weighting to minimize the effects of confounding by indication [27,28].”
From Association between antidepressant use and reduced risk of intubation or death in hospitalized patients with COVID-19: results from an observational study (2021) · cites this paper as [28]
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“To help account for the nonrandomized prescription of antidepressants and reduce the effects of confounding, the primary analyses used a propensity score analysis with inverse probability weighting [27,28].”
From Association between antidepressant use and reduced risk of intubation or death in hospitalized patients with COVID-19: results from an observational study (2021) · cites this paper as [28]
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Self-citationEffect of Hydroxychloroquine in Hospitalized Patients with Covid-19
Horby, P., Mafham, M. M., Linsell, L., Bell, J. L., Staplin, N., Emberson, J., Wiselka, M. J., Ustianowski, A., Elmahi, E., Prudon, B., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2022926 · Cited by 1,481
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Metadata
- Authors
- Geleris, J., Sun, Y., Platt, J., Zucker, J., Baldwin, M., Hripcsak, G., Labella, A., Manson, D. K., Kubin, C., Barr, R. G., Sobieszczyk, M. E., & Schluger, N. W.
- Affiliations
- Columbia University Irving Medical Center (US)
- Corresponding author
- Schluger, Neil W.
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-06-18
- Volume
- 382
- Issue
- 25
- Pages
- 2411-2418
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7224609
- OpenAlex
- W3023346879
- Cited by
- 1,625
- References
- 17
- Citations by year
- 2026: 16 · 2025: 23 · 2024: 57 · 2023: 80 · 2022: 167 · 2021: 440 · 2020: 839
- FWCI
- 49.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (RO1-HL077612, RO1-HL093081, RO1-HL121270, RO1-LM006910)
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (200-2009-32593)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- hydroxychloroquine, COVID-19 pandemic, mechanical ventilation, intubation, mortality, hospitalized patients, antimalarial drugs, treatment efficacy, propensity score weighting, SARS-CoV-2
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Adult, Aged, Aged, 80 and over, Female, Hospitalization, Humans, Hydroxychloroquine, Intubation, Male, Middle Aged, New York City, Pneumonia, Viral, Treatment Failure, Coronavirus Infections, Propensity Score, Pandemics
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