Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis

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Publication
Title
Authors
  • Jean-Christophe Lagier
  • Matthieu Million
  • Philippe Gautret
  • ...
  • Didier Raoult
  • IHU COVID-19 Task force
Journal Travel Med Infect Dis
Date June 25, 2020

Retrospective analysis of 3737 hospitalized COVID-19 patients in Marseille showed early treatment with hydroxychloroquine and azithromycin was associated with a decreased risk of transfer to ICU or death (HR 0.18, CI 0.11-0.27), decreased risk of hospitalization ≥10 days (OR 0.38, CI 0.27–0.54), and shorter duration of viral shedding (HR 1.29, CI 1.17–1.42).

This analysis included both the patients from the IHU’s earlier retrospective analysis of 1061 COVID-19 patients and the additional patients treated in the interim.

Largely an opponent to randomized controlled trials, Didier Raoult chose observational treatment resulting in this publication over a RCT. The low mortality rate, shorter duration of hospitalization and shorter duration of viral shedding in Raoult’s patients compared to other hospitals in Marseille may be confounded by the IHU’s propensity to hospitalize and treat asymptomatic patients and those with mild symptoms.

Major Issues

During pandemic peak times in March and April, hospitalization in France was largely reserved for sick patients who had prognostic indicators of negative outcomes. At the IHU, however, the authors admit that hospitalization was advised for patients who tested positive for COVID-19 even if symptoms were mild or not present. Of note, only 15.6% of hospitalized patients were febrile and 9.1% were asymptomatic.

The study was also challenged based on time bias. Only patients who received 3 days or longer of treatment with hydroxychloroquine were included in the final mortality rate. This is problematic because a large percentage of patients who died in the control group did so in the first 3 days. If the deaths in the control group in the first 3 days are removed from the cohort, the mortality benefit is largely eliminated.

Minor Issues

No minor issues identified at this time.

Impact

This was the largest cohort of patients treated at a single hospital system who received early treatment with hydroxychloroquine and azithromycin for COVID-19. Despite a seemingly impressively low mortality rate, lack of a RCT and treatment time bias has plagued the purported benefit.

Article Revisions

None at this time.

References