Evidence map›Paper›PMID 32409486›Full record

Observational studyBMJ (Clinical research ed.)2020

Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data.

Matthieu Mahévas, Viet-Thi Tran, Mathilde Roumier, Amélie Chabrol, Romain Paule, Constance Guillaud, Elena Fois, Raphael Lepeule, Tali-Anne Szwebel, François-Xavier Lescure and 24 more

Erratum issued Registry-linked trialOpen access · hybridAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT04551755 (The Safety and Efficacy Outcome of Ivermectin Plus Doxycycline in Treatment of RT-PCR Positive Adult Mild Covid-19 Cases), which is not on this map. Cited by 242 papers, 24 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
242citing papers in PubMed, 24 pooled it
11.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04551755 phase2unknown statusnot on this map

The Safety and Efficacy Outcome of Ivermectin Plus Doxycycline in Treatment of RT-PCR Positive Adult Mild Covid-19 Cases: a Randomized Double Blind Placebo Controlled Trial

TypeinterventionalSponsorBangladesh Medical Research Council (BMRC)Ran2020 to 2020Enrolled188ConditionsCovid19ArmsIvermectin and Doxycycline, Placebo
3 · Its place in the literature

Who cites it

242 citing papers in PubMed, 24 syntheses or guidelines pooled it, 460 citations in OpenAlex.

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  6. Methodological evaluation of bias in observational coronavirus disease 2019 studies on drug effectiveness.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021
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  10. Chloroquine or hydroxychloroquine for prevention and treatment of COVID-19.The Cochrane database of systematic reviews · 2021
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  15. Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021
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182 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

34 authors at 7 institutions in 1 country.

Matthieu MahévasDepartment of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France matthieu.mahevas@gmail.com.ORCID http://orcid.org/0000-0001-9182-1434
Viet-Thi TranCentre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.
Mathilde RoumierDepartment of Internal Medicine, Foch Hospital, Suresnes, France.
Amélie ChabrolDepartment of Infectious Diseases, Sud Francilien Hospital, Corbeil-Essonnes, France.
Romain PauleDepartment of Internal Medicine, Foch Hospital, Suresnes, France.
Constance GuillaudDepartment of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Elena FoisDepartment of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Raphael LepeuleTransversal Infections Treatment Unit, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.
Tali-Anne SzwebelDepartment of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
François-Xavier LescureDepartment of Infectious Diseases, Hôpital Bichat Hospital, Paris, France.
Frédéric SchlemmerPulmonology Unit, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.
Marie MatignonDepartment of Nephrology, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.
Mehdi KhellafDepartment of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Etienne CrickxDepartment of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Benjamin TerrierDepartment of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
Caroline MorbieuDepartment of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
Paul LegendreDepartment of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
Julien DangCentre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.
Yoland SchoindreDepartment of Internal Medicine, Foch Hospital, Suresnes, France.
Jean-Michel PawlotskyDepartment of Virology, Bacteriology-Hygiene, and Mycology-Parasitology Centre, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Marc MichelDepartment of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Elodie PerrodeauCentre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.
Nicolas CarlierDepartment of Pulmonology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
Nicolas RocheDepartment of Pulmonology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
Victoire de LastoursDepartment of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
Clément OurghanlianPharmacy, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.
Solen KerneisMobile Infectious Disease Team, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
Philippe MénagerPulmonology Unit, Sud Francilien Hospital, Corbeil-Essonnes, France.
Luc MouthonDepartment of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
Etienne AudureauClinical Epidemiology and Aging Team, Mondor Institute for Biomedical Research (INSERM U955), Public Health Services, Henri-Mondor Hosptial, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France.
Philippe RavaudCentre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.
Bertrand GodeauDepartment of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Sébastien GallienDepartment of Infectious Diseases, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Pari, Paris-Est Créteil University, Créteil, France.
Nathalie Costedoat-ChalumeauCentre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France.
Université Paris Cité · FRUniversité Paris-Est Créteil · FRHôpital Foch · FRCentre Hospitalier Sud Francilien · FRAssistance Publique – Hôpitaux de Paris · FRHôpital Bichat-Claude-Bernard · FRInserm · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen.

designComparative observational study using data collected from routine care.

settingFour French tertiary care centres providing care to patients with covid-19 pneumonia between 12 March and 31 March 2020.

participants181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care.

interventionsHydroxychloroquine at a dose of 600 mg/day within 48 hours of admission to hospital (treatment group) versus standard care without hydroxychloroquine (control group).

main outcome measuresThe primary outcome was survival without transfer to the intensive care unit at day 21. Secondary outcomes were overall survival, survival without acute respiratory distress syndrome, weaning from oxygen, and discharge from hospital to home or rehabilitation (all at day 21). Analyses were adjusted for confounding factors by inverse probability of treatment weighting.

resultsIn the main analysis, 84 patients who received hydroxychloroquine within 48 hours of admission to hospital (treatment group) were compared with 89 patients who did not receive hydroxychloroquine (control group). Eight additional patients received hydroxychloroquine more than 48 hours after admission. In the weighted analyses, the survival rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and 75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, 0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of patients in the treatment group had been weaned from oxygen compared with 76% in the control group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the treatment group (10%) experienced electrocardiographic modifications that required discontinuation of treatment.

conclusionsHydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen.

Indexed as

AdolescentAdultAgedAged, 80 and overAntiviral AgentsCoronavirus InfectionsCOVID-19FemaleHumansHydroxychloroquineMaleMiddle AgedOxygen Inhalation TherapyPandemicsPneumonia, ViralYoung AdultAntiviral AgentsHydroxychloroquine

Identifiers

PMID32409486
PMCPMC7221472
OpenAlexW3025972894

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.