Pandemic Science, Reinfections and hydroxychloroquine
2 European reinfections
https://www.independent.co.uk/news/health/coronavirus-reinfection-netherlands-belgium-hong-kong-covid-19-update-a9687301.html
Netherlands
Marion Koopmans (virologist)
Viral genomes were different
Older person with a weakened immune system
Reinfections had been expected.
We have to see whether it happens often
Belgium
Woman, first time in March, second time in June
Marc Van Ranst (virologist)
Woman’s symptoms relatively mild
May not have created enough antibodies to prevent a reinfection
They might have helped limit the sickness
I think that in the coming days that we will see other similar stories
It’s not good news
How common
High levels of surveillance
Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study (European Journal of Internal Medicine,
Immunomodulatory
Anti-inflammatory
Anti-thrombotic
Directly inhibits viral entry and spread in several in vitro and in vivo models
Might inhibit ACE 2, reduced internalization of the virus
https://www.ejinme.com/article/S0953-6205(20)30335-6/fulltext
https://www.ejinme.com/action/showPdf?pii=S0953-6205%2820%2930335-6
Multicenter Italian collaboration, relationship between HCQ therapy and COVID-19 in-hospital mortality
Methods
Retrospective observational study
N = 3,451
33 clinical centers in Italy
February 19th to May 23rd
Laboratory-confirmed SARS-CoV-2 infection
Comparing patients who received HCQ with patients who did not
Dose
HCQ, all centres, 400 mg/day
One centre, 600 mg/day
5 to 15 days
Dose, BNF link
https://bnf.nice.org.uk/drug/hydroxychloroquine-sulfate.html
Results
Out of 3,451
76.3% received HCQ
HCQ group
N = 2633
Death rate 8.9
Per, 1,000 person days
Non HCQ group
N = 817
Death rate 15.7
After adjustment for propensity scores
30% lower risk of death in patients receiving HCQ
HR=0.70;
95%CI: 0.59 to 0.84;
HCQ use was associated with a 30% reduced death rate
95%CI: 16% to 41%
These data do not discourage the use of HCQ in inpatients with COVID-19
Effect of hydroxychloroquine with or without azithromycin on the mortality of COVID-19 patients: a systematic review and meta-analysis (26 August, Clinical Microbiology and Infection, France)
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30505-X/fulltext
https://www.clinicalmicrobiologyandinfection.com/action/showPdf?pii=S1198-743X%2820%2930505-X
839 articles
29 articles met our inclusion criteria
Including 3 RCTs
Evaluated the effects of hydroxychloroquine with or without azithromycin (except one)
Meta-analysis
Hydroxychloroquine group
n = 11,932 participants for the,
Association with mortality
RR = 0.83 (not significant)
Hydroxychloroquine with azithromycin group
N = 8081
RR = 1.27
Increased risk or mortality
We identified a significant absolute risk difference of +7%
Control group
N = 12,930
Conclusion
Hydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients
the combination of hydroxychloroquine and azithromycin significantly increased mortality
WHO, Solidarity clinical trial for COVID-19 treatments
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
On 4 July 2020, WHO accepted the recommendation from the Solidarity Trial’s International Steering Committee to discontinue the trial’s hydroxychloroquine and lopinavir/ritonavir arms.
WHO dose in Solidarity trial
https://www.palmerfoundation.com.au/who-solidarity-and-uk-recovery-clinical-trials-of-hydroxychloroquine-using-potentially-fatal-doses/
Canadian arm
https://clinicaltrials.gov/ct2/show/NCT04330690
Treatments for COVID-19: Canadian Arm of the SOLIDARITY Trial (CATCO)
Hydroxychloroquine 800mg BID for 1 day
then 400mg BID for 10 days plus optimized supportive care,
Lancet, retracted paper
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext#%20
We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide
Risk of hydroxychloroquine alone and in combination with azithromycin in the treatment of rheumatoid arthritis: a multinational, retrospective study (lancet 21st august
https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30276-9/fulltext
Retrospective, multinational, cohort
N = 956 374
Hydroxychloroquine treatment appears to have no increased risk in the short term among patients with rheumatoid arthritis
Long term it appears to be associated with excess cardiovascular mortality
The addition of azithromycin increases the risk of heart failure and cardiovascular mortality
even in the short term.
We call for careful consideration of the benefit–risk trade-off when counselling those on hydroxychloroquine treatment.
Видео Pandemic Science, Reinfections and hydroxychloroquine канала Dr. John Campbell
https://www.independent.co.uk/news/health/coronavirus-reinfection-netherlands-belgium-hong-kong-covid-19-update-a9687301.html
Netherlands
Marion Koopmans (virologist)
Viral genomes were different
Older person with a weakened immune system
Reinfections had been expected.
We have to see whether it happens often
Belgium
Woman, first time in March, second time in June
Marc Van Ranst (virologist)
Woman’s symptoms relatively mild
May not have created enough antibodies to prevent a reinfection
They might have helped limit the sickness
I think that in the coming days that we will see other similar stories
It’s not good news
How common
High levels of surveillance
Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study (European Journal of Internal Medicine,
Immunomodulatory
Anti-inflammatory
Anti-thrombotic
Directly inhibits viral entry and spread in several in vitro and in vivo models
Might inhibit ACE 2, reduced internalization of the virus
https://www.ejinme.com/article/S0953-6205(20)30335-6/fulltext
https://www.ejinme.com/action/showPdf?pii=S0953-6205%2820%2930335-6
Multicenter Italian collaboration, relationship between HCQ therapy and COVID-19 in-hospital mortality
Methods
Retrospective observational study
N = 3,451
33 clinical centers in Italy
February 19th to May 23rd
Laboratory-confirmed SARS-CoV-2 infection
Comparing patients who received HCQ with patients who did not
Dose
HCQ, all centres, 400 mg/day
One centre, 600 mg/day
5 to 15 days
Dose, BNF link
https://bnf.nice.org.uk/drug/hydroxychloroquine-sulfate.html
Results
Out of 3,451
76.3% received HCQ
HCQ group
N = 2633
Death rate 8.9
Per, 1,000 person days
Non HCQ group
N = 817
Death rate 15.7
After adjustment for propensity scores
30% lower risk of death in patients receiving HCQ
HR=0.70;
95%CI: 0.59 to 0.84;
HCQ use was associated with a 30% reduced death rate
95%CI: 16% to 41%
These data do not discourage the use of HCQ in inpatients with COVID-19
Effect of hydroxychloroquine with or without azithromycin on the mortality of COVID-19 patients: a systematic review and meta-analysis (26 August, Clinical Microbiology and Infection, France)
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30505-X/fulltext
https://www.clinicalmicrobiologyandinfection.com/action/showPdf?pii=S1198-743X%2820%2930505-X
839 articles
29 articles met our inclusion criteria
Including 3 RCTs
Evaluated the effects of hydroxychloroquine with or without azithromycin (except one)
Meta-analysis
Hydroxychloroquine group
n = 11,932 participants for the,
Association with mortality
RR = 0.83 (not significant)
Hydroxychloroquine with azithromycin group
N = 8081
RR = 1.27
Increased risk or mortality
We identified a significant absolute risk difference of +7%
Control group
N = 12,930
Conclusion
Hydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients
the combination of hydroxychloroquine and azithromycin significantly increased mortality
WHO, Solidarity clinical trial for COVID-19 treatments
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
On 4 July 2020, WHO accepted the recommendation from the Solidarity Trial’s International Steering Committee to discontinue the trial’s hydroxychloroquine and lopinavir/ritonavir arms.
WHO dose in Solidarity trial
https://www.palmerfoundation.com.au/who-solidarity-and-uk-recovery-clinical-trials-of-hydroxychloroquine-using-potentially-fatal-doses/
Canadian arm
https://clinicaltrials.gov/ct2/show/NCT04330690
Treatments for COVID-19: Canadian Arm of the SOLIDARITY Trial (CATCO)
Hydroxychloroquine 800mg BID for 1 day
then 400mg BID for 10 days plus optimized supportive care,
Lancet, retracted paper
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext#%20
We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide
Risk of hydroxychloroquine alone and in combination with azithromycin in the treatment of rheumatoid arthritis: a multinational, retrospective study (lancet 21st august
https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30276-9/fulltext
Retrospective, multinational, cohort
N = 956 374
Hydroxychloroquine treatment appears to have no increased risk in the short term among patients with rheumatoid arthritis
Long term it appears to be associated with excess cardiovascular mortality
The addition of azithromycin increases the risk of heart failure and cardiovascular mortality
even in the short term.
We call for careful consideration of the benefit–risk trade-off when counselling those on hydroxychloroquine treatment.
Видео Pandemic Science, Reinfections and hydroxychloroquine канала Dr. John Campbell
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