Andrew Ip1,2,3, Jaeil Ahn4, Yizhao Zhou4, Andre H Goy5, Eric Hansen6, Andrew L Pecora5, Brittany A Sinclaire5, Urszula Bednarz5, Michael Marafelias5, Ihor S Sawczuk7,8, Joseph P Underwood9, David M Walker9, Rajiv Prasad10, Robert L Sweeney11, Marie G Ponce11, Samuel La Capra12, Frank J Cunningham12, Arthur G Calise13, Bradley L Pulver14, Dominic Ruocco15, Greggory E Mojares16, Michael P Eagan17, Kristy L Ziontz18, Paul Mastrokyriakos19, Stuart L Goldberg20. 1. Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, USA. Andrew.Ip@hackensackmeridian.org. 2. Hackensack Meridian Health, Hackensack, NJ, USA. Andrew.Ip@hackensackmeridian.org. 3. Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA. Andrew.Ip@hackensackmeridian.org. 4. Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, D.C., USA. 5. John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA. 6. COTA, Boston, MA, USA. 7. Hackensack Meridian Health, Hackensack, NJ, USA. 8. Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA. 9. Hackensack University Medical Center, Hackensack, NJ, USA. 10. Bayshore Medical Center, Holmdel, NJ, USA. 11. Jersey Shore University Medical Center, Neptune City, NJ, USA. 12. JFK Medical Center, Edison, NJ, USA. 13. Hackensack Meridian Mountainside Medical Center, Montclair, NJ, USA. 14. Ocean Medical Center, Brick, NJ, USA. 15. Palisades Medical Center, North Bergen, NJ, USA. 16. Pascack Valley Medical Center, Westwood, NJ, USA. 17. Raritan Bay Medical Center, Old Bridge, NJ, USA. 18. Riverview Medical Center, Red Bank, NJ, USA. 19. Southern Ocean Medical Center, Manahawkin, NJ, USA. 20. Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, USA.
Abstract
BACKGROUND: Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. METHODS: We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. RESULTS: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. CONCLUSIONS: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.
BACKGROUND:Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. METHODS: We examined the association between outpatienthydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. RESULTS: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. CONCLUSIONS: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patientshydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.
Authors: Simona Iftimie; Ana F López-Azcona; Immaculada Vallverdú; Salvador Hernández-Flix; Gabriel de Febrer; Sandra Parra; Anna Hernández-Aguilera; Francesc Riu; Jorge Joven; Natàlia Andreychuk; Gerard Baiges-Gaya; Frederic Ballester; Marc Benavent; José Burdeos; Alba Català; Èric Castañé; Helena Castañé; Josep Colom; Mireia Feliu; Xavier Gabaldó; Diana Garrido; Pedro Garrido; Joan Gil; Paloma Guelbenzu; Carolina Lozano; Francesc Marimon; Pedro Pardo; Isabel Pujol; Antoni Rabassa; Laia Revuelta; Marta Ríos; Neus Rius-Gordillo; Elisabet Rodríguez-Tomàs; Wojciech Rojewski; Esther Roquer-Fanlo; Noèlia Sabaté; Anna Teixidó; Carlos Vasco; Jordi Camps; Antoni Castro Journal: PLoS One Date: 2021-03-31 Impact factor: 3.240