COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Abd-Elsalam S, Esmail ES, Khalaf M, et al. Hydroxychloroquine in the Treatment of COVID-19: A Multicenter Randomized Controlled Study. Am J Trop Med Hyg. 2020 Oct;103(4):1635-1639. doi: 10.4269/ajtmh.20-0873.
Abstract

The COVID-19 pandemic is showing an exponential growth, mandating an urgent need to develop an effective treatment. Indeed, to date, a well-established therapy is still lacking. We aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) added to standard care in patients with COVID-19. This was a multicenter, randomized controlled trial conducted at three major university hospitals in Egypt. One hundred ninety-four patients with confirmed diagnosis of COVID-19 were included in the study after signing informed consent. They were equally randomized into two arms: 97 patients administrated HCQ plus standard care (HCQ group) and 97 patients administered only standard care as a control arm (control group). The primary endpoints were recovery within 28 days, need for mechanical ventilation, or death. The two groups were matched for age and gender. There was no significant difference between them regarding any of the baseline characteristics or laboratory parameters. Four patients (4.1%) in the HCQ group and 5 (5.2%) patients in the control group needed mechanical ventilation (P = 0.75). The overall mortality did not differ between the two groups, as six patients (6.2%) died in the HCQ group and 5 (5.2%) died in the control group (P = 0.77). Univariate logistic regression analysis showed that HCQ treatment was not significantly associated with decreased mortality in COVID-19 patients. So, adding HCQ to standard care did not add significant benefit, did not decrease the need for ventilation, and did not reduce mortality rates in COVID-19 patients.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Respirology/Pulmonology
Intensivist/Critical Care
Comments from MORE raters

Hospital Doctor/Hospitalists rater

This well designed RCT does not support the hypothesis that hydroxychloroquine improves clinical outcomes. While not powered for evaluation of mortality benefit, this trial adds further evidence to the caution in implementing therapy that has variable efficacy results. I agree with the conclusion about the necessity of further investigation.

Intensivist/Critical Care rater

It adds a nail in the coffin of hydroxychloroquine in COVID-19.

Internal Medicine rater

While this may be a better structured article than some others, it does not really add much information. Everyone but the President knows this already.