april 2020 • medRxiv
Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19
É um estudo observacional, executado em homens de meia idade, que vem confirmar a necessidade de ensaios randomizados robustos para esclarecer a utilidade (ou não) da HCQ associada ou não a AZT no tratamento da covid-19. Apesar da correção estatística, as diferenças de base dos grupos, o tipo de estudo e a má definição do comparador limitam a confiança na associação verificada entre o tratamento com HCQ e a mortalidade. Vem, no entanto, mostrar a fragilidade de eventuais recomendações para uso de HCQ como tratamento da covid-19.
BACKGROUND: Despite limited and conflicting data on the use of hydroxychloroquine in patients with Covid-19, the U.S. Food and Drug Administration has authorized the emergency use of this drug when clinical trials are unavailable or infeasible. Hydroxychloroquine, alone or in combination with azithromycin, is being widely used in Covid-19 therapy based on anecdotal and limited observational evidence. METHODS: We performed a retrospective analysis of data from patients hospitalized with confirmed SARS-CoV-2 infection in all United States Veterans Health Administration medical centers until April 11, 2020. Patients were categorized based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) as treatments in addition to standard supportive management for Covid-19. The two primary outcomes were death and the need for mechanical ventilation. We determined the association between treatment and the primary outcomes using competing risk hazard regression adjusting for clinical characteristics via propensity scores. Discharge and death were taken into account as competing risks and subdistribution hazard ratios are presented...