In patients with COVID-19 requiring hospitalization, there is no evidence of benefit for use of hydroxychloroquine or chloroquine with or without a macrolide, according to a study published online in The Lancet.

Mandeep R. Mehra, M.D., from the Brigham and Women’s Hospital Heart and Vascular Center in Boston, and colleagues conducted a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without macrolides for COVID-19 treatment. A total of 96,032 patients hospitalized at 671 hospitals in six continents between Dec. 20, 2019, and April 14, 2020, were included. They were classified into four treatment groups (1,868 received chloroquine; 3,783 received chloroquine with a macrolide; 3,016 received hydroxychloroquine; and 6,221 received hydroxychloroquine with a macrolide) and a control group (81,144 patients).

Overall, 11.1 percent of patients died in the hospital. The researchers found that compared with mortality in the control group (9.3 percent), there was an independently increased risk for in-hospital mortality with hydroxychloroquine (18.0 percent; hazard ratio, 1.335), hydroxychloroquine with a macrolide (23.8 percent; hazard ratio, 1.447), chloroquine (16.4 percent; hazard ratio, 1.365), and chloroquine with a macrolide (22.2 percent; hazard ratio, 1.368) after adjustment for multiple confounding variables.

An independently increased risk for de-novo ventricular arrhythmia during hospitalization was seen with hydroxychloroquine, hydroxychloroquine with a macrolide, chloroquine, and chloroquine with a macrolide compared with the control group (hazard ratios, 2.369, 5.106, 3.561, and 4.011, respectively).

“These findings suggest that these drug regimens should not be used outside of clinical trials and urgent confirmation from randomized clinical trials is needed,” the authors stressed.

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REFERENCE: Mehra et al: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext