Wednesday, 8 April 2020

No Clinical Benefit evidenced.

No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection, Molina et al, M├ędecine et Maladies Infectieuses, pre publication March 2020.

These virologic results stand in contrast with those reported by Gautret et al. and cast doubts about the strong antiviral efficacy of this combination. Furthermore, in their report Gautret et al also reported one death and three transfers to the ICU among the 26 patients who received hydroxychloroquine, also underlining the poor clinical outcome with this combination. 

In addition, a recent study from China in individuals with COVID-19 found no difference in the rate  of  virologic  clearance  at  7  days  with  or  without  5  days  of  hydroxychloroquine,  and  no difference  in  clinical  outcomes  (duration  of  hospitalization, temperature  normalization, radiological progression) (4). These results are consistent with the lack of virologic or clinical benefit of chloroquine in a number of viral infections where it was assessed for treatment or prophylaxis with sometimes a deleterious effect on viral replication (5-8). 

In summary, despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we found  no  evidence  of  a  strong  antiviral  activity  or  clinical  benefit  of  the  combination  of hydroxychloroquine  and  azithromycin  for  the  treatment  of  our  hospitalized  patients  with severe COVID-19. Ongoing randomized clinical trials with hydroxychloroquine should provide a definitive answer regarding the alleged efficacy of this combination and will assess its safety's not a Double Blind study. There may be some benefit in less severe cases, though there's no good or even fair  evidence of that either. It may be harmful, rather than beneficial, though again, no Double Blind studies have been done.

We can't absolutely exclude the possibility that there may be some benefit at this point. It just seems increasingly unlikely that any benefit, if any exists, is large.

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