Database analysis of many drugs and COVID-19 cases, with 23 cases taking HCQ, and 251 control patients not taking HCQ, showing OR 1.07,
p=0.77, and in multivariable analysis OR 1.48,
p=0.086.
Patients taking HCQ are most likely taking it for systemic autoimmune diseases where the risk of COVID-19 is much higher, for example OR 4.42,
p<0.001 according to [1] (which includes factors such as systemic autoimmune disease patients potentially being more careful to avoid exposure). The result therefore suggests a substantial benefit for HCQ, as is also shown in Ferri et al. Adjusting for the difference in baseline risk of systemic autoimmune patients results in RR 0.24.
Details of the multivarible analysis in the paper are not provided for assessment, but the analysis may be significantly affected by overfitting and/or multicollinearity. We note that many results in this study differ significantly from other research, for example proton pump inhibitors show OR 0.62,
p<0.001 whereas PPIs are classified as "no expected benefit" and other research suggests they increase risk.
Huh et al., 5/4/2020, retrospective, case control, database analysis, South Korea, Asia, preprint, 10 authors.
risk of COVID-19 case, 47.7% higher, RR 1.48, p = 0.09, odds ratio converted to relative risk.
This study is excluded in meta analysis: not fully adjusting for the different baseline risk of systemic autoimmune patients.
Effect extraction follows
pre-specified rules
prioritizing more serious outcomes. For an individual study the most serious
outcome may have a smaller number of events and lower statistical signficance,
however this provides the strongest evidence for the most serious outcomes
when combining the results of many trials.