Retrospective 3,345 hospitalized patients in India, 11.5% treated with HCQ, showing unadjusted higher mortality with treatment. Confounding by indication and time based confounding (due to declining use over the period when overall treatment protocols improved dramatically) are likely.
Mohandas et al., 4/26/2021, retrospective, India, South Asia, peer-reviewed, 6 authors.
risk of death, 81.0% higher, RR 1.81, p = 0.007, treatment 27 of 384 (7.0%), control 115 of 2961 (3.9%).
This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication likely, unadjusted results with no group details, substantial time varying confounding likely due to declining usage over the early period when overall treatment protocols improved dramatically.
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.