Failure of chronic hydroxychloroquine in preventing severe complications of COVID-19 in patients with rheumatic diseases

3/2 Pre-Exposure Prophylaxis study (treated before exposed to the virus)

Pham et al., Rheumatology Advances in Practice, 10.1093/rap/rkab014 (Peer Reviewed)
Failure of chronic hydroxychloroquine in preventing severe complications of COVID-19 in patients with rheumatic diseases

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Tiny retrospective database analysis of hospitalized COVID-19 patients with rheumatologic disease containing 14 chronic HCQ and 28 control patients. Patients are very poorly matched. Bias against HCQ is clear in the abstract which mentions differences favoring HCQ but ignores those favoring control (large differences in ethnicity, rheumatic conditions, hypertension, coronary artery disease, solid organ transplant recipients, immunosuppresive drugs). 61% of control patients also received HCQ. Adherence for chronic HCQ patients was not examined. Despite the very large differences between the groups, no adjustments are made. The study claims that HCQ did not prevent severe cases, but the study is among hospitalized patients, i.e., they already have cases severe enough for hospitalization - this study can not identify a protective effect of HCQ that reduces the probability of disease severe enough for hospitalization.

Pham et al., 3/2/2021, retrospective, USA, North America, peer-reviewed, 5 authors.

risk of death, 19.7% lower, RR 0.80, p = 0.77, treatment 2 of 14 (14.3%), control 5 of 28 (17.9%), odds ratio converted to relative risk, univariate.

risk of ICU admission, 35.5% higher, RR 1.35, p = 0.61, treatment 4 of 14 (28.6%), control 6 of 28 (21.4%), odds ratio converted to relative risk, univariate.

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.

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