In this observational study recently published in the New England Journal of Medicine, the authors examined the association between hydroxychloroquine use and intubation or death at a large medical centre in New York City. The primary endpoint was a composite of intubation or death in a time-to-event analysis. The authors compared outcomes in patients who received hydroxychloroquine with those who did not, using a multivariable Cox model with inverse probability weighting according to propensity score. 1376 patients were included in the study with a median follow-up of 22.5 days. 811 patients (58.9%) received hydroxychloroquine (600 mg twice on day 1, then 400 mg daily for a median of 5 days); 45.8% of the patients were treated within 24 hours after presentation to the emergency department, and 85.9% within 48 hours. Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine. Overall, 346 patients (25.1%) had a primary endpoint event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses. The authors concluded that, in their study, hydroxychloroquine administration was not associated with any decrease or increase in risk of intubation or death. However, they highlight the need to perform randomised, controlled trials of hydroxychloroquine in patients with Covid-19.
by Marialuisa Zedde and Francesco Cavallieri