Journal Article

Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review

Saddique, Maryum, Sadiq, Usama, Farooq, Soban, Chohan, Asad, Boigon, Margot, Jafar, Munnam, Roomi, Sohaib, Ullah, Waqas, Ahmed, Faizan, Watson, Robert, Khanal, Shristi

2020

Overview

During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic.

• Publisher: Gunther Eysenbach MD MPH, Associate Professor,JMIR Publications
• Subject: Aged / Antibodies, Monoclonal, Humanized - pharmacology / Antibodies, Monoclonal, Humanized - therapeutic use / C-reactive protein / Cardiovascular disease / Chart reviews / Chronic obstructive pulmonary disease / Clinical effectiveness / Clinical outcomes / Clinical trials / Cohort analysis / Coronary vessels / Coronavirus Infections - drug therapy / Coronavirus Infections - mortality / Coronaviruses / COVID-19 / COVID-19 Drug Treatment / Data collection / Diabetes / Dialysis / Drugs / Efficacy / Female / Groups / Health care / Health services / Hemodialysis / Hospital Mortality / Hospitalization / Hospitalization - statistics & numerical data / Humans / Hydroxychloroquine - adverse effects / Hydroxychloroquine - pharmacology / Hydroxychloroquine - therapeutic use / Hypertension / Immunomodulators / Immunosuppressive agents / Intensive care / Kidney diseases / Male / Mechanical ventilation / Medical diagnosis / Medical research / Middle Aged / Monoclonal antibodies / Mortality / Odds Ratio / Original Paper / Pandemics / Patients / Pneumonia, Viral - drug therapy / Pneumonia, Viral - mortality / Recovery / Regression analysis / Retrospective Studies / Severe acute respiratory syndrome coronavirus 2 / Steroids / Treatment Outcome / Treatment outcomes / Variance analysis / Ventilation