Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France

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Travel Medicine and Infectious Disease

Available online 5 May 2020, 101738
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Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France

Author links open overlay panelMatthieuMillion[SUP]a[/SUP][SUP]b[/SUP][SUP]1[/SUP]Jean-ChristopheLagier[SUP]a[/SUP][SUP]b[/SUP][SUP]1[/SUP]PhilippeGautret[SUP]a[/SUP][SUP]c[/SUP][SUP]1[/SUP]PhilippeColson[SUP]a[/SUP][SUP]b[/SUP]Pierre-EdouardFournier[SUP]a[/SUP][SUP]c[/SUP]SophieAmrane[SUP]a[/SUP][SUP]b[/SUP]MarieHocquart[SUP]a[/SUP]MorganeMailhe[SUP]a[/SUP]VeraEsteves-Vieira[SUP]a[/SUP]BarbaraDoudier[SUP]a[/SUP]CamilleAubry[SUP]a[/SUP]FlorianCorreard[SUP]d[/SUP][SUP]e[/SUP]AudreyGiraud-Gatineau[SUP]a[/SUP][SUP]c[/SUP][SUP]f[/SUP][SUP]g[/SUP]YanisRoussel[SUP]a[/SUP][SUP]b[/SUP]CyrilBerenger[SUP]a[/SUP][SUP]c[/SUP]NadimCassir[SUP]a[/SUP][SUP]b[/SUP]PisethSeng[SUP]a[/SUP][SUP]b[/SUP]ChristineZandotti[SUP]a[/SUP]CatherineDhiver[SUP]a[/SUP]IsabelleRavaux[SUP]a[/SUP]ChristelleTomei[SUP]a[/SUP]CaroleEldin[SUP]a[/SUP][SUP]c[/SUP]Herv?Tissot-Dupont[SUP]a[/SUP]St?phaneHonor?[SUP]d[/SUP][SUP]e[/SUP]AndreasStein[SUP]a[/SUP][SUP]b[/SUP]AlexisJacquier[SUP]h[/SUP]Jean-ClaudeDeharo[SUP]i[/SUP]EricChabri?re[SUP]a[/SUP][SUP]b[/SUP]AnthonyLevasseur[SUP]a[/SUP][SUP]b[/SUP]FlorenceFenollar[SUP]a[/SUP][SUP]c[/SUP]Jean-MarcRolain[SUP]a[/SUP][SUP]b[/SUP]YolandeObadia[SUP]a[/SUP]PhilippeBrouqui[SUP]a[/SUP][SUP]b[/SUP]MichelDrancourt[SUP]a[/SUP][SUP]b[/SUP]BernardLa Scola[SUP]a[/SUP][SUP]b[/SUP]PhilippeParola[SUP]a[/SUP][SUP]c[/SUP]DidierRaoult[SUP]a[/SUP][SUP]b[/SUP][SUP]a[/SUP]IHU-M?diterran?e Infection, Marseille, France[SUP]b[/SUP]Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France[SUP]c[/SUP]Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France[SUP]d[/SUP]Aix Marseille Univ., Laboratoire de Pharmacie Clinique, Marseille, France[SUP]e[/SUP]AP-HM, h?pital Timone, service Pharmacie, Marseille, France[SUP]f[/SUP]Centre d'Epid?miologie et de Sant? Publique des Arm?es (CESPA), Marseille, France[SUP]g[/SUP]AP-HM, Marseille, France[SUP]h[/SUP]Department of Radiology and Cardiovascular Imaging, Aix-Marseille Univ., UMR 7339, CNRS, CRMBM-CEMEREM (Centre de R?sonance Magn?tique Biologique et M?dicale-Centre d'Exploration M?taboliques par R?sonance Magn?tique), Marseille, France[SUP]i[/SUP]AP-HM, Aix Marseille Univ., h?pital Timone, Cardiologie, Rythmologie, Marseille, France
Received 20 April 2020, Revised 30 April 2020, Accepted 1 May 2020, Available online 5 May 2020.

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https://doi.org/10.1016/j.tmaid.2020.101738Get rights and contentAbstract

Background


In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19.

Methods


We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days).

Results


A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years – range 14–95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74–95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision).

Conclusion


Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.


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