Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis

• Published in: Travel medicine and infectious disease Vol. 36; p. 101791
• Main Authors: Lagier, Jean-Christophe, Million, Matthieu, Gautret, Philippe, Colson, Philippe, Cortaredona, Sébastien, Giraud-Gatineau, Audrey, Honoré, Stéphane, Gaubert, Jean-Yves, Fournier, Pierre-Edouard, Tissot-Dupont, Hervé, Chabrière, Eric, Stein, Andreas, Deharo, Jean-Claude, Fenollar, Florence, Rolain, Jean-Marc, Obadia, Yolande, Jacquier, Alexis, La Scola, Bernard, Brouqui, Philippe, Drancourt, Michel, Parola, Philippe, Raoult, Didier, Amrane, Sophie, Aubry, Camille, Bardou, Matthieu, Berenger, Cyril, Camoin-Jau, Laurence, Cassir, Nadim, Decoster, Claire, Dhiver, Catherine, Doudier, Barbara, Edouard, Sophie, Gentile, Stéphanie, Guillon-Lorvellec, Katell, Hocquart, Marie, Levasseur, Anthony, Mailhe, Morgane, Ravaux, Isabelle, Richez, Magali, Roussel, Yanis, Seng, Piseth, Tomei, Christelle, Zandotti, Christine
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2020; Elsevier Limited; Elsevier; The Authors. Published by Elsevier Ltd
• Subjects: Adult; Age; Antibiotics; Antiviral Agents - therapeutic use; Azithromycin; Azithromycin - therapeutic use; Bacteriology; Betacoronavirus; Cardiology and cardiovascular system; Chronic illnesses; Clinical outcomes; Comorbidity; Computed tomography; Coronavirus Infections - drug therapy; Coronavirus Infections - mortality; Coronavirus Infections - virology; Coronaviruses; COVID-19; COVID-19 Drug Treatment; DNA; Emerging diseases; Female; France - epidemiology; Hospitalization; Hospitals; Human health and pathology; Humans; Hydroxychloroquine; Hydroxychloroquine - therapeutic use; Hypoxemia; Immunomodulators; Infections; Infectious Disease; Infectious diseases; Lactate; Lesions; Life Sciences; Lungs; Male; Microbiology and Parasitology; Middle Aged; Mortality; Nucleotide sequence; Pandemics; Parasitology; Patients; PCR; Pneumonia; Pneumonia, Viral - drug therapy; Pneumonia, Viral - mortality; Pneumonia, Viral - virology; Ratios; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Software; Symptoms; Tomography; Travel medicine; Treatment Outcome; Virology; Zinc; France; COVID-19; SARS-CoV-2; Hydroxychloroquine; Azithromycin
• ISSN: 1477-8939; 1873-0442; 1873-0442
• DOI: 10.1016/j.tmaid.2020.101791

In our institute in Marseille, France, we initiated early and massive screening for coronavirus disease 2019 (COVID-19). Hospitalization and early treatment with hydroxychloroquine and azithromycin (HCQ-AZ) was proposed for the positive cases. We retrospectively report the clinical management of 3,737 screened patients, including 3,119 (83.5%) treated with HCQ-AZ (200 mg of oral HCQ, three times daily for ten days and 500 mg of oral AZ on day 1 followed by 250 mg daily for the next four days, respectively) for at least three days and 618 (16.5%) patients treated with other regimen (“others”). Outcomes were death, transfer to the intensive care unit (ICU), ≥10 days of hospitalization and viral shedding. The patients’ mean age was 45 (sd 17) years, 45% were male, and the case fatality rate was 0.9%. We performed 2,065 low-dose computed tomography (CT) scans highlighting lung lesions in 592 of the 991 (59.7%) patients with minimal clinical symptoms (NEWS score = 0). A discrepancy between spontaneous dyspnoea, hypoxemia and lung lesions was observed. Clinical factors (age, comorbidities, NEWS-2 score), biological factors (lymphocytopenia; eosinopenia; decrease in blood zinc; and increase in D-dimers, lactate dehydrogenase, creatinine phosphokinase, troponin and C-reactive protein) and moderate and severe lesions detected in low-dose CT scans were associated with poor clinical outcome. Treatment with HCQ-AZ was associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11–0.27), decreased risk of hospitalization ≥10 days (odds ratios 95% CI 0.38 0.27–0.54) and shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17–1.42). QTc prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 12 cases including 3 cases with QTc> 500 ms. No cases of torsade de pointe or sudden death were observed. Although this is a retrospective analysis, results suggest that early diagnosis, early isolation and early treatment of COVID-19 patients, with at least 3 days of HCQ-AZ lead to a significantly better clinical outcome and a faster viral load reduction than other treatments.