Lagier J. C., Million M., Gautret P., Colson P., Cortaredona Sébastien, Giraud-Gatineau A., Honore S., Gaubert J. Y., Fournier P. E., Tissot-Dupont H., Chabriere E., Stein A., Deharo J.C., Fenollar F., Rolain J. M., Obadia Y., Jacquier A., La Scola B., Brouqui P., Drancourt M., Parola P., Raoult D., IHU COVID-19 Task Force. (2020). Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France : a retrospective analysis. Travel Medicine and Infectious Disease, 36, p. 101791 [11 p.]. ISSN 1477-8939.
Titre du document
Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France : a retrospective analysis
Année de publication
2020
Auteurs
Lagier J. C., Million M., Gautret P., Colson P., Cortaredona Sébastien, Giraud-Gatineau A., Honore S., Gaubert J. Y., Fournier P. E., Tissot-Dupont H., Chabriere E., Stein A., Deharo J.C., Fenollar F., Rolain J. M., Obadia Y., Jacquier A., La Scola B., Brouqui P., Drancourt M., Parola P., Raoult D., IHU COVID-19 Task Force
Source
Travel Medicine and Infectious Disease, 2020,
36, p. 101791 [11 p.] ISSN 1477-8939
Background: 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. Methods: 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. Results: 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. Conclusion: 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.
Plan de classement
Santé : généralités [050]
;
Entomologie médicale / Parasitologie / Virologie [052]
Description Géographique
FRANCE
Localisation
Fonds IRD [F B010079835]
Identifiant IRD
PAR00021521
