%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Lagier, J. C.
%A Million, M.
%A Gautret, P.
%A Colson, P.
%A Cortaredona, Sébastien
%A Giraud-Gatineau, A.
%A Honore, S.
%A Gaubert, J. Y.
%A Fournier, P. E.
%A Tissot-Dupont, H.
%A Chabriere, E.
%A Stein, A.
%A Deharo, J.C.
%A Fenollar, F.
%A Rolain, J. M.
%A Obadia, Y.
%A Jacquier, A.
%A La Scola, B.
%A Brouqui, P.
%A Drancourt, M.
%A Parola, P.
%A Raoult, D.
%A IHU COVID-19 Task Force
%T Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France : a retrospective analysis
%D 2020
%L PAR00021521
%G ENG
%J Travel Medicine and Infectious Disease
%@ 1477-8939
%K SARS-CoV-2 ; COVID-19 ; Hydroxychloroquine ; Azithromycin
%K FRANCE
%K MARSEILLE
%M ISI:000575401600039
%P 101791 [11 ]
%R 10.1016/j.tmaid.2020.101791
%U https://www.documentation.ird.fr/hor/PAR00021521
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers20-10/010079835.pdf
%V 36
%W Horizon (IRD)
%X 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.
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