J. Lagier, M. Million, P. Gautret, P. Colson, S. Cortaredona, A. Giraud-Gatineau, S. Honoré, J. Gaubert, P. Fournier, H. Tissot-Dupont, E. Chabrière, A. Stein, J. Deharo, F. Fenollar, J. Rolain, Y. Obadia, A. Jacquier, B. La Scola, P. Brouqui, M. Drancourt, P. Parola, D. Raoult, Sophie Camille Matthieu Cyril Laurence Nadim Claire Cathe Amrane Aubry Bardou Berenger Camoin-Jau Cassir Dec, S. Amrane, C. Aubry, M. Bardou, C. Bérenger, L. Camoin-Jau, N. Cassir, C. Decoster, C. Dhiver, B. Doudier, S. Edouard, S. Gentile, Katell Guillon-Lorvellec, Marie Hocquart, A. Levasseur, M. Mailhe, I. Ravaux, M. Richez, Y. Roussel, P. Seng, C. Tomei, C. Zandotti
Travel Medicine and Infectious Disease, 2020
Abstract 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, 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.
Cited by 117 publications.
Field of study: Medicine