Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America.
NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States of America.
PLoS One. 2020 Jul 23;15(7):e0236778. doi: 10.1371/journal.pone.0236778. eCollection 2020.
Severe acute respiratory coronavirus 2 (SARS-CoV-2) has caused a devastating worldwide pandemic. Hydroxychloroquine (HCQ) has in vitro activity against SARS-CoV-2, but clinical data supporting HCQ for coronavirus disease 2019 (COVID-19) are limited.
This was a retrospective cohort study of hospitalized patients with COVID-19 who received ≥1 dose of HCQ at two New York City hospitals. We measured incident Grade 3 or 4 blood count and liver test abnormalities, ventricular arrhythmias, and vomiting and diarrhea within 10 days after HCQ initiation, and the proportion of patients who completed HCQ therapy. We also describe changes in Sequential Organ Failure Assessment hypoxia scores between baseline and day 10 after HCQ initiation and in-hospital mortality.
None of the 153 hospitalized patients with COVID-19 who received HCQ developed a sustained ventricular tachyarrhythmia. Incident blood count and liver test abnormalities occurred in <15% of patients and incident vomiting or diarrhea was rare. Eighty-nine percent of patients completed their HCQ course and three patients discontinued therapy because of QT prolongation. Fifty-two percent of patients had improved hypoxia scores 10 days after starting HCQ. Thirty-one percent of patients who were receiving mechanical ventilation at the time of HCQ initiation died during their hospitalization, compared to 18% of patients who were receiving supplemental oxygen but not requiring mechanical ventilation, and 8% of patients who were not requiring supplemental oxygen. Co-administration of azithromycin was not associated with improved outcomes.
HCQ appears to be reasonably safe and tolerable in most hospitalized patients with COVID-19. However, nearly one-half of patients did not improve with this treatment, highlighting the need to evaluate HCQ and alternate therapies in randomized trials.
严重急性呼吸冠状病毒 2（SARS-CoV-2）已在全球范围内造成严重大流行。羟氯喹（HCQ）对 SARS-CoV-2 具有体外活性，但支持羟氯喹治疗 2019 年冠状病毒病（COVID-19）的临床数据有限。
这是一项回顾性队列研究，纳入在纽约市的两家医院住院的 COVID-19 患者，这些患者接受了≥1 剂 HCQ 治疗。我们测量了 HCQ 治疗开始后 10 天内出现的 3 级或 4 级血细胞计数和肝试验异常、室性心律失常、呕吐和腹泻，以及完成 HCQ 治疗的患者比例。我们还描述了 HCQ 治疗开始后基线和第 10 天之间序贯器官衰竭评估缺氧评分的变化以及住院死亡率。
未接受 HCQ 治疗的 153 例 COVID-19 住院患者均未发生持续性室性心动过速。不到 15%的患者出现血细胞计数和肝试验异常，且呕吐或腹泻罕见。89%的患者完成了 HCQ 疗程，有 3 例患者因 QT 延长而停止治疗。52%的患者在开始 HCQ 治疗 10 天后缺氧评分得到改善。在开始 HCQ 治疗时接受机械通气的患者中，有 31%在住院期间死亡，而接受补充氧气但无需机械通气的患者中有 18%，无需补充氧气的患者中有 8%。联合使用阿奇霉素并未改善结局。
在大多数 COVID-19 住院患者中，HCQ 似乎是安全且耐受良好的。然而，几乎有一半的患者没有从这种治疗中获益，这突出表明需要在随机试验中评估 HCQ 和其他替代疗法。
