A preliminary study little evidence on the hydroxychloroquine in the United States

Une étude préliminaire peu probante sur l’hydroxychloroquine aux États-Unis

Hydroxychloroquine has not seemed to improve the fate of sick americans of the COVID-19, according to a study by the relatively large conducted a posteriori on the administered drug in the world, but whose effectiveness remains to confirm or refute rigorously.

The preliminary study, made public Tuesday by its authors before being assessed by the committee to read a medical journal, focuses on 368 patients in the network of public hospitals for veterans in the u.s., and who are either dead, or out of hospitalization before the 11 April.

The authors analyzed retrospectively the medical records of these patients, they were grouped into three groups for comparison: those treated with hydroxychloroquine alone (HC); and those who had the cocktail hydroxychloroquine-azithromycin (an antibiotic) has been promoted in particular by the French physician Didier Raoult; and those who had never received hydroxychloroquine.

The proportion of patients who died was highest in the group hydroxychloroquine alone (28 %), compared to the group cocktail party (22 %) and the group without HC (11 %).

But this conclusion may be misleading, because the group of patients who received only hydroxychloroquine was, at the outset, sicker and more at risk than the other two groups: it contained more smokers and people with diabetes or a history of cardiovascular and pulmonary.

The authors have corrected statistically for this imbalance initial, and observed that ” the increased risk of mortality in the group hydroxychloroquine-only persisted “.

The specificity of the treated patients should also lead to caution on any generalization to an entire population. The patients studied were all male, the majority of blacks, a population hardest hit by the epidemic in the United States. The median age was advanced: over 65 years of age.

Hydroxychloroquine is one of the treatments used in multiple countries in emergency on severe cases COVID-19, but controversy exists about its impact.

The ideal, scientifically, is to conduct a randomized clinical trial, where groups of patients comparable to follow different treatments, randomly.

Such large-scale tests are underway, including the european trial Discovery, but their results are not yet known.

In the meantime, doctors are experimenting with the molecules and treatments. Researchers can look at the ex post results, but in the absence of harmonized protocols on the duration, doses, times of intervention, the degree of severity of the case at the outset, it is difficult to draw reliable conclusions.

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