The French group in Marseille whose small study really got the ball rolling on using hydroxychloroquine and azithromycin to treat COVID-19 released data on 80 more patients. Six of those were from the first cohort of 20 patients.
The study is really an observational one and not a randomized controlled trial.
The aims of the study were threefold – if aggressive treatment with the combo of drugs could reduce the need for oxygen therapy of transfer to the ICU, if treatment could reduce contagiousness and length of stay in the hospital.
Out of the 80 patients, one died (86 year old) and one is still in the ICU.
Treatment with the combination led to a rapid fall in the viral load of SARS-CoV-2 in the nasopharynx as measured by PCR. It was down by 83% on Day 7 and 93% on day 8.
The patients were given Hydroxychloroquine 200mg 3x a day for 10 days and Azithromycin 500 mg on day 1 and then 250 mg a day for 3 more days.
The patients were all admitted initially to the floor (ward) and treatment initiated.
The median age was 52 (ranging from 18 to 88 years) and 57.5% of these patients had at least one of these conditions: hypertension, COPD, diabetes.
53.8% had symptoms compatible with pneumonia.
Treatment was started on average about 4.9 days after the onset of symptoms.
Sixty-five out of the 80 patients did well and were discharged from the floor. Their average length of stay was 4.6 days. That means 15 did not do well but the paper does not state clearly what happened to those patients.
The paper states 12 (15%) needed oxygen therapy. 3 patients were transferred to the ICU. Two returned to the floor but one is still there.
One patient died on the floor.
One patient did not finish treatment because of drug-incompatibility.
The study is observational and has missing information on some patients but since there is really no other treatment for COVID-19 at this point, the combo might be the best we have now.
Start treatment as early as possible when symptoms are mild before they develop into more severe symptoms. They started 4.9 days after symptoms started.
The study does not say whether it will be effective in patients with ARDS or cytokine storm syndrome.
The combo reduces the nasopharyngeal viral load and may decrease the length of time that infected people shed the virus. This has been noted to last 16 – 30 days with a report of a South Korean man shedding for 2 months. The combo reduces the levels by Day 8.
It reduced the length of stay in the hospital.
It is important to do ECG monitoring in those with underlying cardiac conditions.
Nana Dadzie Ghansah is an anesthesiologist who lives and works in Lexington, Kentucky