Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: a multi-center observational study

Ip, Andrew; Ahn, Jaeil; Zhou, Yizhao; Goy, Andre H.; Hansen, Eric; Pecora, Andrew L.; Sinclaire, Brittany A.; Bednarz, Urszula; Marafelias, Michael; Sawczuk, Ihor S.; Underwood, Joseph P.; Walker, David M.; Prasad, Rajiv; Sweeney, Robert L.; Ponce, Marie G.; La Capra, Samuel; Cunningham, Frank J.; Calise, Arthur G.; Pulver, Bradley L.; Ruocco, Dominic; Mojares, Greggory E.; Eagan, Michael P.; Ziontz, Kristy L.; Mastrokyriakos, Paul; Goldberg, Stuart L.

BACKGROUND: Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. METHODS: We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. RESULTS: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. CONCLUSIONS: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-05773-w.