Clinical outcomes of hydroxychloroquine in hospitalized patients with COVID-19: a quasi-randomized comparative study

Background: Off-label use of hydroxychloroquine in the SARS-CoV-2 positive population has become widespread with only empirical evidence on its efficacy. This study addresses the efficacy of hydroxychloroquine on serological and supportive care measures in a hospitalized population. Methods: Consecutive adult subjects admitted for viral pneumonia secondary to SARS-CoV-2 (by polymerase chain reaction) during the last two weeks of March, 2020 were included. Those that were started on hydroxychloroquine and supportive care were compared to supportive care alone. The primary end points were effect of hydroxychloroquine usage on the need to escalate respiratory support, change in lymphocyte count, and change in neutrophil-to-lymphocyte ratio. Results: A total of 63 patients were included with 32 in the hydroxychloroquine arm. Hydroxychloroquine administration was associated with a need for escalation of respiratory support level compared to those that did not receive hydroxychloroquine at 5 days (p=0.013). The same findings were observed in a baseline-matched subgroup analysis. Absolute lymphocyte change in the hydroxychloroquine group was no different than supportive care alone (p=0.413). Hydroxychloroquine use trended towards worsening neutrophil-to-lymphocyte ratio compared to supportive care alone (+9.59 vs +1.58, p=0.51) as well as a higher risk for intubation (p=0.051). Conclusion: Hydroxychloroquine administration to the hospitalized SARS-CoV-2 positive population was associated with an increased need for escalation of respiratory support. There were no benefits of hydroxychloroquine on mortality, lymphopenia, or neutrophil-tolymphocyte ratio improvement.