Study: Hydroxychloroquine doesn’t improve survival in hospitalized COVID-19 patients, but tocilizumab does

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An observational study of more than 3,000 patients hospitalized with COVID-19 at Hackensack Meridian Health has shown that hydroxychloroquine doesn’t improve survival for hospitalized patients.

However, tocilizumab appears to improve survival among critically ill intensive care unit patients, the study showed. If confirmed, tocilizumab would become the first medication improving survival from COVID-19.

Hackensack Meridian Health released the findings on medRxiv, which allow researchers to share critical scientific information rapidly prior to publication in peer-reviewed journals.

The results are based on the new data analysis platform—the HMH Universal Observational Database for COVID-19, or RECOVERY, which compiles outcomes from 13 Hackensack Meridian Health hospitals throughout New Jersey.

“Our researchers’ observations that tocilizumab may improve survival among the most critically ill could alter the course of the pandemic if confirmed in randomized trials—and Hackensack Meridian Health is participating in those randomized trials as well,” Robert C. Garrett, chief executive officer of Hackensack Meridian Health, said in a statement.

The outcomes division of the John Theurer Cancer Center at Hackensack University Medical Center, under the leadership of Stuart Goldberg and Andrew Ip, created a database to guide the analysis of more than 3,000 patients admitted to Hackensack Meridian Health facilities for urgent care.

Results from the study follow:

  • Among 2,512 hospitalized patients with COVID-19, 76% received at least one dose of hydroxychloroquine and 59% received hydroxychloroquine with azithromycin.

  • After adjusting for imbalances via propensity modeling, compared to receiving no hydroxychloroquine, there was no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospital stay.

  • Among 547 ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival rate: 56% who received the drug compared to 46% who did not receive the therapy, and a propensity adjusted hazard ratio 0.76.

The Hackensack Meridian JTCC team worked with COTA Inc., to conduct propensity modeling to assess for potential effective therapeutic interventions. The data and statistical analysis were enhanced by Donald A. Berry, professor in the Department of Biostatistics at MD Anderson Cancer Center, and his statistical team at Berry Consultants.

“Our study adds to the emerging data finding no benefit for hydroxychloroquine among hospitalized patients, but now we will turn our database’s attention to exploring if the medication is beneficial earlier in the pre-hospital course,”Andre Goy, physician in chief at Hackensack Meridian Health Oncology and chairman and chief physician officer at John Theurer Cancer Center, said in a statement.

Researchers established an observational database through Epic–Hackensack Meridian’s electronic health records system—and collected a random sampling of COVID-19 patients who received treatment at one of 13 hospitals across the network. To date, Hackensack Meridian Health has cared for more than 10,000 patients with confirmed COVID-19 infections and has discharged more than 6,000 patients from network hospitals.

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