法国巴黎东方大学Matthieu Mahévas课题组探讨了羟氯喹治疗需供氧的covid-19患者的疗效。相关论文于2020年5月14日发表在《英国医学杂志》上。

为了评估羟氯喹治疗covid-19需吸氧患者的疗效，2020年3月12日至31日，研究组在法国设立了4个三级治疗中心，为患有covid-19肺炎的患者提供治疗。共招募了181名SARS-CoV-2感染者，年龄为18-80岁，需要供氧但无需重症监护。将其随机分组，84名患者入院48小时内接受羟氯喹治疗（治疗组），8名入院后超过48小时接受羟氯喹治疗，89名未接受羟氯喹治疗（对照组）。

在加权分析中，治疗组在第21天时未转入重症监护病房的生存率为76％，对照组为75％，加权危险比为0.9。治疗组第21天的总生存率为89％，对照组为91％。治疗组第21天无急性呼吸窘迫综合征的生存率为69％，而对照组为74％。在第21天，治疗组82％的患者已停止吸氧，而对照组则为76％。治疗组中有8名患者（占10％）经历了心电图改变，需中断治疗。

虽然羟氯喹作为covid-19的潜在治疗方法已受到全世界的关注，但该研究结果不支持羟氯喹治疗需要吸氧的covid-19住院患者。

附：英文原文

Title: Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data

Author: Matthieu Mahévas, Viet-Thi Tran, Mathilde Roumier, Amélie Chabrol, Romain Paule, Constance Guillaud, Elena Fois, Raphael Lepeule, Tali-Anne Szwebel, Franois-Xavier Lescure, Frédéric Schlemmer, Marie Matignon, Mehdi Khellaf, Etienne Crickx, Benjamin Terrier, Caroline Morbieu, Paul Legendre, Julien Dang, Yoland Schoindre, Jean-Michel Pawlotsky, Marc Michel, Elodie Perrodeau, Nicolas Carlier, Nicolas Roche, Victoire de Lastours, Clément Ourghanlian, Solen Kerneis, Philippe Ménager, Luc Mouthon, Etienne Audureau, Philippe Ravaud, Bertrand Godeau, Sébastien Gallien, Nathalie Costedoat-Chalumeau

Issue&Volume: 2020/05/14

Abstract: Objective To assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen.

Design Comparative observational study using data collected from routine care.

Setting Four French tertiary care centres providing care to patients with covid-19 pneumonia between 12 March and 31 March 2020.

Participants 181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care.

Interventions Hydroxychloroquine at a dose of 600 mg/day within 48 hours of admission to hospital (treatment group) versus standard care without hydroxychloroquine (control group).

Main outcome measures The primary outcome was survival without transfer to the intensive care unit at day 21. Secondary outcomes were overall survival, survival without acute respiratory distress syndrome, weaning from oxygen, and discharge from hospital to home or rehabilitation (all at day 21). Analyses were adjusted for confounding factors by inverse probability of treatment weighting.

Results In the main analysis, 84 patients who received hydroxychloroquine within 48 hours of admission to hospital (treatment group) were compared with 89 patients who did not receive hydroxychloroquine (control group). Eight additional patients received hydroxychloroquine more than 48 hours after admission. In the weighted analyses, the survival rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and 75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, 0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of patients in the treatment group had been weaned from oxygen compared with 76% in the control group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the treatment group (10%) experienced electrocardiographic modifications that required discontinuation of treatment.

Conclusions Hydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen.

DOI: 10.1136/bmj.m1844

Source: https://www.bmj.com/content/369/bmj.m1844