JISCMail - EVIDENCE-BASED-HEALTH Archives

Included patients for whom a clinical outcome of either hospital discharge or death during hospitalisation was recorded -- those with missing data would have been excluded (potential for selection bias)

Disease severity was based on qSOFA and SPO2 -- composite nature of score limits confidence in the balance of resp. functional status (potential confounding bias)

Confounding by CRP, D-dimer, PCT (which could have influenced 4-aminoquinoline therapy) was not considered (another confounding by indication concern)

PCR assay validation was not established

Some concerns about data accuracy -- " if the patient’s electronic health record did not include information on a clinical characteristic, it was assumed that the characteristic was not present"

No dose response relationship could be established.

I would judge this study as high risk of bias for the main outcome and VA, and would want replication in future differently designed studies to establish more certainty. However, high risk of bias may not be risk of high bias.

On Mon, May 25, 2020 at 10:15 PM Kumara Mendis <[log in to unmask]> wrote:

Dear all

In Sri Lanka everyone who is admitted to the designated hospitals with PCR+ COVID gets at least Chloroquine /HCQ

The Lancet has published a study
Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis
The findings are :
We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.

Has anyone done a critical appraisal of this paper?

My question if you are a clinicians would you give HCQ and or macrolide to each and every person (I will add my own criteria after taking an ECG and if there is no abnormal changes of rhythm or other ischaemic changes)

Would much value your comments

Thank you

Kumara

Truth, wisdom, learning, and good sense—these are worth paying for, but too valuable for you to sell.
Proverbs 23:23

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