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====Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19====  

====Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19====  

Joshua Geleris studied the patients who came to the New York–Presbyterian Hospital (NYP)–Columbia University Irving Medical Center (CUIMC).  Having the results come from one hospital could mean that some of the variables one might encounter with a multi-hospital analysis are controlled for, that doesn't hold true in this case.  While the hospital initially recommended dosing for HCQ at 400 mg, these recommendations were subsequently removed and treatment was left to the doctor's discretion.  Moreover, it was only until after patients reached the emergency room that they were given HCQ (see figure S3), and even then only 45.8% received it within 24 hours.  That is pretty late to be giving HCQ.  In any case, what did they find?

Joshua Geleris studied the patients who came to the New York–Presbyterian Hospital (NYP)–Columbia University Irving Medical Center (CUIMC).  Having the results come from one hospital could mean that some of the variables one might encounter with a multi-hospital analysis are controlled for, but that doesn't hold true in this case.  While the hospital initially recommended dosing for HCQ at 400 mg, these recommendations were subsequently removed and treatment was left to the doctor's discretion.  Moreover, it was only until after patients reached the emergency room that they were given HCQ (see figure S3), and even then only 45.8% received it within 24 hours.  That is pretty late to be giving HCQ.  In any case, what did they find?

{{quotebox|Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine (median ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, 223 vs. 360). Overall, 346 patients (25.1%) had a primary end-point event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses.<ref>[https://www.nejm.org/doi/10.1056/NEJMoa2012410?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19] by Joshua Geleris et.al (June 18, 2020) ''The New England Journal of Medicine''</ref>}} In short, the researchers found that if you give HCQ in an ER preferentially to patients who were more severely ill at baseline, there is no significant difference between those given HCQ and those who weren't given it.  It is difficult to figure out how to interpret that result. Is there no effect in an ER setting as evidenced by the similarity of outcomes between the two groups?  Does it mean that there was a net positive effect to HCQ because the sicker patients weren't dying as often as one might otherwise expect?

{{quotebox|Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine (median ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, 223 vs. 360). Overall, 346 patients (25.1%) had a primary end-point event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses.<ref>[https://www.nejm.org/doi/10.1056/NEJMoa2012410?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19] by Joshua Geleris et.al (June 18, 2020) ''The New England Journal of Medicine''</ref>}} In short, the researchers found that if you give HCQ in an ER preferentially to patients who were more severely ill at baseline, there is no significant difference between those given HCQ and those who weren't given it.  It is difficult to figure out how to interpret that result. Is there no effect in an ER setting as evidenced by the similarity of outcomes between the two groups?  Does it mean that there was a net positive effect to HCQ because the sicker patients weren't dying as often as one might otherwise expect?