Alliance for Pandemic Preparedness

May 12, 2020

Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State

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  • A retrospective multi-center cohort study sampled randomly from all admitted participants with laboratory-confirmed COVID-19 in 25 hospitals (N=1,438) and compared hydroxychloroquine alone, azithromycin alone, and combination of the two relative to treatment with neither medication.  
  • There was a greater odds of cardiac arrest in patients receiving combination therapy (OR 2.13 95% CI: 1.12, 4.05), but otherwise no statistically significant associates with mortality or abnormal electrocardiogram findings.  
  • However, combination therapy had a non-significant association with increased risk of mortality (HR 1.35, 95% CI 0.76, 2.40) and abnormal ECG findings (OR=1.55, 95%CI 0.89–2.67), as did hydroxychloroquine alone for cardiac arrest (OR=1.91, 95%CI: 0.96–3.81) and abnormal ECG findings (OR=1.50, 95%CI: 0.88–2.58). The effect of hydroxychloroquine alone was also non-significantly associate with a small increased risk of mortality (HR=1.08, 95%CI 0.63–1.85).  
  • Azithromycin alone was associated with a non-significant lower risk of mortality (HR=0.56, 95%CI 0.26–1.21), cardiac arrest (OR=0.64, 95%CI: 0.27–1.56), and abnormal ECG findings (OR=0.95, 95%CI 0.77–3.24).  
  • While limited by the observational design, these findings provide concerning evidence that treatment with hydroxychloroquine is associated with a higher likelihood of mortality and adverse cardiac outcomes, and that addition of azithromycin may increase these risks further.  

Rosenberg et al. (May 11, 2020). Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. https://doi.org/10.1001/jama.2020.8630