Safety, tolerability, and clinical outcomes of hydroxychloroquine for hospitalized patients with coronavirus 2019 disease.

TitleSafety, tolerability, and clinical outcomes of hydroxychloroquine for hospitalized patients with coronavirus 2019 disease.
Publication TypeJournal Article
Year of Publication2020
AuthorsSatlin MJ, Goyal P, Magleby R, Maldarelli GA, Pham K, Kondo M, Schenck EJ, Rennert H, Westblade LF, Choi JJ, Safford MM, Gulick RM
JournalPLoS One
Date Published2020
KeywordsAdult, Aged, Azithromycin, Betacoronavirus, Clinical Laboratory Techniques, Coronavirus Infections, COVID-19, COVID-19 Testing, Female, Humans, Hydroxychloroquine, Male, Middle Aged, New York City, Pandemics, Pneumonia, Viral, Retrospective Studies, SARS-CoV-2, Treatment Outcome

BACKGROUND: Severe acute respiratory coronavirus 2 (SARS-CoV-2) has caused a devastating worldwide pandemic. Hydroxychloroquine (HCQ) has in vitro activity against SARS-CoV-2, but clinical data supporting HCQ for coronavirus disease 2019 (COVID-19) are limited.

METHODS: This was a retrospective cohort study of hospitalized patients with COVID-19 who received ≥1 dose of HCQ at two New York City hospitals. We measured incident Grade 3 or 4 blood count and liver test abnormalities, ventricular arrhythmias, and vomiting and diarrhea within 10 days after HCQ initiation, and the proportion of patients who completed HCQ therapy. We also describe changes in Sequential Organ Failure Assessment hypoxia scores between baseline and day 10 after HCQ initiation and in-hospital mortality.

RESULTS: None of the 153 hospitalized patients with COVID-19 who received HCQ developed a sustained ventricular tachyarrhythmia. Incident blood count and liver test abnormalities occurred in <15% of patients and incident vomiting or diarrhea was rare. Eighty-nine percent of patients completed their HCQ course and three patients discontinued therapy because of QT prolongation. Fifty-two percent of patients had improved hypoxia scores 10 days after starting HCQ. Thirty-one percent of patients who were receiving mechanical ventilation at the time of HCQ initiation died during their hospitalization, compared to 18% of patients who were receiving supplemental oxygen but not requiring mechanical ventilation, and 8% of patients who were not requiring supplemental oxygen. Co-administration of azithromycin was not associated with improved outcomes.

CONCLUSIONS: HCQ appears to be reasonably safe and tolerable in most hospitalized patients with COVID-19. However, nearly one-half of patients did not improve with this treatment, highlighting the need to evaluate HCQ and alternate therapies in randomized trials.

Alternate JournalPLoS One
PubMed ID32701969
PubMed Central IDPMC7377460
Grant ListT32 AI007613 / AI / NIAID NIH HHS / United States
UL1 TR002384 / TR / NCATS NIH HHS / United States
Related Faculty: 
Hanna Rennert, Ph.D. Lars Westblade, Ph.D.


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