Question explored with the scientific record
Conversation so far
- 1 Hydroxychloroquine dangerous or not
- 2 Your answer is wrong
- 3 To know, study the results of institute mediterrannee of prof Raoult: used hydroxychloroquine and has the lowest death rate for covid in the world
Answered on this page ↓
To know, study the results of institute mediterrannee of prof Raoult: used hydroxychloroquine and has the lowest death rate for covid in the world
The short version: the claim that Raoult's IHU Méditerranée had the world's lowest COVID death rate because of hydroxychloroquine is an artifact of comparing a young, largely non-hospitalized cohort to a hospitalized fatality rate.
The core error is simple and well-documented. Risch claimed a 41-fold mortality reduction by applying a 20% hospitalized fatality rate to Raoult's Marseille cohort, whose mean age was 43.6 years and included teenagers [1]. The Fleury critique shows that when you compare the Marseille cohort to the general-population fatality rate (0.5%-2%), the apparent benefit vanishes [1]. The estimated clinical fatality rate within the hospitalized subset of that cohort was about 10%, comparable to other hospitals [1].
The randomized evidence is clear. A meta-analysis of 11 RCTs in hospitalized patients found no significant mortality benefit (RR 1.13, 95% CI 0.99-1.27) and a significant increase in adverse events (RR 1.81) [2]. A separate meta-analysis of 5 RCTs in outpatients found a modest 24% reduction in a composite of infection, hospitalization, or death (RR 0.76, 95% CI 0.59-0.97), but the individual trials were underpowered and the confidence interval is wide [18]. The hospitalized data shows no benefit and some harm; the outpatient data shows a possible small benefit with gastrointestinal side effects.
| Population | Design | Mortality finding | Adverse events |
|---|---|---|---|
| Hospitalized (11 RCTs) | Meta-analysis | No benefit (RR 1.13, 95% CI 0.99-1.27) [2] | Increased (RR 1.81) [2] |
| Outpatients (5 RCTs) | Meta-analysis | 24% reduction composite (RR 0.76, 95% CI 0.59-0.97) [18] | GI side effects, no serious cardiac AEs [18] |
| Marseille cohort (1,061) | Observational | 0.37%-2% (general population rate) [1] | Not systematically reported |
My call: the claim that Raoult's protocol produced the world's lowest death rate is not supported by the evidence. The low mortality in his cohort matches the general population rate for that age group, and the randomized trials show no benefit in hospitalized patients and at most a modest benefit in outpatients.
Sources examined 18
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Does Combining Severe and Mild Cases of COVID-19 Produce Low Fatality Rates After Treatment With Hydroxychloroquine and Azithromycin?
Fleury criticizes Risch's claim that hydroxychloroquine plus azithromycin reduces COVID-19 mortality 41-fold, arguing that Risch misapplied a 20% hospitalized fatality rate to the much younger, largely non-hospitalized Marseille and Zelenko cohorts, so the apparent benefit is an…
DOI: 10.1093/aje/kwaa155 -
Hydroxychloroquine plus standard of care compared with standard of care alone in COVID-19: a meta-analysis of randomized controlled trials
A meta-analysis of 11 randomized controlled trials found that adding hydroxychloroquine to standard care for hospitalized COVID-19 patients provides no significant benefit in reducing mortality, PCR negativity, hospital stay, or other outcomes, but increases adverse events.
DOI: 10.1038/s41598-021-91089-3 -
Early Ambulatory Multidrug Therapy Reduces Hospitalization and Death in High-Risk Patients with SARS-CoV-2 (COVID-19)
Early ambulatory multidrug therapy for high-risk COVID-19 patients reduced hospitalization by about 88% and death by about 75% versus expected regional rates.
DOI: 10.23958/ijirms/vol06-i03/1100 -
Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection
In a retrospective series of 320 high-risk outpatients with suspected or confirmed COVID-19 treated with empiric multidrug therapy, hospitalization occurred in 6 (1.9%) and death in 1 (0.3%), suggesting low event rates but lacking a control group.
DOI: 10.31083/j.rcm.2020.04.260 -
Clinical outcomes and adverse events in patients hospitalised with COVID‐19, treated with off‐label hydroxychloroquine and azithromycin
In a retrospective cohort of 134 hospitalised COVID-19 patients, off-label hydroxychloroquine plus azithromycin did not improve clinical outcomes and was associated with significantly higher day-28 mortality and QT prolongation compared to no targeted therapy.
DOI: 10.1111/bcp.14482 -
Hydroxychloroquine for treatment of nonsevere COVID‐19 patients: Systematic review and meta‐analysis of controlled clinical trials
Hydroxychloroquine shows no net benefit for nonsevere COVID-19: it prevents early radiological progression but does not improve clinical outcomes, viral clearance, or mortality, and increases adverse effects.
DOI: 10.1002/jmv.26442 -
A pragmatic randomized controlled trial reports lack of efficacy of hydroxychloroquine on coronavirus disease 2019 viral kinetics
In a pragmatic randomized trial of 53 hospitalized COVID-19 patients, hydroxychloroquine added to standard care did not significantly accelerate SARS-CoV-2 oropharyngeal viral load decline compared to standard care alone over five days.
DOI: 10.1038/s41467-020-19056-6 -
Early Outpatient Treatment of COVID-19: A Retrospective Analysis of 392 Cases in Italy
Early outpatient treatment of COVID-19 with combined anti-inflammatory, antiplatelet, and anticoagulant drugs was associated with low hospitalization (5.8%) and mortality (0.2%) rates in a retrospective cohort of 392 Italian patients treated within the IppocrateOrg network.
DOI: 10.3390/jcm11206138 -
Hydroxychloroquine in Hospitalized Patients with COVID‐19: Real‐World Experience Assessing Mortality
A retrospective multinational cohort study found no significant association between hydroxychloroquine (with or without azithromycin) and 30-day mortality or mortality/arrhythmia in hospitalized COVID-19 patients after propensity matching.
DOI: 10.1002/phar.2467 -
Safety and efficacy of different therapeutic regimens in Egyptian adults with moderate COVID-19 infection (EVEREST): a real-world retrospective study
A real-world retrospective cohort study in 310 Egyptian adults with moderate COVID-19 compares four antiviral regimens (sofosbuvir/daclatasvir ± ivermectin; sofosbuvir/ledipasvir ± hydroxychloroquine; and sofosbuvir/ledipasvir plus ivermectin) against standard care, finding redu…
DOI: 10.1038/s41598-025-23660-1 -
Novel therapeutic approaches for treatment of COVID-19
This review summarizes potential therapeutic approaches for COVID-19, including antivirals, immunotherapies, cell therapies, and nanomedicine, highlighting both promising results and unresolved controversies.
DOI: 10.1007/s00109-020-01927-6 -
COVID-19: Emergence, Spread, Possible Treatments, and Global Burden
A narrative overview of COVID-19 emergence, spread, provisional treatments, and global burden, summarizing current evidence for Remdesivir, convalescent plasma, hydroxychloroquine/chloroquine, lopinavir/ritonavir, corticosteroids, and vaccine development as of 2020.
DOI: 10.3389/fpubh.2020.00216 -
Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients That Should Be Ramped Up Immediately as Key to the Pandemic Crisis
This review argues that hydroxychloroquine plus azithromycin or doxycycline, preferably with zinc, is safe and effective as early outpatient treatment for high-risk COVID-19 patients, citing non-randomized and observational evidence to prevent hospitalization.
DOI: 10.1093/aje/kwaa093 -
Cardiac adverse events associated with chloroquine and hydroxychloroquine exposure in 20 years of drug safety surveillance reports
Chloroquine and hydroxychloroquine were associated with significantly increased cardiac adverse event reporting in FAERS after adjustment, with chloroquine showing a larger effect than hydroxychloroquine.
DOI: 10.1038/s41598-020-76258-0 -
The association of treatment with hydroxychloroquine and hospital mortality in COVID-19 patients
In this observational study of 2,075 hospitalized COVID-19 patients across 17 Spanish hospitals, hydroxychloroquine treatment was significantly associated with lower hospital mortality in all four multivariable logistic regression models (adjusted OR 0.39–0.45, all p<0.001), wit…
DOI: 10.1007/s11739-020-02505-x -
Adverse Cardiac Events Related to Hydroxychloroquine Prophylaxis and Treatment of COVID-19
This paper presents three case reports of cardiac adverse events (QT interval prolongation, tachycardia, and arrhythmias) following hydroxychloroquine use, either alone or with other QT-prolonging drugs, for COVID-19 prophylaxis or treatment.
DOI: 10.36519/idcm.2020.0012 -
The Potential Benefit of Beta-Blockers for the Management of COVID-19 Protocol Therapy-Induced QT Prolongation: A Literature Review
This literature review assesses whether cardio-selective beta-blockers, particularly bisoprolol, can mitigate QT interval prolongation caused by COVID-19 protocol therapies (chloroquine/hydroxychloroquine and azithromycin) and discusses potential additional benefits and underlyi…
DOI: 10.3390/scipharm88040055 - Randomized Controlled Trials of Early Ambulatory Hydroxychloroquine in the Prevention of COVID-19 Infection, Hospitalization, and Death: Meta-Analysis DOI: 10.1101/2020.09.30.20204693