Deaths induced by compassionated hydroxycholoroquine administration during first COVID-19 wave: An estimate

ABSTRACT

Introduction: During the first wave of Covid-19, various treatments have been tested off label, including HCQ, despite its significant adverse effects and the absence of proof of effectiveness against this virus. A recent meta-analysis showed an increase of mortality rate related to HCQ use. We aimed to estimate the number of deaths caused by HCQ worldwide. Material and methods: The HCQ exposure according to countries was estimated from meta-analysis using published cohorts (Pubmed) identified thanks to a systematic review. We retrieved the mortality rate of HCQ from meta-analysis of randomized trials (MetaEvidence tool) as well as the number of hospitalized patients in the selected countries between the beginning of the pandemic and mid-July 2020 using various online databases. Results: The included studies were conducted in Turkey (k = 3), Brazil (k = 1), Belgium (k = 1), France (k = 2), United Kingdom (k = 1), Spain (k = 10), Italy (k = 13), and United States of America (k = 19). The prescription HCQ rates vary greatly from one country to another (median 52%, range 6-97). The number of hospitalisations related to the first wave of COVID-19 ranged from 3,082 (Brazil) to 888,037 (USA). In Belgium, HCQ induced 151 deaths. In Turkey, the median was 111 HCQ-induced deaths (range 109-150). In France, the HCQ-related deaths varied between 98 and 256. In Italy and Spain, the medians of HCQ-induced deaths were, respectively, 1,549 (range 996-1,758) and 1,435 (range 760-1,704). In UK, HCQ induced 415 deaths. The highest number of HCQ-induced deaths is found in the USA with a median of 5645 (range 1,194-9,059). Overall, using median estimates, HCQ totalized 9564 deaths in countries with available data. Discussion/Conclusion: HCQ was associated with at least 9,564 deaths during first wave of COVID-19 pandemic. These results were underestimated in regards of lacking data in mostly countries. These findings illustrate the risk of drug repurposing from chronic diseases to deadly conditions, with a low-level evidence.