Excluding any therapeutic trial prescription of hydroxychloroquine to hospitalized patients with covid-19 during the first wave of the pandemic: A national survey on the prescription habits of French hospital workers

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PLoS One. 2022 Jan 21;17(1):e0261843. doi: 10.1371/journal.pone.0261843. eCollection 2022.

ABSTRACT

INTRODUCTION: During the first wave of the coronavirus disease 2019 (covid-19) pandemic in early 2020, hydroxychloroquine (HCQ) was widely prescribed based on its in vitro activity against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2 ). Our objective was to evaluate at the start of 2020 the rate of French hospital workers declaring that they had prescribed HCQ to treat covid-19 patients outside of any therapeutic trial, to compare the reasons and determinants for having prescribed or not having prescribed HCQ. ‘HCQ.

MATERIALS AND METHODS: A national survey submitted by email from May 7 to 25, 2020, to a sample of French hospital workers: doctors caring for patients hospitalized for covid-19 in a French internal medicine or infectious disease department and identified in hospital directories or as a member of the French Society of Infectiology (SPILF). The primary endpoint was the percentage of hospitals reporting having prescribed HCQ to covid-19 patients. Secondary outcomes were reasons for and determinants of HCQ prescription.

RESULTS: Among 400 (22.8%) responding hospitalists, 45.3% (95% CI, 40.4–50.1%) reported having prescribed HCQ to covid-19 patients. Two main profiles were distinguished: prescribers of HCQ who did not invoke its efficacy as a reason, and non-prescribers who based their decision on evidence-based medicine. The multivariate analysis retained the following prescribing determinants (adjusted odds ratio; 95% confidence interval): a departmental approach to prescribing HCQ (8.25; 4.79 to 14.20), having prescribed other treatments outside of a therapeutic trial (3.21; 1.81 to 5.71), HCQ prior prescription (2.75; 1.5 to 5.03) and HCQ prescribed as part of a therapeutic trial (0.56 0.33 to 0.95).

CONCLUSION: Nearly half of the hospital staff prescribed HCQ. The doctor’s personality (whether or not questioning the principles of evidence-based medicine in the context of the pandemic) and the therapeutic modalities of the service were the main factors influencing the prescription of HCQ. The establishment of “therapeutic” procedures represents a potential means of improving the quality of therapeutic decision-making during a pandemic.

PMID:35061735 | DOI:10.1371/journal.pone.0261843

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