Cette après-midi Macron est venu visiter l'IHU Méditerranée et s'entretenir avec le Pr Raoult. Ce qui est scientifiquement sans intérêt, comme si le pape avait rencontré Galilée. Je crois bien qu'il l'a rencontré d'ailleurs. Par contre, il a reçu en avant-première la dernière étude menée à l'IHU et portant cette fois sur 1061 patients traités avec la combinaison hydroxychloroquine (HCQ) et azithromycin (AZ). On va dire un échantillon significatif. Ce n'est pas encore tout à fait le protocole idéal exigé par l'EBM, mais on s'en approche. Les lecteurs de Mediapart, scientifiques éclairés ou amateurs, baragouinant l'anglais de laboratoire, peuvent en prendre connaissance, presqu'en même temps que le président. Voir ci-dessous.
Ceux qui voudront absolument lire le tableau de données le trouveront sur le site de l'IHU Méditerranée parmi les pré publications.
La première version de notre article sur les 1061 patients qui ont été traités entièrement par hydroxychloroquine et azithromycine est terminée. Vous verrez dans les résultats que la mortalité est de l’ordre de 0,5% et que le taux de guérison est extrêmement élevé. Ce traitement a déjà été utilisé par d’autres services de l’AP-HM, avec des résultats comparables, indépendamment de notre équipe. Nous mettons en pré-publication le résumé de cet article en anglais et un tableau qui résume l’ensemble de nos données pour que ceci puisse servir éventuellement à des décisions politiques.
Signé par: Matthieu Million, Jean-Christophe Lagier, Philippe Gautret, Philippe Colson, Pierre-Edouard Fournier, Sophie Amrane, Marie Hocquart, Morgane Mailhe, Vera Esteves-Vieira, Barbara Doudier, Camille Aubry, Florian Correard, Audrey Giraud-Gatineau, Yanis Roussel, Cyril Bellenger, Nadim Cassir, Piseth Seng, Christine Zandotti, Catherine Dhiver, Isabelle Ravaux, Christelle Tomei, Carole Eldin, David Braunstein, Hervé Tissot-Dupont, Stéphane Honoré, Andreas Stein, Alexis Jacquier, Jean-Claude Deharo, Eric Chabrière, Anthony Levasseur, Florence Fenollar, Jean-Marc Rolain, Yolande Obadia, Philippe Brouqui, Michel Drancourt, Bernard La Scola, Philippe Parola, Didier Raoult
ABSTRACT
Background In a recent survey, most physicians worldwide considered that hydroxychloroquine (HCQ) and azithromycin (AZ) are the two most effective drugs among available molecules against COVID-19. Nevertheless, to date, one preliminary clinical trial only has demonstrated its efficacy on the viral load. Additionally, a clinical study including 80 patients was published, and in vitro efficiency of this association was demonstrated.
Methods
The study was performed at IHU Méditerranée Infection, Marseille, France.
A cohort of 1061 COVID-19 patients, treated for at least 3 days with the HCQ-AZ combination and a follow-up of at least 9 days was investigated. Endpoints were death, worsening and viral shedding persistence.
Findings
From March 3rd to April 9th, 2020, 59,655 specimens from 38,617 patients were tested for COVID-19 by PCR. Of the 3,165 positive patients placed in the care of our institute, 1061 previously unpublished patients met our inclusion criteria. Their mean age was 43.6 years old and 492 were male (46.4%). No cardiac toxicity was observed. A good clinical outcome and virological cure was obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage at completion of treatment was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < 10-2 ) but viral culture was negative at day 10 and all but one were PCR-cleared at day 15. A poor outcome was observed for 46 patients (4.3%); 10 were transferred to intensive care units, 5 patients died (0.47%) (74-95 years old) and 31 required 10 days of hospitalization or more. Among this group, 25 patients are now cured and 16 are still hospitalized (98% of patients cured so far). Poor clinical outcome was significantly associated to older age (OR 1.11), initial higher severity (OR 10.05) and low 2 hydroxychloroquine serum concentration. In addition, both poor clinical and virological outcomes were associated to the use of selective beta-blocking agents and angiotensin II receptor blockers (P<0.05). Mortality was significantly lower in patients who had received > 3 days of HCQ-AZ than in patients treated with other regimens both at IHU and in all Marseille public hospitals (p< 10-2 ).
Interpretation
The HCQ-AZ combination, when started immediately after diagnosis, is a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients. It avoids worsening and clears virus persistence and contagiosity in most cases.