Öz
Giriş: Koronavirüs hastalığı-2019’un (COVID-19) yönetiminde etkinliği ve güvenliği kanıtlanmış spesifik bir antiviral tedavi yoktur. Laboratuvarca doğrulanmış COVID-19 hastalarında hidroksiklorokin monoterapisi ile hidroksiklorokin-lopinavir/ritonavir (Lpv/r) kombine tedavisinin etkinliğini karşılaştırmayı ve mortaliteyi öngören bağımsız faktörleri belirlemeyi amaçladık.
Gereç ve Yöntem: Geriye dönük gözlemsel çok merkezli kohort çalışmasıdır.
Bulgular: Toplamda, COVID-19 pnömonili 151 hasta (ortalama yaş 61±17 yıl, %66’sı erkek) dahil edildi. Altmış sekiz hasta kombinasyon tedavisi (hidroksiklorokine ek olarak Lpv/r), 83 hasta sadece hidroksiklorokin aldı. Her iki gruptaki hastalar; lökosit sayısı, prokalsitonin, laktat dehidrojenaz seviyeleri, yoğun bakım ünitesine (YBÜ) yatış oranları haricinde (kombinasyon grubunda önemli ölçüde daha fazla artmış ve oksijen satürasyonu azalmış) temel değişkenlerin çoğu açısından benzerdi. Ortalama semptom süresi 5,6±2,3 gün ve hastanede kalış süresi 12,7±9,4 gündü. Hastaların yaklaşık %43’ü (n=65) YBÜ’ye yatırıldı. Hidroksiklorokin monoterapi grubundaki hastaların hastanede kalış süresi kombinasyon grubuna göre daha kısaydı (10’a karşı 16 gün, p<0,005). Primer sonlanım noktaları 14 ve 28 günlük mortaliteydi. Eğilim skoru eşleştirmesi öncesi ve sonrasında her iki tedavi grubu arasında anlamlı farklılık gözlenmedi. Yaş, hipertansiyon, diabetes mellitus, kronik obstrüktif akciğer hastalığı, Charlson Komorbidite İndeksi (CCI) ve YBÜ’de kalış 14 günlük mortaliteyi öngören değişkenler iken, CCI [Hazard oranı (HR) [%95 güven aralığı (CI): 0,85 (0,43-0,9)] ve YBÜ’de kalış [HR (%95 CI): 1,5 (1,39-1,76)], 28 günlük mortalitenin bağımsız prediktörleri idi.
Sonuç: Lpv/r ve hidroksiklorokin ile kombinasyon tedavisi, hidroksiklorokin monoterapisine kıyasla herhangi bir fayda sağlamadı. Charlson Komorbidite İndeksi ve YBÜ’de kalış, 28 günlük mortalitenin bağımsız belirleyicileriydi.
Anahtar Kelimeler: SARS-CoV-2, COVID-19, tedavi, hidroksiklorokin, lopinavir/ritonavir
Kaynakça
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