TY - JOUR
T1 - Efficacy of chloroquine and hydroxychloroquine in treating COVID-19 infection
T2 - A meta-review of systematic reviews and an updated meta-analysis
AU - Chivese, Tawanda
AU - Musa, Omran A.H.
AU - Hindy, George
AU - Al-Wattary, Noor
AU - Badran, Saif
AU - Soliman, Nada
AU - Aboughalia, Ahmed T.M.
AU - Matizanadzo, Joshua T.
AU - Emara, Mohamed M.
AU - Thalib, Lukman
AU - Doi, Suhail A.R.
N1 - Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Objective: To synthesize findings from systematic reviews and meta-analyses on the efficacy and safety of chloroquine (CQ) and hydroxychloroquine (HCQ) with or without Azithromycin for treating COVID-19, and to update the evidence using a meta-analysis. Methods: A comprehensive search was carried out in electronic databases for systematic reviews, meta-analyses and experimental studies which investigated the efficacy and safety of CQ, HCQ with or without Azithromycin to treat COVID-19. Findings from the reviews were synthesised using tables and forest plots and the quality effect model was used for the updated meta-analysis. The main outcomes were mortality, the need for intensive care services, disease exacerbation, viral clearance and occurrence of adverse events. Results: Thirteen reviews with 40 primary studies were included. Two meta-analyses reported a high risk of mortality, with ORs of 2.2 and 3.0, and the two others found no association between HCQ and mortality. Findings from two meta-analyses showed that HCQ with Azithromycin increased the risk of mortality, with similar ORs of 2.5. The updated meta-analysis of experimental studies showed that the drugs were not effective in reducing mortality (RR 1.1, 95%CI 1.0–1.3, I2 = 0.0%), need for intensive care services (OR 1.1, 95%CI 0.9–1.4, I2 = 0.0%), virological cure (OR 1.5, 95%CI 0.5–4.4, I2 = 39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3–5.9, I2 = 31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5–59.9, I2 = 76.6%). Conclusion: There is conclusive evidence that CQ and HCQ, with or without Azithromycin are not effective in treating COVID-19 or its exacerbation. Registration: PROSPERO: CRD42020191353.
AB - Objective: To synthesize findings from systematic reviews and meta-analyses on the efficacy and safety of chloroquine (CQ) and hydroxychloroquine (HCQ) with or without Azithromycin for treating COVID-19, and to update the evidence using a meta-analysis. Methods: A comprehensive search was carried out in electronic databases for systematic reviews, meta-analyses and experimental studies which investigated the efficacy and safety of CQ, HCQ with or without Azithromycin to treat COVID-19. Findings from the reviews were synthesised using tables and forest plots and the quality effect model was used for the updated meta-analysis. The main outcomes were mortality, the need for intensive care services, disease exacerbation, viral clearance and occurrence of adverse events. Results: Thirteen reviews with 40 primary studies were included. Two meta-analyses reported a high risk of mortality, with ORs of 2.2 and 3.0, and the two others found no association between HCQ and mortality. Findings from two meta-analyses showed that HCQ with Azithromycin increased the risk of mortality, with similar ORs of 2.5. The updated meta-analysis of experimental studies showed that the drugs were not effective in reducing mortality (RR 1.1, 95%CI 1.0–1.3, I2 = 0.0%), need for intensive care services (OR 1.1, 95%CI 0.9–1.4, I2 = 0.0%), virological cure (OR 1.5, 95%CI 0.5–4.4, I2 = 39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3–5.9, I2 = 31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5–59.9, I2 = 76.6%). Conclusion: There is conclusive evidence that CQ and HCQ, with or without Azithromycin are not effective in treating COVID-19 or its exacerbation. Registration: PROSPERO: CRD42020191353.
KW - Adverse events
KW - Chloroquine
KW - COVID-19
KW - Disease worsening
KW - Efficacy
KW - Hydroxychloroquine
KW - ICU
KW - Mortality
KW - Virological cure
UR - http://www.scopus.com/inward/record.url?scp=85109749063&partnerID=8YFLogxK
U2 - 10.1016/j.tmaid.2021.102135
DO - 10.1016/j.tmaid.2021.102135
M3 - Review article
C2 - 34265436
AN - SCOPUS:85109749063
SN - 1477-8939
VL - 43
JO - Travel Medicine and Infectious Disease
JF - Travel Medicine and Infectious Disease
M1 - 102135
ER -