Efficacy and safety of hydroxychloroquine/chloroquine against SARS-CoV-2 infection: A systematic review and meta-analysis.
Identifieur interne : 000267 ( Main/Corpus ); précédent : 000266; suivant : 000268Efficacy and safety of hydroxychloroquine/chloroquine against SARS-CoV-2 infection: A systematic review and meta-analysis.
Auteurs : Jogender Kumar ; Siddharth Jain ; Jitendra Meena ; Arushi YadavSource :
- Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy [ 1437-7780 ] ; 2021.
English descriptors
- KwdEn :
- MESH :
- chemical , adverse effects : Chloroquine, Hydroxychloroquine.
- chemical , therapeutic use : Antiviral Agents, Chloroquine, Hydroxychloroquine.
- drug therapy : COVID-19.
- mortality : COVID-19.
- Humans, Treatment Outcome.
Abstract
INTRODUCTION
Hydroxychloroquine (HCQ)/Chloroquine (CQ) has been evaluated for treatment and prophylaxis against SARS-CoV-2 infection in various studies with conflicting results. We performed a systematic review to synthesize the currently available evidence over the efficacy and safety of HCQ/CQ therapy alone against SARS-CoV-2 infection.
METHODS
We searched Embase, PubMed, Web of Science, and Cochrane central for randomized controlled trials (RCTs) and prospective cohort studies published until October 15, 2020 and assessing the efficacy of HCQ alone against SARS-CoV-2 infection. We included studies evaluating HCQ/CQ alone as intervention and placebo/standard care as a control group. Retrospective studies and studies using other drugs (namely azithromycin, corticosteroids, immunomodulators, etc.) we excluded. Thirteen RCTs and three prospective cohort studies were included in this review. We pooled data using a random-effect model.
RESULTS
Pooled data from 12 studies (9917 participants) showed that HCQs increase mortality as compared to placebo/standard of care (RR 1.10; 95% CI:1.00-1.20). Hydroxychloroquine did not reduce the need for hospitalization in out-patients (RR 0.57; 95% CI 0.31-1.02). HCQ group has a significantly higher rate of any adverse event (RR 2.68; 95% CI 1.55-4.64), as compared to the control group. Also, using HCQ for prophylaxis against SARS-CoV-2 infection did not reduce the risk of acquiring SARS-CoV-2 infection (RR 1.04; 95% CI 0.58-1.88).
CONCLUSIONS
HCQ therapy for COVID-19 is associated with an increase in mortality and other adverse events. The negative effects are more pronounced in hospitalized patients. Therefore, with the available evidence, HCQ should not be used in prophylaxis or treatment of patients with COVID-19.
DOI: 10.1016/j.jiac.2021.02.021
PubMed: 33678548
PubMed Central: PMC7899036
Links to Exploration step
pubmed:33678548Le document en format XML
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<author><name sortKey="Kumar, Jogender" sort="Kumar, Jogender" uniqKey="Kumar J" first="Jogender" last="Kumar">Jogender Kumar</name>
<affiliation><nlm:affiliation>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: jogendrayadv@gmail.com.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Jain, Siddharth" sort="Jain, Siddharth" uniqKey="Jain S" first="Siddharth" last="Jain">Siddharth Jain</name>
<affiliation><nlm:affiliation>Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: aiims.siddharth@gmail.com.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Meena, Jitendra" sort="Meena, Jitendra" uniqKey="Meena J" first="Jitendra" last="Meena">Jitendra Meena</name>
<affiliation><nlm:affiliation>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: jitendra.2544aiims@gmail.com.</nlm:affiliation>
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<author><name sortKey="Yadav, Arushi" sort="Yadav, Arushi" uniqKey="Yadav A" first="Arushi" last="Yadav">Arushi Yadav</name>
<affiliation><nlm:affiliation>Department of Radiodiagnosis, Government Medical College and Hospital -32, Chandigarh, India. Electronic address: arushiy403@gmail.com.</nlm:affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Efficacy and safety of hydroxychloroquine/chloroquine against SARS-CoV-2 infection: A systematic review and meta-analysis.</title>
<author><name sortKey="Kumar, Jogender" sort="Kumar, Jogender" uniqKey="Kumar J" first="Jogender" last="Kumar">Jogender Kumar</name>
<affiliation><nlm:affiliation>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: jogendrayadv@gmail.com.</nlm:affiliation>
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<author><name sortKey="Jain, Siddharth" sort="Jain, Siddharth" uniqKey="Jain S" first="Siddharth" last="Jain">Siddharth Jain</name>
<affiliation><nlm:affiliation>Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: aiims.siddharth@gmail.com.</nlm:affiliation>
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<author><name sortKey="Meena, Jitendra" sort="Meena, Jitendra" uniqKey="Meena J" first="Jitendra" last="Meena">Jitendra Meena</name>
<affiliation><nlm:affiliation>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: jitendra.2544aiims@gmail.com.</nlm:affiliation>
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<author><name sortKey="Yadav, Arushi" sort="Yadav, Arushi" uniqKey="Yadav A" first="Arushi" last="Yadav">Arushi Yadav</name>
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<term>COVID-19 (drug therapy)</term>
<term>COVID-19 (mortality)</term>
<term>Chloroquine (adverse effects)</term>
<term>Chloroquine (therapeutic use)</term>
<term>Humans (MeSH)</term>
<term>Hydroxychloroquine (adverse effects)</term>
<term>Hydroxychloroquine (therapeutic use)</term>
<term>Treatment Outcome (MeSH)</term>
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<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Chloroquine</term>
<term>Hydroxychloroquine</term>
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<term>Chloroquine</term>
<term>Hydroxychloroquine</term>
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<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>COVID-19</term>
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<keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>COVID-19</term>
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<front><div type="abstract" xml:lang="en"><p><b>INTRODUCTION</b>
</p>
<p>Hydroxychloroquine (HCQ)/Chloroquine (CQ) has been evaluated for treatment and prophylaxis against SARS-CoV-2 infection in various studies with conflicting results. We performed a systematic review to synthesize the currently available evidence over the efficacy and safety of HCQ/CQ therapy alone against SARS-CoV-2 infection.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We searched Embase, PubMed, Web of Science, and Cochrane central for randomized controlled trials (RCTs) and prospective cohort studies published until October 15, 2020 and assessing the efficacy of HCQ alone against SARS-CoV-2 infection. We included studies evaluating HCQ/CQ alone as intervention and placebo/standard care as a control group. Retrospective studies and studies using other drugs (namely azithromycin, corticosteroids, immunomodulators, etc.) we excluded. Thirteen RCTs and three prospective cohort studies were included in this review. We pooled data using a random-effect model.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Pooled data from 12 studies (9917 participants) showed that HCQs increase mortality as compared to placebo/standard of care (RR 1.10; 95% CI:1.00-1.20). Hydroxychloroquine did not reduce the need for hospitalization in out-patients (RR 0.57; 95% CI 0.31-1.02). HCQ group has a significantly higher rate of any adverse event (RR 2.68; 95% CI 1.55-4.64), as compared to the control group. Also, using HCQ for prophylaxis against SARS-CoV-2 infection did not reduce the risk of acquiring SARS-CoV-2 infection (RR 1.04; 95% CI 0.58-1.88).</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>HCQ therapy for COVID-19 is associated with an increase in mortality and other adverse events. The negative effects are more pronounced in hospitalized patients. Therefore, with the available evidence, HCQ should not be used in prophylaxis or treatment of patients with COVID-19.</p>
</div>
</front>
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<ArticleTitle>Efficacy and safety of hydroxychloroquine/chloroquine against SARS-CoV-2 infection: A systematic review and meta-analysis.</ArticleTitle>
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<Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">Hydroxychloroquine (HCQ)/Chloroquine (CQ) has been evaluated for treatment and prophylaxis against SARS-CoV-2 infection in various studies with conflicting results. We performed a systematic review to synthesize the currently available evidence over the efficacy and safety of HCQ/CQ therapy alone against SARS-CoV-2 infection.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">We searched Embase, PubMed, Web of Science, and Cochrane central for randomized controlled trials (RCTs) and prospective cohort studies published until October 15, 2020 and assessing the efficacy of HCQ alone against SARS-CoV-2 infection. We included studies evaluating HCQ/CQ alone as intervention and placebo/standard care as a control group. Retrospective studies and studies using other drugs (namely azithromycin, corticosteroids, immunomodulators, etc.) we excluded. Thirteen RCTs and three prospective cohort studies were included in this review. We pooled data using a random-effect model.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Pooled data from 12 studies (9917 participants) showed that HCQs increase mortality as compared to placebo/standard of care (RR 1.10; 95% CI:1.00-1.20). Hydroxychloroquine did not reduce the need for hospitalization in out-patients (RR 0.57; 95% CI 0.31-1.02). HCQ group has a significantly higher rate of any adverse event (RR 2.68; 95% CI 1.55-4.64), as compared to the control group. Also, using HCQ for prophylaxis against SARS-CoV-2 infection did not reduce the risk of acquiring SARS-CoV-2 infection (RR 1.04; 95% CI 0.58-1.88).</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">HCQ therapy for COVID-19 is associated with an increase in mortality and other adverse events. The negative effects are more pronounced in hospitalized patients. Therefore, with the available evidence, HCQ should not be used in prophylaxis or treatment of patients with COVID-19.</AbstractText>
<CopyrightInformation>Copyright © 2021 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation>
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<CoiStatement>Declaration of competing interest None.</CoiStatement>
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