Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis.
Identifieur interne : 000D53 ( Main/Corpus ); précédent : 000D52; suivant : 000D54Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis.
Auteurs : Thibault Fiolet ; Anthony Guihur ; Mathieu Edouard Rebeaud ; Matthieu Mulot ; Nathan Peiffer-Smadja ; Yahya Mahamat-SalehSource :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [ 1469-0691 ] ; 2021.
English descriptors
- KwdEn :
- Antiviral Agents (therapeutic use), Azithromycin (therapeutic use), Bayes Theorem (MeSH), Bias (MeSH), COVID-19 (drug therapy), COVID-19 (mortality), COVID-19 (virology), Chloroquine (therapeutic use), Drug Repositioning (MeSH), Humans (MeSH), Hydroxychloroquine (therapeutic use), Risk (MeSH), SARS-CoV-2 (drug effects), SARS-CoV-2 (pathogenicity), Standard of Care (MeSH), Survival Analysis (MeSH).
- MESH :
- chemical , therapeutic use : Antiviral Agents, Azithromycin, Chloroquine, Hydroxychloroquine.
- drug effects : SARS-CoV-2.
- drug therapy : COVID-19.
- mortality : COVID-19.
- pathogenicity : SARS-CoV-2.
- virology : COVID-19.
- Bayes Theorem, Bias, Drug Repositioning, Humans, Risk, Standard of Care, Survival Analysis.
Abstract
BACKGROUND
Hydroxychloroquine or chloroquine with or without azithromycin have been widely promoted to treat coronavirus disease 2019 (COVID-19) following early in vitro antiviral effects against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
OBJECTIVE
The aim of this systematic review and meta-analysis was to assess whether chloroquine or hydroxychloroquine with or without azithromycin decreased COVID-19 mortality compared with the standard of care.
DATA SOURCES
PubMed, Web of Science, Embase Cochrane Library, Google Scholar and MedRxiv were searched up to 25 July 2020.
STUDY ELIGIBILITY CRITERIA
We included published and unpublished studies comparing the mortality rate between patients treated with chloroquine or hydroxychloroquine with or without azithromycin and patients managed with standard of care.
PARTICIPANTS
Patients ≥18 years old with confirmed COVID-19.
INTERVENTIONS
Chloroquine or hydroxychloroquine with or without azithromycin.
METHODS
Effect sizes were pooled using a random-effects model. Multiple subgroup analyses were conducted to assess drug safety.
RESULTS
The initial search yielded 839 articles, of which 29 met our inclusion criteria. All studies except one were conducted on hospitalized patients and evaluated the effects of hydroxychloroquine with or without azithromycin. Among the 29 articles, three were randomized controlled trials, one was a non-randomized trial and 25 were observational studies, including 11 with a critical risk of bias and 14 with a serious or moderate risk of bias. After excluding studies with critical risk of bias, the meta-analysis included 11 932 participants for the hydroxychloroquine group, 8081 for the hydroxychloroquine with azithromycin group and 12 930 for the control group. Hydroxychloroquine was not significantly associated with mortality: pooled relative risk (RR) 0.83 (95% CI 0.65-1.06, n = 17 studies) for all studies and RR = 1.09 (95% CI 0.97-1.24, n = 3 studies) for randomized controlled trials. Hydroxychloroquine with azithromycin was associated with an increased mortality (RR = 1.27; 95% CI 1.04-1.54, n = 7 studies). We found similar results with a Bayesian meta-analysis.
CONCLUSION
Hydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients but the combination of hydroxychloroquine and azithromycin significantly increased mortality.
DOI: 10.1016/j.cmi.2020.08.022
PubMed: 32860962
PubMed Central: PMC7449662
Links to Exploration step
pubmed:32860962Le document en format XML
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Electronic address: Thibault.fiolet@gustaveroussy.fr.</nlm:affiliation></affiliation></author><author><name sortKey="Guihur, Anthony" sort="Guihur, Anthony" uniqKey="Guihur A" first="Anthony" last="Guihur">Anthony Guihur</name><affiliation><nlm:affiliation>Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Rebeaud, Mathieu Edouard" sort="Rebeaud, Mathieu Edouard" uniqKey="Rebeaud M" first="Mathieu Edouard" last="Rebeaud">Mathieu Edouard Rebeaud</name><affiliation><nlm:affiliation>Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Mulot, Matthieu" sort="Mulot, Matthieu" uniqKey="Mulot M" first="Matthieu" last="Mulot">Matthieu Mulot</name><affiliation><nlm:affiliation>Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchâtel, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Peiffer Smadja, Nathan" sort="Peiffer Smadja, Nathan" uniqKey="Peiffer Smadja N" first="Nathan" last="Peiffer-Smadja">Nathan Peiffer-Smadja</name><affiliation><nlm:affiliation>Université de Paris, IAME, INSERM, Paris, France; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Mahamat Saleh, Yahya" sort="Mahamat Saleh, Yahya" uniqKey="Mahamat Saleh Y" first="Yahya" last="Mahamat-Saleh">Yahya Mahamat-Saleh</name><affiliation><nlm:affiliation>CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021</date><idno type="RBID">pubmed:32860962</idno><idno type="pmid">32860962</idno><idno type="doi">10.1016/j.cmi.2020.08.022</idno><idno type="pmc">PMC7449662</idno><idno type="wicri:Area/Main/Corpus">000D53</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000D53</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis.</title><author><name sortKey="Fiolet, Thibault" sort="Fiolet, Thibault" uniqKey="Fiolet T" first="Thibault" last="Fiolet">Thibault Fiolet</name><affiliation><nlm:affiliation>CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France. Electronic address: Thibault.fiolet@gustaveroussy.fr.</nlm:affiliation></affiliation></author><author><name sortKey="Guihur, Anthony" sort="Guihur, Anthony" uniqKey="Guihur A" first="Anthony" last="Guihur">Anthony Guihur</name><affiliation><nlm:affiliation>Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Rebeaud, Mathieu Edouard" sort="Rebeaud, Mathieu Edouard" uniqKey="Rebeaud M" first="Mathieu Edouard" last="Rebeaud">Mathieu Edouard Rebeaud</name><affiliation><nlm:affiliation>Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Mulot, Matthieu" sort="Mulot, Matthieu" uniqKey="Mulot M" first="Matthieu" last="Mulot">Matthieu Mulot</name><affiliation><nlm:affiliation>Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchâtel, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Peiffer Smadja, Nathan" sort="Peiffer Smadja, Nathan" uniqKey="Peiffer Smadja N" first="Nathan" last="Peiffer-Smadja">Nathan Peiffer-Smadja</name><affiliation><nlm:affiliation>Université de Paris, IAME, INSERM, Paris, France; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Mahamat Saleh, Yahya" sort="Mahamat Saleh, Yahya" uniqKey="Mahamat Saleh Y" first="Yahya" last="Mahamat-Saleh">Yahya Mahamat-Saleh</name><affiliation><nlm:affiliation>CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases</title><idno type="eISSN">1469-0691</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antiviral Agents (therapeutic use)</term><term>Azithromycin (therapeutic use)</term><term>Bayes Theorem (MeSH)</term><term>Bias (MeSH)</term><term>COVID-19 (drug therapy)</term><term>COVID-19 (mortality)</term><term>COVID-19 (virology)</term><term>Chloroquine (therapeutic use)</term><term>Drug Repositioning (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Risk (MeSH)</term><term>SARS-CoV-2 (drug effects)</term><term>SARS-CoV-2 (pathogenicity)</term><term>Standard of Care (MeSH)</term><term>Survival Analysis (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiviral Agents</term><term>Azithromycin</term><term>Chloroquine</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="pathogenicity" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Bayes Theorem</term><term>Bias</term><term>Drug Repositioning</term><term>Humans</term><term>Risk</term><term>Standard of Care</term><term>Survival Analysis</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Hydroxychloroquine or chloroquine with or without azithromycin have been widely promoted to treat coronavirus disease 2019 (COVID-19) following early in vitro antiviral effects against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>The aim of this systematic review and meta-analysis was to assess whether chloroquine or hydroxychloroquine with or without azithromycin decreased COVID-19 mortality compared with the standard of care.</p></div><div type="abstract" xml:lang="en"><p><b>DATA SOURCES</b></p><p>PubMed, Web of Science, Embase Cochrane Library, Google Scholar and MedRxiv were searched up to 25 July 2020.</p></div><div type="abstract" xml:lang="en"><p><b>STUDY ELIGIBILITY CRITERIA</b></p><p>We included published and unpublished studies comparing the mortality rate between patients treated with chloroquine or hydroxychloroquine with or without azithromycin and patients managed with standard of care.</p></div><div type="abstract" xml:lang="en"><p><b>PARTICIPANTS</b></p><p>Patients ≥18 years old with confirmed COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>INTERVENTIONS</b></p><p>Chloroquine or hydroxychloroquine with or without azithromycin.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Effect sizes were pooled using a random-effects model. Multiple subgroup analyses were conducted to assess drug safety.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>The initial search yielded 839 articles, of which 29 met our inclusion criteria. All studies except one were conducted on hospitalized patients and evaluated the effects of hydroxychloroquine with or without azithromycin. Among the 29 articles, three were randomized controlled trials, one was a non-randomized trial and 25 were observational studies, including 11 with a critical risk of bias and 14 with a serious or moderate risk of bias. After excluding studies with critical risk of bias, the meta-analysis included 11 932 participants for the hydroxychloroquine group, 8081 for the hydroxychloroquine with azithromycin group and 12 930 for the control group. Hydroxychloroquine was not significantly associated with mortality: pooled relative risk (RR) 0.83 (95% CI 0.65-1.06, n = 17 studies) for all studies and RR = 1.09 (95% CI 0.97-1.24, n = 3 studies) for randomized controlled trials. Hydroxychloroquine with azithromycin was associated with an increased mortality (RR = 1.27; 95% CI 1.04-1.54, n = 7 studies). We found similar results with a Bayesian meta-analysis.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Hydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients but the combination of hydroxychloroquine and azithromycin significantly increased mortality.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32860962</PMID><DateCompleted><Year>2020</Year><Month>12</Month><Day>31</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>31</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1469-0691</ISSN><JournalIssue CitedMedium="Internet"><Volume>27</Volume><Issue>1</Issue><PubDate><Year>2021</Year><Month>Jan</Month></PubDate></JournalIssue><Title>Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases</Title><ISOAbbreviation>Clin Microbiol Infect</ISOAbbreviation></Journal><ArticleTitle>Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis.</ArticleTitle><Pagination><MedlinePgn>19-27</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S1198-743X(20)30505-X</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.cmi.2020.08.022</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Hydroxychloroquine or chloroquine with or without azithromycin have been widely promoted to treat coronavirus disease 2019 (COVID-19) following early in vitro antiviral effects against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).</AbstractText><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">The aim of this systematic review and meta-analysis was to assess whether chloroquine or hydroxychloroquine with or without azithromycin decreased COVID-19 mortality compared with the standard of care.</AbstractText><AbstractText Label="DATA SOURCES" NlmCategory="METHODS">PubMed, Web of Science, Embase Cochrane Library, Google Scholar and MedRxiv were searched up to 25 July 2020.</AbstractText><AbstractText Label="STUDY ELIGIBILITY CRITERIA" NlmCategory="METHODS">We included published and unpublished studies comparing the mortality rate between patients treated with chloroquine or hydroxychloroquine with or without azithromycin and patients managed with standard of care.</AbstractText><AbstractText Label="PARTICIPANTS" NlmCategory="METHODS">Patients ≥18 years old with confirmed COVID-19.</AbstractText><AbstractText Label="INTERVENTIONS" NlmCategory="METHODS">Chloroquine or hydroxychloroquine with or without azithromycin.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Effect sizes were pooled using a random-effects model. Multiple subgroup analyses were conducted to assess drug safety.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">The initial search yielded 839 articles, of which 29 met our inclusion criteria. All studies except one were conducted on hospitalized patients and evaluated the effects of hydroxychloroquine with or without azithromycin. Among the 29 articles, three were randomized controlled trials, one was a non-randomized trial and 25 were observational studies, including 11 with a critical risk of bias and 14 with a serious or moderate risk of bias. After excluding studies with critical risk of bias, the meta-analysis included 11 932 participants for the hydroxychloroquine group, 8081 for the hydroxychloroquine with azithromycin group and 12 930 for the control group. Hydroxychloroquine was not significantly associated with mortality: pooled relative risk (RR) 0.83 (95% CI 0.65-1.06, n = 17 studies) for all studies and RR = 1.09 (95% CI 0.97-1.24, n = 3 studies) for randomized controlled trials. Hydroxychloroquine with azithromycin was associated with an increased mortality (RR = 1.27; 95% CI 1.04-1.54, n = 7 studies). We found similar results with a Bayesian meta-analysis.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Hydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients but the combination of hydroxychloroquine and azithromycin significantly increased mortality.</AbstractText><CopyrightInformation>Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Fiolet</LastName><ForeName>Thibault</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France. Electronic address: Thibault.fiolet@gustaveroussy.fr.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Guihur</LastName><ForeName>Anthony</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rebeaud</LastName><ForeName>Mathieu Edouard</ForeName><Initials>ME</Initials><AffiliationInfo><Affiliation>Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mulot</LastName><ForeName>Matthieu</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchâtel, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Peiffer-Smadja</LastName><ForeName>Nathan</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Université de Paris, IAME, INSERM, Paris, France; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mahamat-Saleh</LastName><ForeName>Yahya</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D017418">Meta-Analysis</PublicationType><PublicationType UI="D000078182">Systematic Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>08</Month><Day>26</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Clin Microbiol Infect</MedlineTA><NlmUniqueID>9516420</NlmUniqueID><ISSNLinking>1198-743X</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>83905-01-5</RegistryNumber><NameOfSubstance UI="D017963">Azithromycin</NameOfSubstance></Chemical><Chemical><RegistryNumber>886U3H6UFF</RegistryNumber><NameOfSubstance UI="D002738">Chloroquine</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Clin Microbiol Infect. 2021 Jan;27(1):132-133</RefSource><PMID Version="1">32980527</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Clin Microbiol Infect. 2021 Jan;27(1):134-135</RefSource><PMID Version="1">32987193</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Clin Microbiol Infect. 2021 Jan;27(1):136-137</RefSource><PMID Version="1">33007473</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017963" MajorTopicYN="N">Azithromycin</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001499" MajorTopicYN="N">Bayes Theorem</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015982" MajorTopicYN="N">Bias</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000401" MajorTopicYN="Y">mortality</QualifierName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002738" MajorTopicYN="N">Chloroquine</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058492" MajorTopicYN="N">Drug Repositioning</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012306" MajorTopicYN="N">Risk</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="N">drug effects</QualifierName><QualifierName UI="Q000472" MajorTopicYN="N">pathogenicity</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D059039" MajorTopicYN="N">Standard of Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016019" MajorTopicYN="N">Survival Analysis</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Azithromycin</Keyword><Keyword MajorTopicYN="N">Chloroquine</Keyword><Keyword MajorTopicYN="N">Coronavirus</Keyword><Keyword MajorTopicYN="N">Coronavirus disease 2019</Keyword><Keyword 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