Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review.
Identifieur interne : 001575 ( Main/Corpus ); précédent : 001574; suivant : 001576Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review.
Auteurs : Adrian V. Hernandez ; Yuani M. Roman ; Vinay Pasupuleti ; Joshuan J. Barboza ; C Michael WhiteSource :
- Annals of internal medicine [ 1539-3704 ] ; 2020.
English descriptors
- KwdEn :
- Antiviral Agents (administration & dosage), Antiviral Agents (therapeutic use), Betacoronavirus (MeSH), COVID-19 (MeSH), Chloroquine (administration & dosage), Chloroquine (therapeutic use), Coronavirus Infections (drug therapy), Humans (MeSH), Hydroxychloroquine (administration & dosage), Hydroxychloroquine (therapeutic use), Pandemics (MeSH), Pneumonia, Viral (drug therapy), SARS-CoV-2 (MeSH).
- MESH :
- chemical , administration & dosage : Antiviral Agents, Chloroquine, Hydroxychloroquine.
- chemical , therapeutic use : Antiviral Agents, Chloroquine, Hydroxychloroquine.
- drug therapy : Coronavirus Infections, Pneumonia, Viral.
- Betacoronavirus, COVID-19, Humans, Pandemics, SARS-CoV-2.
Abstract
BACKGROUND
Hydroxychloroquine and chloroquine have antiviral effects in vitro against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
PURPOSE
To summarize evidence about the benefits and harms of hydroxychloroquine or chloroquine for the treatment or prophylaxis of coronavirus disease 2019 (COVID-19).
DATA SOURCES
PubMed (via MEDLINE), EMBASE (via Ovid), Scopus, Web of Science, Cochrane Library, bioRxiv, Preprints, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and the Chinese Clinical Trials Registry from 1 December 2019 until 8 May 2020.
STUDY SELECTION
Studies in any language reporting efficacy or safety outcomes from hydroxychloroquine or chloroquine use in any setting in adults or children with suspected COVID-19 or at risk for SARS-CoV-2 infection.
DATA EXTRACTION
Independent, dually performed data extraction and quality assessments.
DATA SYNTHESIS
Four randomized controlled trials, 10 cohort studies, and 9 case series assessed treatment effects of the medications, but no studies evaluated prophylaxis. Evidence was conflicting and insufficient regarding the effect of hydroxychloroquine on such outcomes as all-cause mortality, progression to severe disease, clinical symptoms, and upper respiratory virologic clearance with antigen testing. Several studies found that patients receiving hydroxychloroquine developed a QTc interval of 500 ms or greater, but the proportion of patients with this finding varied among the studies. Two studies assessed the efficacy of chloroquine; 1 trial, which compared higher-dose (600 mg twice daily for 10 days) with lower-dose (450 mg twice daily on day 1 and once daily for 4 days) therapy, was stopped owing to concern that the higher dose therapy increased lethality and QTc interval prolongation. An observational study that compared adults with COVID-19 receiving chloroquine phosphate, 500 mg once or twice daily, with patients not receiving chloroquine found minor fever resolution and virologic clearance benefits with chloroquine.
LIMITATION
There were few controlled studies, and control for confounding was inadequate in observational studies.
CONCLUSION
Evidence on the benefits and harms of using hydroxychloroquine or chloroquine to treat COVID-19 is very weak and conflicting.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
DOI: 10.7326/M20-2496
PubMed: 32459529
Links to Exploration step
pubmed:32459529Le document en format XML
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Roman</name><affiliation><nlm:affiliation>University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and Hartford Hospital Department of Research Administration, Hartford, Connecticut (Y.M.R.).</nlm:affiliation></affiliation></author><author><name sortKey="Pasupuleti, Vinay" sort="Pasupuleti, Vinay" uniqKey="Pasupuleti V" first="Vinay" last="Pasupuleti">Vinay Pasupuleti</name><affiliation><nlm:affiliation>MedErgy HealthGroup Inc., Yardley, Pennsylvania (V.P.).</nlm:affiliation></affiliation></author><author><name sortKey="Barboza, Joshuan J" sort="Barboza, Joshuan J" uniqKey="Barboza J" first="Joshuan J" last="Barboza">Joshuan J. Barboza</name><affiliation><nlm:affiliation>Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru (J.J.B.).</nlm:affiliation></affiliation></author><author><name sortKey="White, C Michael" sort="White, C Michael" uniqKey="White C" first="C Michael" last="White">C Michael White</name><affiliation><nlm:affiliation>University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and Hartford Hospital Department of Research Administration, Hartford, and School of Pharmacy, Storrs, Connecticut (C.M.W.).</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32459529</idno><idno type="pmid">32459529</idno><idno type="doi">10.7326/M20-2496</idno><idno type="wicri:Area/Main/Corpus">001575</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001575</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review.</title><author><name sortKey="Hernandez, Adrian V" sort="Hernandez, Adrian V" uniqKey="Hernandez A" first="Adrian V" last="Hernandez">Adrian V. Hernandez</name><affiliation><nlm:affiliation>University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and Hartford Hospital Department of Research Administration, Hartford, and School of Pharmacy, Storrs, Connecticut, and Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru (A.V.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Roman, Yuani M" sort="Roman, Yuani M" uniqKey="Roman Y" first="Yuani M" last="Roman">Yuani M. Roman</name><affiliation><nlm:affiliation>University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and Hartford Hospital Department of Research Administration, Hartford, Connecticut (Y.M.R.).</nlm:affiliation></affiliation></author><author><name sortKey="Pasupuleti, Vinay" sort="Pasupuleti, Vinay" uniqKey="Pasupuleti V" first="Vinay" last="Pasupuleti">Vinay Pasupuleti</name><affiliation><nlm:affiliation>MedErgy HealthGroup Inc., Yardley, Pennsylvania (V.P.).</nlm:affiliation></affiliation></author><author><name sortKey="Barboza, Joshuan J" sort="Barboza, Joshuan J" uniqKey="Barboza J" first="Joshuan J" last="Barboza">Joshuan J. Barboza</name><affiliation><nlm:affiliation>Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru (J.J.B.).</nlm:affiliation></affiliation></author><author><name sortKey="White, C Michael" sort="White, C Michael" uniqKey="White C" first="C Michael" last="White">C Michael White</name><affiliation><nlm:affiliation>University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and Hartford Hospital Department of Research Administration, Hartford, and School of Pharmacy, Storrs, Connecticut (C.M.W.).</nlm:affiliation></affiliation></author></analytic><series><title level="j">Annals of internal medicine</title><idno type="eISSN">1539-3704</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antiviral Agents (administration & dosage)</term><term>Antiviral Agents (therapeutic use)</term><term>Betacoronavirus (MeSH)</term><term>COVID-19 (MeSH)</term><term>Chloroquine (administration & dosage)</term><term>Chloroquine (therapeutic use)</term><term>Coronavirus Infections (drug therapy)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (administration & dosage)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (drug therapy)</term><term>SARS-CoV-2 (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Antiviral Agents</term><term>Chloroquine</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiviral Agents</term><term>Chloroquine</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Betacoronavirus</term><term>COVID-19</term><term>Humans</term><term>Pandemics</term><term>SARS-CoV-2</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Hydroxychloroquine and chloroquine have antiviral effects in vitro against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).</p></div><div type="abstract" xml:lang="en"><p><b>PURPOSE</b></p><p>To summarize evidence about the benefits and harms of hydroxychloroquine or chloroquine for the treatment or prophylaxis of coronavirus disease 2019 (COVID-19).</p></div><div type="abstract" xml:lang="en"><p><b>DATA SOURCES</b></p><p>PubMed (via MEDLINE), EMBASE (via Ovid), Scopus, Web of Science, Cochrane Library, bioRxiv, Preprints, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and the Chinese Clinical Trials Registry from 1 December 2019 until 8 May 2020.</p></div><div type="abstract" xml:lang="en"><p><b>STUDY SELECTION</b></p><p>Studies in any language reporting efficacy or safety outcomes from hydroxychloroquine or chloroquine use in any setting in adults or children with suspected COVID-19 or at risk for SARS-CoV-2 infection.</p></div><div type="abstract" xml:lang="en"><p><b>DATA EXTRACTION</b></p><p>Independent, dually performed data extraction and quality assessments.</p></div><div type="abstract" xml:lang="en"><p><b>DATA SYNTHESIS</b></p><p>Four randomized controlled trials, 10 cohort studies, and 9 case series assessed treatment effects of the medications, but no studies evaluated prophylaxis. Evidence was conflicting and insufficient regarding the effect of hydroxychloroquine on such outcomes as all-cause mortality, progression to severe disease, clinical symptoms, and upper respiratory virologic clearance with antigen testing. Several studies found that patients receiving hydroxychloroquine developed a QTc interval of 500 ms or greater, but the proportion of patients with this finding varied among the studies. Two studies assessed the efficacy of chloroquine; 1 trial, which compared higher-dose (600 mg twice daily for 10 days) with lower-dose (450 mg twice daily on day 1 and once daily for 4 days) therapy, was stopped owing to concern that the higher dose therapy increased lethality and QTc interval prolongation. An observational study that compared adults with COVID-19 receiving chloroquine phosphate, 500 mg once or twice daily, with patients not receiving chloroquine found minor fever resolution and virologic clearance benefits with chloroquine.</p></div><div type="abstract" xml:lang="en"><p><b>LIMITATION</b></p><p>There were few controlled studies, and control for confounding was inadequate in observational studies.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Evidence on the benefits and harms of using hydroxychloroquine or chloroquine to treat COVID-19 is very weak and conflicting.</p></div><div type="abstract" xml:lang="en"><p><b>PRIMARY FUNDING SOURCE</b></p><p>Agency for Healthcare Research and Quality.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32459529</PMID><DateCompleted><Year>2020</Year><Month>08</Month><Day>27</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>10</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1539-3704</ISSN><JournalIssue CitedMedium="Internet"><Volume>173</Volume><Issue>4</Issue><PubDate><Year>2020</Year><Month>08</Month><Day>18</Day></PubDate></JournalIssue><Title>Annals of internal medicine</Title><ISOAbbreviation>Ann Intern Med</ISOAbbreviation></Journal><ArticleTitle>Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review.</ArticleTitle><Pagination><MedlinePgn>287-296</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.7326/M20-2496</ELocationID><Abstract><AbstractText Label="BACKGROUND">Hydroxychloroquine and chloroquine have antiviral effects in vitro against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).</AbstractText><AbstractText Label="PURPOSE">To summarize evidence about the benefits and harms of hydroxychloroquine or chloroquine for the treatment or prophylaxis of coronavirus disease 2019 (COVID-19).</AbstractText><AbstractText Label="DATA SOURCES">PubMed (via MEDLINE), EMBASE (via Ovid), Scopus, Web of Science, Cochrane Library, bioRxiv, Preprints, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and the Chinese Clinical Trials Registry from 1 December 2019 until 8 May 2020.</AbstractText><AbstractText Label="STUDY SELECTION">Studies in any language reporting efficacy or safety outcomes from hydroxychloroquine or chloroquine use in any setting in adults or children with suspected COVID-19 or at risk for SARS-CoV-2 infection.</AbstractText><AbstractText Label="DATA EXTRACTION">Independent, dually performed data extraction and quality assessments.</AbstractText><AbstractText Label="DATA SYNTHESIS">Four randomized controlled trials, 10 cohort studies, and 9 case series assessed treatment effects of the medications, but no studies evaluated prophylaxis. Evidence was conflicting and insufficient regarding the effect of hydroxychloroquine on such outcomes as all-cause mortality, progression to severe disease, clinical symptoms, and upper respiratory virologic clearance with antigen testing. Several studies found that patients receiving hydroxychloroquine developed a QTc interval of 500 ms or greater, but the proportion of patients with this finding varied among the studies. Two studies assessed the efficacy of chloroquine; 1 trial, which compared higher-dose (600 mg twice daily for 10 days) with lower-dose (450 mg twice daily on day 1 and once daily for 4 days) therapy, was stopped owing to concern that the higher dose therapy increased lethality and QTc interval prolongation. An observational study that compared adults with COVID-19 receiving chloroquine phosphate, 500 mg once or twice daily, with patients not receiving chloroquine found minor fever resolution and virologic clearance benefits with chloroquine.</AbstractText><AbstractText Label="LIMITATION">There were few controlled studies, and control for confounding was inadequate in observational studies.</AbstractText><AbstractText Label="CONCLUSION">Evidence on the benefits and harms of using hydroxychloroquine or chloroquine to treat COVID-19 is very weak and conflicting.</AbstractText><AbstractText Label="PRIMARY FUNDING SOURCE">Agency for Healthcare Research and Quality.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Hernandez</LastName><ForeName>Adrian V</ForeName><Initials>AV</Initials><Identifier Source="ORCID">0000-0002-9999-4003</Identifier><AffiliationInfo><Affiliation>University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and Hartford Hospital Department of Research Administration, Hartford, and School of Pharmacy, Storrs, Connecticut, and Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru (A.V.H.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Roman</LastName><ForeName>Yuani M</ForeName><Initials>YM</Initials><AffiliationInfo><Affiliation>University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and Hartford Hospital Department of Research Administration, Hartford, Connecticut (Y.M.R.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pasupuleti</LastName><ForeName>Vinay</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>MedErgy HealthGroup Inc., Yardley, Pennsylvania (V.P.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Barboza</LastName><ForeName>Joshuan J</ForeName><Initials>JJ</Initials><Identifier Source="ORCID">0000-0002-2896-1407</Identifier><AffiliationInfo><Affiliation>Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru (J.J.B.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>White</LastName><ForeName>C Michael</ForeName><Initials>CM</Initials><AffiliationInfo><Affiliation>University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and Hartford Hospital Department of Research Administration, Hartford, and School of Pharmacy, Storrs, Connecticut (C.M.W.).</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType><PublicationType UI="D000078182">Systematic Review</PublicationType><PublicationType UI="D059040">Video-Audio Media</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>05</Month><Day>27</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Ann Intern Med</MedlineTA><NlmUniqueID>0372351</NlmUniqueID><ISSNLinking>0003-4819</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>886U3H6UFF</RegistryNumber><NameOfSubstance UI="D002738">Chloroquine</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName></SupplMeshList><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Ann Intern Med. 2020 Aug 18;173(4):78-79</RefSource><PMID Version="1">32667853</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Ann Intern Med. 2020 Oct 6;173(7):W128-W129</RefSource><PMID Version="1">32853033</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Ann Intern Med. 2020 Dec 1;173(11):W156-W157</RefSource><PMID Version="1">33085507</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002738" MajorTopicYN="N">Chloroquine</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>5</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>8</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>5</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32459529</ArticleId><ArticleId IdType="doi">10.7326/M20-2496</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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