Efficacy and safety of hydroxychloroquine/chloroquine against SARS-CoV-2 infection: A systematic review and meta-analysis.
Identifieur interne : 000522 ( Main/Exploration ); précédent : 000521; suivant : 000523Efficacy and safety of hydroxychloroquine/chloroquine against SARS-CoV-2 infection: A systematic review and meta-analysis.
Auteurs : Jogender Kumar [Inde] ; Siddharth Jain [Inde] ; Jitendra Meena [Inde] ; Arushi Yadav [Inde]Source :
- Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy [ 1437-7780 ] ; 2021.
Descripteurs français
- KwdFr :
- MESH :
- effets indésirables : Chloroquine, Hydroxychloroquine.
- usage thérapeutique : Antiviraux, Chloroquine, Hydroxychloroquine.
- Humains, Résultat thérapeutique.
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
Affiliations:
Links toward previous steps (curation, corpus...)
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Electronic address: jogendrayadv@gmail.com.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author><author><name sortKey="Jain, Siddharth" sort="Jain, Siddharth" uniqKey="Jain S" first="Siddharth" last="Jain">Siddharth Jain</name><affiliation wicri:level="1"><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><country xml:lang="fr">Inde</country><wicri:regionArea>Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author><author><name sortKey="Meena, Jitendra" sort="Meena, Jitendra" uniqKey="Meena J" first="Jitendra" last="Meena">Jitendra Meena</name><affiliation wicri:level="1"><nlm:affiliation>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: jitendra.2544aiims@gmail.com.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author><author><name sortKey="Yadav, Arushi" sort="Yadav, Arushi" uniqKey="Yadav A" first="Arushi" last="Yadav">Arushi Yadav</name><affiliation wicri:level="1"><nlm:affiliation>Department of Radiodiagnosis, Government Medical College and Hospital -32, Chandigarh, India. Electronic address: arushiy403@gmail.com.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Radiodiagnosis, Government Medical College and Hospital -32, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy</title><idno type="eISSN">1437-7780</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>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></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Antiviraux (usage thérapeutique)</term><term>Chloroquine (effets indésirables)</term><term>Chloroquine (usage thérapeutique)</term><term>Humains (MeSH)</term><term>Hydroxychloroquine (effets indésirables)</term><term>Hydroxychloroquine (usage thérapeutique)</term><term>Résultat thérapeutique (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><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>COVID-19</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Chloroquine</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antiviraux</term><term>Chloroquine</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Humains</term><term>Résultat thérapeutique</term></keywords></textClass></profileDesc></teiHeader><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></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">33678548</PMID><DateCompleted><Year>2021</Year><Month>05</Month><Day>13</Day></DateCompleted><DateRevised><Year>2021</Year><Month>05</Month><Day>13</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1437-7780</ISSN><JournalIssue CitedMedium="Internet"><Volume>27</Volume><Issue>6</Issue><PubDate><Year>2021</Year><Month>Jun</Month></PubDate></JournalIssue><Title>Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy</Title><ISOAbbreviation>J Infect Chemother</ISOAbbreviation></Journal><ArticleTitle>Efficacy and safety of hydroxychloroquine/chloroquine against SARS-CoV-2 infection: A systematic review and meta-analysis.</ArticleTitle><Pagination><MedlinePgn>882-889</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S1341-321X(21)00061-1</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jiac.2021.02.021</ELocationID><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></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kumar</LastName><ForeName>Jogender</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: jogendrayadv@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jain</LastName><ForeName>Siddharth</ForeName><Initials>S</Initials><AffiliationInfo><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.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meena</LastName><ForeName>Jitendra</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: jitendra.2544aiims@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yadav</LastName><ForeName>Arushi</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Radiodiagnosis, Government Medical College and Hospital -32, Chandigarh, India. Electronic address: arushiy403@gmail.com.</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>2021</Year><Month>02</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>J Infect Chemother</MedlineTA><NlmUniqueID>9608375</NlmUniqueID><ISSNLinking>1341-321X</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>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002738" MajorTopicYN="N">Chloroquine</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Coronavirus</Keyword><Keyword MajorTopicYN="N">Mortality</Keyword><Keyword MajorTopicYN="N">Prophylaxis</Keyword><Keyword MajorTopicYN="N">Therapy</Keyword></KeywordList><CoiStatement>Declaration of competing interest None.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>11</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2021</Year><Month>01</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>02</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>3</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>5</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>3</Month><Day>8</Day><Hour>5</Hour><Minute>37</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33678548</ArticleId><ArticleId IdType="pii">S1341-321X(21)00061-1</ArticleId><ArticleId IdType="doi">10.1016/j.jiac.2021.02.021</ArticleId><ArticleId IdType="pmc">PMC7899036</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Inde</li></country></list><tree><country name="Inde"><noRegion><name sortKey="Kumar, Jogender" sort="Kumar, Jogender" uniqKey="Kumar J" first="Jogender" last="Kumar">Jogender Kumar</name></noRegion><name sortKey="Jain, Siddharth" sort="Jain, Siddharth" uniqKey="Jain S" first="Siddharth" last="Jain">Siddharth Jain</name><name sortKey="Meena, Jitendra" sort="Meena, Jitendra" uniqKey="Meena J" first="Jitendra" last="Meena">Jitendra Meena</name><name sortKey="Yadav, Arushi" sort="Yadav, Arushi" uniqKey="Yadav A" first="Arushi" last="Yadav">Arushi Yadav</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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