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Meta-Analysis
. 2021 Jan 1;76(1):30-42.
doi: 10.1093/jac/dkaa403.

Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis

Zakariya Kashour  1 , Muhammad Riaz  2 , Musa A Garbati  3 , Oweida AlDosary  4 , Haytham Tlayjeh  5 , Dana Gerberi  6 , M Hassan Murad  7   8 , M Rizwan Sohail  9   10 , Tarek Kashour  11 , Imad M Tleyjeh  4   9   12   13
Affiliations
Meta-Analysis

Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis

Zakariya Kashour et al. J Antimicrob Chemother. .

Abstract

Objectives: Clinical studies of chloroquine (CQ) and hydroxychloroquine (HCQ) in COVID-19 disease reported conflicting results. We sought to systematically evaluate the effect of CQ and HCQ with or without azithromycin on outcomes of COVID-19 patients.

Methods: We searched multiple databases, preprints and grey literature up to 17 July 2020. We pooled only adjusted-effect estimates of mortality using a random-effect model. We summarized the effect of CQ or HCQ on viral clearance, ICU admission/mechanical ventilation and hospitalization.

Results: Seven randomized clinical trials (RCTs) and 14 cohort studies were included (20 979 patients). Thirteen studies (1 RCT and 12 cohort studies) with 15 938 hospitalized patients examined the effect of HCQ on short-term mortality. The pooled adjusted OR was 1.05 (95% CI 0.96-1.15, I2 = 0%). Six cohort studies examined the effect of the HCQ+azithromycin combination with a pooled adjusted OR of 1.32 (95% CI 1.00-1.75, I2 = 68.1%). Two cohort studies and four RCTs found no effect of HCQ on viral clearance. One small RCT demonstrated improved viral clearance with CQ and HCQ. Three cohort studies found that HCQ had no significant effect on mechanical ventilation/ICU admission. Two RCTs found no effect for HCQ on hospitalization risk in outpatients with COVID-19.

Conclusions: Moderate certainty evidence suggests that HCQ, with or without azithromycin, lacks efficacy in reducing short-term mortality in patients hospitalized with COVID-19 or risk of hospitalization in outpatients with COVID-19.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram of eligible studies. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
Figure 2.
Figure 2.
Association between HCQ and short-term mortality in COVID-19 patients (all cohort studies and one RCT). This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
Figure 3.
Figure 3.
Association between HCQ and short-term mortality in COVID-19 patients (excluding studies at high risk of bias). This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
Figure 4.
Figure 4.
Association between HCQ+azithromycin combination and short-term mortality in COVID-19 patients. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
See this image and copyright information in PMC

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