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Review
. 2021 Sep-Oct:43:102135.
doi: 10.1016/j.tmaid.2021.102135. Epub 2021 Jul 12.

Efficacy of chloroquine and hydroxychloroquine in treating COVID-19 infection: A meta-review of systematic reviews and an updated meta-analysis

Tawanda Chivese  1 , Omran A H Musa  2 , George Hindy  2 , Noor Al-Wattary  2 , Saif Badran  3 , Nada Soliman  4 , Ahmed T M Aboughalia  4 , Joshua T Matizanadzo  5 , Mohamed M Emara  6 , Lukman Thalib  7 , Suhail A R Doi  2
Affiliations
Review

Efficacy of chloroquine and hydroxychloroquine in treating COVID-19 infection: A meta-review of systematic reviews and an updated meta-analysis

Tawanda Chivese et al. Travel Med Infect Dis. 2021 Sep-Oct.

Abstract

Objective: To synthesize findings from systematic reviews and meta-analyses on the efficacy and safety of chloroquine (CQ) and hydroxychloroquine (HCQ) with or without Azithromycin for treating COVID-19, and to update the evidence using a meta-analysis.

Methods: A comprehensive search was carried out in electronic databases for systematic reviews, meta-analyses and experimental studies which investigated the efficacy and safety of CQ, HCQ with or without Azithromycin to treat COVID-19. Findings from the reviews were synthesised using tables and forest plots and the quality effect model was used for the updated meta-analysis. The main outcomes were mortality, the need for intensive care services, disease exacerbation, viral clearance and occurrence of adverse events.

Results: Thirteen reviews with 40 primary studies were included. Two meta-analyses reported a high risk of mortality, with ORs of 2.2 and 3.0, and the two others found no association between HCQ and mortality. Findings from two meta-analyses showed that HCQ with Azithromycin increased the risk of mortality, with similar ORs of 2.5. The updated meta-analysis of experimental studies showed that the drugs were not effective in reducing mortality (RR 1.1, 95%CI 1.0-1.3, I2 = 0.0%), need for intensive care services (OR 1.1, 95%CI 0.9-1.4, I2 = 0.0%), virological cure (OR 1.5, 95%CI 0.5-4.4, I2 = 39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3-5.9, I2 = 31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5-59.9, I2 = 76.6%).

Conclusion: There is conclusive evidence that CQ and HCQ, with or without Azithromycin are not effective in treating COVID-19 or its exacerbation.

Registration: PROSPERO: CRD42020191353.

Keywords: Adverse events; COVID-19; Chloroquine; Disease worsening; Efficacy; Hydroxychloroquine; ICU; Mortality; Virological cure.

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Conflict of interest statement

All the authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart for the meta-review.
Fig. 2
Fig. 2
Location of all primary studies in included reviews.
Fig. 3
Fig. 3
Results of meta-analyses - HCQ and all-cause mortality.
Fig. 4
Fig. 4
Updated meta-analysis of experimental studies – all-cause mortality.
Fig. 5
Fig. 5
Updated meta-analysis of experimental studies - secondary outcomes.
Fig. 6
Fig. 6
Results of meta-analyses on HCQ and virological cure and disease exacerbation.
See this image and copyright information in PMC

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