tetano
Editor, Senior Moderator
J Clin Med Res
. 2020 Aug;12(8):483-491.
doi: 10.14740/jocmr4233. Epub 2020 Jul 4.
Safety and Efficacy of Hydroxychloroquine in COVID-19: A Systematic Review and Meta-Analysis
Waqas Ullah[SUP] 1 [/SUP], Hafez M Abdullah[SUP] 2 [/SUP], Sohaib Roomi[SUP] 1 [/SUP], Yasar Sattar[SUP] 3 [/SUP], Talal Almas[SUP] 4 [/SUP], Smitha Narayana Gowda[SUP] 2 [/SUP], Rehan Saeed[SUP] 1 [/SUP], Maryam Mukhtar[SUP] 5 [/SUP], Ammar Ahmad[SUP] 6 [/SUP], Tony Oliver[SUP] 2 [/SUP], M Chadi Alraies[SUP] 7 [/SUP], Donald C Haas[SUP] 1 [/SUP], David L Fischman[SUP] 8 [/SUP]
Affiliations
Abstract
Background: During the initial phases of the coronavirus disease 2019 (COVID-19) epidemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ); however, recently, the Centers for Disease Control and Prevention (CDC) has recommended against routine use of HCQ outside of study protocols citing possible adverse outcomes.
Methods: Multiple databases were searched to identify articles on COVID-19. An unadjusted odds ratio (OR) was used to calculate the safety and efficacy of HCQ on a random effect model.
Results: Twelve studies comprising 3,912 patients (HCQ 2,512 and control 1400) were included. The odds of all-cause mortality (OR: 2.23, 95% confidence interval (CI): 1.58 - 3.13, P value < 0.00001) were significantly higher in patients on HCQ compared to patients on control agent. The response to therapy assessed by negative repeat polymerase chain reaction (PCR) (OR: 1.83, 95% CI: 0.50 - 6.75, P = 0.36), radiological resolution (OR: 1.98, 95% CI: 0.47 - 8.36, P value = 0.36) and the need for invasive mechanical ventilation (IMV) (OR: 1.21, 95% CI: 0.34 - 4.33, P value = 0.76) were identical between the two groups. Overall, four times higher odds of net adverse events (NAEs) were observed in the HCQ group (OR: 4.59, 95% CI 1.73 - 12.20, P value = 0.02). The measures for individual safety endpoints were also numerically lower in the control arm; however, none of these values reached the level of statistical significance.
Conclusions: HCQ might offer no benefits in terms of decreasing the viral load and radiological improvement in patients with COVID-19. HCQ appears to be associated with higher odds of all-cause mortality and NAEs.
Keywords: COVID-19; CQ; HCQ; SARS-CoV-2.
. 2020 Aug;12(8):483-491.
doi: 10.14740/jocmr4233. Epub 2020 Jul 4.
Safety and Efficacy of Hydroxychloroquine in COVID-19: A Systematic Review and Meta-Analysis
Waqas Ullah[SUP] 1 [/SUP], Hafez M Abdullah[SUP] 2 [/SUP], Sohaib Roomi[SUP] 1 [/SUP], Yasar Sattar[SUP] 3 [/SUP], Talal Almas[SUP] 4 [/SUP], Smitha Narayana Gowda[SUP] 2 [/SUP], Rehan Saeed[SUP] 1 [/SUP], Maryam Mukhtar[SUP] 5 [/SUP], Ammar Ahmad[SUP] 6 [/SUP], Tony Oliver[SUP] 2 [/SUP], M Chadi Alraies[SUP] 7 [/SUP], Donald C Haas[SUP] 1 [/SUP], David L Fischman[SUP] 8 [/SUP]
Affiliations
- PMID: 32849936
- PMCID: PMC7430873
- DOI: 10.14740/jocmr4233
Abstract
Background: During the initial phases of the coronavirus disease 2019 (COVID-19) epidemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ); however, recently, the Centers for Disease Control and Prevention (CDC) has recommended against routine use of HCQ outside of study protocols citing possible adverse outcomes.
Methods: Multiple databases were searched to identify articles on COVID-19. An unadjusted odds ratio (OR) was used to calculate the safety and efficacy of HCQ on a random effect model.
Results: Twelve studies comprising 3,912 patients (HCQ 2,512 and control 1400) were included. The odds of all-cause mortality (OR: 2.23, 95% confidence interval (CI): 1.58 - 3.13, P value < 0.00001) were significantly higher in patients on HCQ compared to patients on control agent. The response to therapy assessed by negative repeat polymerase chain reaction (PCR) (OR: 1.83, 95% CI: 0.50 - 6.75, P = 0.36), radiological resolution (OR: 1.98, 95% CI: 0.47 - 8.36, P value = 0.36) and the need for invasive mechanical ventilation (IMV) (OR: 1.21, 95% CI: 0.34 - 4.33, P value = 0.76) were identical between the two groups. Overall, four times higher odds of net adverse events (NAEs) were observed in the HCQ group (OR: 4.59, 95% CI 1.73 - 12.20, P value = 0.02). The measures for individual safety endpoints were also numerically lower in the control arm; however, none of these values reached the level of statistical significance.
Conclusions: HCQ might offer no benefits in terms of decreasing the viral load and radiological improvement in patients with COVID-19. HCQ appears to be associated with higher odds of all-cause mortality and NAEs.
Keywords: COVID-19; CQ; HCQ; SARS-CoV-2.