tetano
Editor, Senior Moderator
J Med Virol
. 2021 Aug 9.
doi: 10.1002/jmv.27259. Online ahead of print.
Effect of Azithromycin and Hydroxychloroquine in Patients Hospitalized with COVID-19: Network Meta-Analysis of Randomized Controlled Trials
Gerald Chi[SUP] 1 [/SUP], Sahar Memar Montazerin[SUP] 1 [/SUP], Jane J Lee[SUP] 2 [/SUP], Syed Hassan A Kazmi[SUP] 1 [/SUP], Fahimehalsadat Shojaei[SUP] 1 [/SUP], Clara Fitzgerald[SUP] 1 [/SUP], C Michael Gibson[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Chloroquine or its derivative hydroxychloroquine (HCQ) combined with or without azithromycin (AZ) have been widely investigated in observational studies as a treatment option for Coronavirus 2019 (COVID-19) infection. The network meta-analysis (NMA) aims to summarize evidence from randomized controlled trials (RCTs) to determine if AZ or HCQ is associated with improved clinical outcomes.
Methods: PubMed and Embase were searched from inception to March 7, 2021. We included published RCTs that investigated the efficacy of AZ, HCQ, or its combination among hospitalized patients with COVID-19 infection. The outcomes of interest were all-cause mortality and the use of mechanical ventilation. The pooled odds ratio was calculated using a random-effect model.
Results: A total of 10 RCTs were analyzed. Participant's mean age ranged from 40.4 to 66.5 years. There was no significant effect on mortality associated with AZ plus HCQ (odds ratio [OR]=0.562 [95% CI: 0.168 to 1.887]), AZ alone (OR=0.965 [95% CI: 0.865 to 1.077]), or HCQ alone (OR=1.122 [95% CI: 0.995 to 1.266]; p=0.06). Similarly, based on pooled effect sizes derived from direct and indirect evidence, none of the treatments had a significant benefit in decreasing the use of mechanical ventilation. No heterogeneity was identified (Cochran's Q=1.68; p=0.95; 𝜏[SUP]2[/SUP] =0; I[SUP]2[/SUP] =0% [95% CI: 0% to 0%]).
Conclusions: Evidence from RCTs suggests that AZ with or without HCQ was not associated with a significant effect on the mortality or mechanical ventilation rates in hospitalized patients with COVID-19. More research is needed to explore therapeutics agents that can effectively reduce the mortality or severity of COVID-19. This article is protected by copyright. All rights reserved.
Keywords: Azithromycin; Chloroquine; Coronavirus; Coronavirus disease 2019; Hydroxychloroquine; Mechanical ventilation; Mortality; Network Meta-analysis.
. 2021 Aug 9.
doi: 10.1002/jmv.27259. Online ahead of print.
Effect of Azithromycin and Hydroxychloroquine in Patients Hospitalized with COVID-19: Network Meta-Analysis of Randomized Controlled Trials
Gerald Chi[SUP] 1 [/SUP], Sahar Memar Montazerin[SUP] 1 [/SUP], Jane J Lee[SUP] 2 [/SUP], Syed Hassan A Kazmi[SUP] 1 [/SUP], Fahimehalsadat Shojaei[SUP] 1 [/SUP], Clara Fitzgerald[SUP] 1 [/SUP], C Michael Gibson[SUP] 1 [/SUP]
Affiliations
- PMID: 34370328
- DOI: 10.1002/jmv.27259
Abstract
Background: Chloroquine or its derivative hydroxychloroquine (HCQ) combined with or without azithromycin (AZ) have been widely investigated in observational studies as a treatment option for Coronavirus 2019 (COVID-19) infection. The network meta-analysis (NMA) aims to summarize evidence from randomized controlled trials (RCTs) to determine if AZ or HCQ is associated with improved clinical outcomes.
Methods: PubMed and Embase were searched from inception to March 7, 2021. We included published RCTs that investigated the efficacy of AZ, HCQ, or its combination among hospitalized patients with COVID-19 infection. The outcomes of interest were all-cause mortality and the use of mechanical ventilation. The pooled odds ratio was calculated using a random-effect model.
Results: A total of 10 RCTs were analyzed. Participant's mean age ranged from 40.4 to 66.5 years. There was no significant effect on mortality associated with AZ plus HCQ (odds ratio [OR]=0.562 [95% CI: 0.168 to 1.887]), AZ alone (OR=0.965 [95% CI: 0.865 to 1.077]), or HCQ alone (OR=1.122 [95% CI: 0.995 to 1.266]; p=0.06). Similarly, based on pooled effect sizes derived from direct and indirect evidence, none of the treatments had a significant benefit in decreasing the use of mechanical ventilation. No heterogeneity was identified (Cochran's Q=1.68; p=0.95; 𝜏[SUP]2[/SUP] =0; I[SUP]2[/SUP] =0% [95% CI: 0% to 0%]).
Conclusions: Evidence from RCTs suggests that AZ with or without HCQ was not associated with a significant effect on the mortality or mechanical ventilation rates in hospitalized patients with COVID-19. More research is needed to explore therapeutics agents that can effectively reduce the mortality or severity of COVID-19. This article is protected by copyright. All rights reserved.
Keywords: Azithromycin; Chloroquine; Coronavirus; Coronavirus disease 2019; Hydroxychloroquine; Mechanical ventilation; Mortality; Network Meta-analysis.