COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Chowdhury MS, Rathod J, Gernsheimer J A Rapid Systematic Review of Clinical Trials Utilizing Chloroquine and Hydroxychloroquine as a Treatment for COVID-19. Acad Emerg Med. 2020 Jun;27(6):493-504. doi: 10.1111/acem.14005. Epub 2020 May 29.

OBJECTIVES: The emergence of SARS-CoV-2 has presented clinicians with a difficult therapeutic dilemma. With supportive care as the current mainstay of treatment, the fatality rate of COVID-19 is 6.9%. There are currently several trials assessing the efficacy of different antivirals as treatment. Of these, chloroquine (CQ) and its derivative hydroxychloroquine (HCQ) have garnered the most attention.

METHODS: In this study, the literature currently available on CQ and HCQ as treatment of COVID-19 was surveyed using EMBASE, PubMed, Cochrane Library, MedRxiv, and one clinical trial registry. Upon gathering published and preprint trials, risk of bias was assessed using Cochrane Risk of Bias Tool 2.0.

RESULTS: There are currently seven completed clinical trials and 29 registered clinical trials focusing on HCQ or CQ as a therapeutic avenue for COVID-19. Of these, five of seven trials have shown favorable outcomes for patients using CQ or HCQ and two of seven have shown no change compared to control. However, all seven trials carried varying degrees of bias and poor study design.

CONCLUSION: There are currently not enough data available to support the routine use of HCQ and CQ as therapies for COVID-19. Pending further results from more extensive studies with more stringent study parameters, clinicians should defer from routine use of HCQ and CQ. There are several clinical trials currently under way with results expected soon.

Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Infectious Disease
Public Health
Pediatric Hospital Medicine
Emergency Medicine
Comments from MORE raters

Emergency Medicine rater

Useful only to point out the lack of evidence but does not help the clinician make a decision.

Emergency Medicine rater

This is a timely and relevant analysis of the use of antimalarial agents in COVID-19. As expected, the analysis revealed inconclusive results in terms of the efficacy of aforementioned drugs in this context as majority of studies had methodological flaws and high risk of bias. For that reason, further double-blind randomized controlled trials with robust enrollment and precise methodology are required in order to assess the true efficacy of these agents. At this moment, they cannot be routinely administered to COVID-19 patients in daily clinical practice.

Hospital Doctor/Hospitalists rater

I found it useful to read a detailed description of the various studies and the shortcomings of the published data. I would definitely recommend this to my colleagues.

Intensivist/Critical Care rater

Strengths: There is a good initiative to really find real outcomes of debatable drugs. They analysed most currently available studies with their pros and cons to find strengths and weaknesses. This will really help us to take from those studies. Weakness: 1. The inclusion criteria for the studies were too lucid, which may have affected the final selection. 2. Depending mainly on power of study in this ever changing epidemic may not be a solid fact finding idea. 3. Pure studies should have been compared and analysied, rather than mixing between they.

Internal Medicine rater

This systematic review offers limited insight into the efficacy of hydroxychloroquine in treating COVID-19 due to the inherent flaws and high bias risk in the included studies. Furthermore, due to the rapid publication pace of COVID-19-related studies, unfortunately this review is already outdated and eclipsed by newer studies. Ongoing large, publicly-funded RCTs will provide the definitive answer for this important clinical question.

Internal Medicine rater

Systematic reviews with ongoing pandemics are premature.

Public Health rater

Most practitioners are aware that the studies have been inadequate; the article adds little to that.

Respirology/Pulmonology rater

There is a big debate about HCQ in COVID-19; thus, this systematic review is very useful to see all papers on usage of HCQ.