COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Singh AK, Singh A, Singh R, et al. "Hydroxychloroquine in patients with COVID-19: A Systematic Review and meta-analysis." Diabetes Metab Syndr. 2020 Jul - Aug;14(4):589-596. doi: 10.1016/j.dsx.2020.05.017. Epub 2020 May 12.

BACKGROUNDS AND AIMS: The role of hydroxychloroquine (HCQ) in the treatment of COVID-19 is not fully known. We studied the efficacy of HCQ compared to the control in COVID-19 subjects on - a. viral clearance measured by reverse transcriptase polymerase chain reaction (RT-PCR) and, b. death due to all cause.

METHODS: PubMed, Scopus, Cochrane and MedRxiv database were searched using the specific keywords up to April 30, 2020. Studies that met our objectives were assessed for the risk of bias applying various tools as indicated. Three studies each that reported the outcome of viral clearance by RT-PCR and death due to all cause, were meta-analyzed by applying inverse variance-weighted averages of logarithmic risk ratio (RR) using a random effects model. Heterogeneity and publication bias were assessed using the I2 statistic and funnel plots, respectively.

RESULTS: Meta-analysis of 3 studies (n = 210) on viral clearance assessed by RT-PCR showed no benefit (RR, 1.05; 95% CI, 0.79 to 1.38; p = 0.74), although with a moderate heterogeneity (I2 = 61.7%, p = 0.07). While meta-analysis of 3 studies (n = 474) showed a significant increase in death with HCQ, compared to the control (RR, 2.17; 95% 1.32 to 3.57; p = 0.002), without any heterogeneity (I2 = 0.0%, p = 0.43).

CONCLUSIONS: No benefit on viral clearance but a significant increase in mortality was observed with HCQ compared to control in patients with COVID-19.

Discipline / Specialty Area Score
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Intensivist/Critical Care
Public Health
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

HCQ has been in the news, ever since COVID19 has been in the news. I wish some old, well studied, cheap drug would be the magic bullet for COVID19. HCQ isn't it.

Hospital Doctor/Hospitalists rater

Most practioners likely know that hydroxychloroquine is NOT beneficial in COVID-19 despite the US President's current stance. This article's key point is clearly stated in the discussion: "a significant 2-fold increase in mortality with the HCQ warrants its use if at all, with an extreme caution, until the results from larger randomized controlled trials are available."

Infectious Disease rater

This meta-analysis provides important information for consideration of the risks and benefits of hydroxychloroquine in COVID-19 infections while we await results of larger randomized trials.

Intensivist/Critical Care rater

Unfortunately, this meta-analysis` shortcomings are not emphasized. The results appear biased because of the included studies.

Intensivist/Critical Care rater

This meta-analysis includes only a few poor-quality studies. Overall, I'm not sure the information is novel or helpful.

Intensivist/Critical Care rater

Although a trendy topic, there is not much data in this meta-analysis. The results are consistent with what has been propagated throughout the media. Bottom line: insufficient data to generate conclusions.

Internal Medicine rater

Of course this is a topical issue, but I don't see this SR and MA as adding much useful info to what is known. I normally don't comment on the methods of studies I am asked to assess, but this one crosses a line that I can't go over. This question is going to need the results of better quality primary studies than the ones included in this review.

Public Health rater

The topic was relevant at one time but is no longer so. The moderate heterogeneity, lack of well done trials, small population size, and very different outcomes in each of the trials all limit the robustness of the study. The intense public attention given to the role of hydroxychloroquine in COVID-19 limits the newsworthiness of this article.

Public Health rater

This analysis cobbles together data to shed light on the efficacy/toxicity of ‘chloroquines’ for treating Covid. There is a paucity of data supporting it and an abundance of anecdotes based on no validated protocols recommending its use. Whether it is effective with a macrolide remains in question as well. People will be harmed in the rush to discover a ‘remedy.`

Public Health rater

Systematic review on hydroxychloroquine for COVID-19. Multiple studies were included that may be out of date soon as additional trials are published, but so far this supports the belief that hydroxychloroquine does not help and likely causes some degree of harm when used solely for SARS-CoV-2 infection.

Respirology/Pulmonology rater

An attempt at meta-analysis of studies using hydroxychloroquine to treat Covid-19 finds no therapeutic benefit and a risk for increased mortality. This paper highlights the ongoing uncertainty of how to deal with this new disease. Well designed prospective trials are needed to learn whether or not hydroxychloroquine has any role in treating Covid-19.