COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Manuscript Elsawah HK, Elsokary MA, Elrazzaz MG, et al. Hydroxychloroquine for treatment of non-severe COVID-19 patients; systematic review and meta-analysis of controlled clinical trials. J Med Virol. 2020 Aug 18. doi: 10.1002/jmv.26442.

BACKGROUND: Being a pandemic and having a high global case fatality rate directed us to assess the evidence strength of hydroxychloroquine efficacy in treating COVID-19 arising from clinical trials and to update the practice with the most reliable clinical evidence.

METHODS: A comprehensive search was started in June up to July-18, 2020 in many databases, including PubMed, Embase and others. Of 432 studies found, only six studies fulfilled the inclusion criteria which includes: clinical trials, age>12 years with non-severe COVID-19, PCR-confirmed COVID-19, hydroxychloroquine is the intervention beyond the usual care. Data extraction and bias risk assessment were done by two independent authors. Both fixed-effect and random-effect models were utilized for pooling data using risk difference as a summary measure. The primary outcomes are clinical and radiological COVID-19 progression, SARS-CoV-2 clearance in the pharyngeal swab, and mortality. The secondary outcomes are the adverse effects of hydroxychloroquine.

RESULTS: Among 609 COVID-19 confirmed patients obtained from pooling 6 studies, 294 patients received Hydroxychloroquine and 315 patients served as a control. Hydroxychloroquine significantly prevent early radiological progression relative to control with risk difference and 95% confidence interval of -0.2 (-0.36 to -0.03). On the other hand, hydroxychloroquine did not prevent clinical COVID-19 progression, reduce 5-days mortality, or enhance viral clearance on days 5, 6, 7. Moreover, many adverse effects were reported with hydroxychloroquine therapy.

CONCLUSIONS: Failure of hydroxychloroquine to show viral clearance or clinical benefits with additional adverse effects outweigh its protective effect from radiological progression in non-severe COVID-19 patients. Benefit-risk balance should guide hydroxychloroquine use in COVID-19. This article is protected by copyright. All rights reserved.

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