Current best evidence for clinical care (more info)
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.
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Even though many already know this, I think this is a timely and valuable article to share.
As an emergency medicine physician and medical toxicologist, I find the lack of evidence supporting the use of hydroxychloroquine (HCQ) in COVID-19 disease combined with its known toxicity (in addition to the risk of a shortage for actually indicated conditions) has been a topic of great concern. This meta-analysis confirms the suspicions that many clinicians have had based on the piecemeal evidence to date: in a review of 12 studies of close to 4000 patients, HCQ seems to have no benefit and likely has a detrimental effect in COVID-19 disease.
This is an opportune and thorough meta analysis on a questionable indication for COVID-19.
As an allergist and pulmonologist, I find these results very useful for my clinical practice. It is well written article and gives very important information for all the other clinicians. Pulmonologists already know this.