COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Zang Y, Han X, He M, et al. Hydroxychloroquine use and progression or prognosis of COVID-19: a systematic review and meta-analysis. Naunyn Schmiedebergs Arch Pharmacol. 2020 Sep 6. pii: 10.1007/s00210-020-01964-5. doi: 10.1007/s00210-020-01964-5.
Abstract

Hydroxychloroquine (HCQ) has been implicated in antiviral activity in vitro against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there is still controversy about whether HCQ should be used for coronavirus disease 2019 (COVID-19) patients due to the conflicting results in different clinical trials. To systematically assess the benefits and harms of HCQ for the treatment of COVID-19. Data sources were systematically searched from Pubmed, Biorxiv, ChiCTR, Clinicalrials.gov , and the Cochrane library of RCTs for studies published from inception to June 1, 2020, to obtain any possible inclusion. This meta-analysis of inclusion criteria was directed on the basis of the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). Pooled studies by the title and abstract were screened and removed in the light of meta-analysis by two reviewers. Seven studies involving 851 participants with COVID-19 were eligible for analysis. There was no significant difference in RT-PCR negative conversion between HCQ group and standard treatment (ST) group (RR = 1.11, 95% CI = 0.77-1.59, P = 0.591). The rate of exacerbated pneumonia on chest CT in HCQ group was lower than that in ST group (RR = 0.44, 95% CI = 0.20-0.94, P = 0.035). There was no statistical difference in progressed illness between the HCQ group and the ST group (RR = 0.66, 95% CI = 0.18-2.43, P = 0.530). Death (RR = 1.92, 95% CI = 1.26-2.93, P = 0.003) was distinctly different in HCQ group compared with ST group in the treatment of COVID-19. Our meta-analysis demonstrated that there was no robust evidence to support prescribing HCQ as a treatment for COVID-19.

Ratings
Discipline / Specialty Area Score
Infectious Disease
Intensivist/Critical Care
Respirology/Pulmonology
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Infectious Disease rater

This is a meta-analysis of clinical trials of hydroxychloroquine in SARS-CoV-2 infection. It shows paucity of data and poor quality of trials. It also shows lack of benefit and apparent harm with available data.

Infectious Disease rater

While many hospitalists will have seen this summarized in news report, it's important for them to see a thoughtful, systematic, statistical summary of available evidence on HCQ in COVID-19.

Intensivist/Critical Care rater

The papers that came out after the publication of this meta-analysis confirm the useless data of this therapy in this scenario.