PURPOSE:

• Singh et al. (Diabetes Metabolic Syndrome, 2020) sought to determine the efficacy of hydroxychloroquine (HCQ) compared to the control in COVID-19

METHODS:

• Meta-analysis
• Search conducted in PubMed, Scopus, Cochrane and MedRxiv database were searched using the specific keywords (through April 30, 2020)
• Study inclusion criteria
  • Hydroxychloroquine used in patients with COVID-19 and compared to control | Results include ≥1 outcome of interest (Viral clearance and/or death due to all causes)
  • COVID-19 infection documented with RT-PCR
• Study exclusion criteria
  • Case reports | Preclinical studies | Outcomes of interest not included |HCQ not compared to placebo or control
• Study design
  • Meta-analysis performed to identify relationship between HCQ and
    • Viral clearance
    • Death due to all causes
  • 4 reviewers assessed studies for risk of bias (independent analysis)
  • Risk ratio calculated using random-effects model

RESULTS:

• The authors provide an in-depth literature review of 10 studies that assessed the efficacy and safety of HCQ in patients with COVID-19
• 7 studies initially selected that compared HCQ to a control in COVID-19 patients
• 3 studies with specific outcomes of interest

HCQ and Viral Clearance

• 3 studies included | n = 210 | 2 RCTs and a non-randomized trial
• HCQ showed no benefit (p=0.74)
  • RR: 1.05 (95% CI, 0.79 to 1.38)

HCQ and Death

• 3 studies included | n = 474 | 2 Retrospective and 1 RCT
• HCQ was associated with increased risk of death vs controls (p = 0.002)
  • RR: 2.17 (95% CI, 1.32 to 3.57)

CONCLUSION:

• In this study HCQ did not hasten viral clearance and may be associated with a twofold risk of death from all causes in patients with COVID-19
• The authors acknowledge study limitations including
  • Small overall ‘n’ | No individual patient data | Combination of randomized and non-randomized data | Some data pre-print publications | Data could not be sufficiently adjusted for confounders
  • There are studies that suggest improvement of pneumonia and chest imaging findings
• The authors conclude that

Despite several limitations of this meta-analysis, we feel this finding would instill some degree of skepticism and shall help in curbing the exuberant use of over enthusiastically claimed “magical” drug

Hopefully, large randomized controlled trial such as DISCOVERY (EudraCT 2020-000936-23) and RECOVERY (UK), that is currently studying the effect of HCQ in COVID-19 and comparing it with other anti-viral drugs will finally decide its fate

Learn More – Primary Sources:

Hydroxychloroquine in Patients With COVID-19: A Systematic Review and Meta-Analysis

Related ObG Topics:

NIH COVID-19 Treatment Guidelines

COVID-19: Category Definitions, Symptoms and Those at Increased Risk

Remdesivir Emergency Authorization: FDA Update and Summary of Preliminary NIH Study Data