Use of hydroxychloroquine to prevent SARS-CoV-2 infection and treat mild COVID-19: a systematic review and meta-analysis

Abstract

Objective: Chloroquine or hydroxychloroquine has demonstrated no effect on the treatment of hospitalized COVID-19 patients. This study aimed to answer questions related to the use of hydroxychloroquine for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection and in the treatment of patients with mild COVID-19 in terms of hospitalization, adverse events, and mortality. Methods: This was a systematic review and meta-analysis of phase 3 randomized clinical trials, selected from various databases, which compared patients who received hydroxychloroquine for SARS-CoV-2 prophylaxis or treatment of mild COVID-19 cases with controls. Results: A total number of 1,376 studies were retrieved. Of those, 9 met the eligibility criteria and were included in the study. No statistically significant differences were found between the hydroxychloroquine and control groups in terms of pre- or post-exposure prophylaxis of SARS-CoV-2 infection. The use of hydroxychloroquine increased the risk of adverse events by 12% (95% CI, 6-18%; p < 0.001), and the number needed to harm was 9. In addition, no significant differences were found between the hydroxychloroquine and control groups regarding hospitalization (risk difference [RD] = -0.02; 95% CI, -0.04 to 0.00; p = 0.14) or mortality (RD = 0.00; 95% CI, -0.01 to 0.02; p = 0.98) in the treatment of mild COVID-19. Conclusions: The use of hydroxychloroquine for prophylaxis of SARS-CoV-2 infection or treatment of patients with mild COVID-19 is not recommended.

Long-Term Symptoms after Mild Coronavirus Disease in Healthy Healthcare Professionals: A 12-Month Prospective Cohort Study

“…In addition, the Brazilian president encouraged the use of these medications for the “early” treatment of COVID-19 [ 35 ]. However, subsequent studies have not found any evidence of the effectiveness of these drugs for COVID-19 treatment [ 36 ]. Further, studies even indicate the existence of life-threatening side effects in the gastric, neurological, and mainly the cardiac system due to the alteration in the QT segment in cardiac waves [ 37 , 38 ].…”

Molecular Insights of SARS-CoV-2 Antivirals Administration: A Balance between Safety Profiles and Impact on Cardiovascular Phenotypes

“…Chi et al [ 38 ] reported a network metanalysis of randomized controlled trials showing no differences in terms of mortality or mechanical ventilation use. Moreover, other studies found no differences regarding hospitalization risks in mild COVID-19 cases when comparing usual care or placebo with hydroxychloroquine use, instead, higher levels of side effects were noted [ 39 , 40 , 41 , 42 ].…”

Hydroxychloroquine for treatment of non‐hospitalized adults with COVID‐19: A meta‐analysis of individual participant data of randomized trials

“…Moreover, the validity of aggregate data meta-analyses is affected by the reporting quality of the RCTs and inconsistent definition of outcomes across included trials. [23][24][25][26][27] Unlike conventional meta-analyses, which rely on aggregate data of trials addressing the same research question, in this IPD meta-analyses, we collected both published and unpublished data from eligible primary studies, derived standardized outcome definitions, used a consistent unit of analysis across included RCTs, and assessed interactions between interventions and participants' characteristics. 28 This approach allowed us to analyze the hospitalization risk on a dataset of 2037 outpatients (1058 treated with HCQ) with confirmed COVID-19.…”

“…Second, the heterogeneity of different trials on the dose, dose interval, and populations among different trials either requires the exclusion of many individual trials in conventional meta‐analyses or renders the veracity of the estimates uncertain. Moreover, the validity of aggregate data meta‐analyses is affected by the reporting quality of the RCTs and inconsistent definition of outcomes across included trials 23–27 …”