Journal of Family Medicine and Primary Care

REVIEW ARTICLE
Year
: 2021  |  Volume : 10  |  Issue : 6  |  Page : 2126--2139

Systematic review and meta-analysis of efficacy and safety of hydroxychloroquine and chloroquine in the treatment of COVID-19


Niti Mittal1, Rakesh Mittal1, MC Gupta1, Jyoti Kaushal1, Ankita Chugh2, Daisy Khera3, Surjit Singh4 
1 Department of Pharmacology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
2 Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
4 Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Correspondence Address:
Dr. Surjit Singh
Department of Pharmacology, AIIMS, Jodhpur, Rajasthan
India

Repurposed drugs like hydroxycloroquine (HCQ) and chloroquine (CQ) are being tested for potential therapeutic role in COVID-19. We aimed to evaluate efficacy and safety of HCQ and CQ in COVID-19. Using PubMed, EMBASE, medRxiv, Google Scholar, clinicaltrials.gov, electronic search was carried out to identify relevant articles till June 2020 with re-evaluation in last week of November 2020. Observational and interventional clinical studies comparing efficacy of CQ or HCQ to standard management or other drug/s for SARS-CoV-2 infection patients were included. Cochrane review manager version 5.3 was used for synthesis of meta-analysis results. For randomized controlled trials, risk of bias was assessed using cochrane collaboration risk of bias assessment tool, version 2.0 (ROB-2). ROBINS-I was used for quality assessment of observational studies. Overall evidence quality generated by review was graded as per GRADE Recommendation. A total of 903 studies were screened. Nineteen studies were included in synthesis of meta-analysis with total of 4,693, 1,626, and 6,491 patients in HCQ/CQ, HCQ/CQ + AZ and control groups, respectively. HCQ/CQ treatment was associated with significantly increased rates of virological cure (OR = 2.08, 95%cI = 1.36–3.17; P = 0.0007) and radiological cure (OR = 3.89, 95%cI = 1.35 – 11.23; P = 0.01) compared to control. HCQ/CQ had no difference in unadjusted mortality rate (unadjusted OR = 0.98 95% cI = 0.70–1.37, P = 0.89, random effect model) and adjusted hazard ratio for mortality (adjusted HR = 1.05, 95%cI = 0.86--1.29; P = 0.64). However, a significant increase in odds of disease progression (OR = 1.77, 95%cI = 1.46–2.13; P < 0.00001) and QT prolongation (OR = 11.15, 95%cI = 3.95–31.44; P < 0.00001) was noted. The results with HCQ/CQ and azithromycin combination were similar to HCQ/CQ mono-therapy. In the light of contemporary evidence on effectiveness of HCQ/CQ, judicious and monitored use of HCQ/CQ for treatment of COVID-19 patients is recommended in low to middle income countries with emphasis on no mortality benefit. Registration number of Systematic review. Register in PROSPERO database: cRD42020187710


How to cite this article:
Mittal N, Mittal R, Gupta M C, Kaushal J, Chugh A, Khera D, Singh S. Systematic review and meta-analysis of efficacy and safety of hydroxychloroquine and chloroquine in the treatment of COVID-19.J Family Med Prim Care 2021;10:2126-2139


How to cite this URL:
Mittal N, Mittal R, Gupta M C, Kaushal J, Chugh A, Khera D, Singh S. Systematic review and meta-analysis of efficacy and safety of hydroxychloroquine and chloroquine in the treatment of COVID-19. J Family Med Prim Care [serial online] 2021 [cited 2021 Aug 4 ];10:2126-2139
Available from: https://www.jfmpc.com/article.asp?issn=2249-4863;year=2021;volume=10;issue=6;spage=2126;epage=2139;aulast=Mittal;type=0