Abstract
Being a pandemic and having a high global case fatality rate directed us to assess the evidence strength of hydroxychloroquine efficacy in treating coronavirus disease-2019 (COVID-19) arising from clinical trials and to update the practice with the most reliable clinical evidence. A comprehensive search was started in June up to 18 July, 2020 in many databases, including PubMed, Embase, and others. Of 432 studies found, only six studies fulfilled the inclusion criteria, which includes: clinical trials, age more than 12 years with nonsevere COVID-19, polymerase chain reaction-confirmed COVID-19, hydroxychloroquine is the intervention beyond the usual care. Data extraction and bias risk assessment were done by two independent authors. Both fixed-effect and random-effect models were utilized for pooling data using risk difference as a summary measure. The primary outcomes are clinical and radiological COVID-19 progression, severe acute respiratory syndrome coronavirus-2 clearance in the pharyngeal swab, and mortality. The secondary outcomes are the adverse effects of hydroxychloroquine. Among 609 COVID-19 confirmed patients obtained from pooling six studies, 294 patients received hydroxychloroquine and 315 patients served as a control. Hydroxychloroquine significantly prevents early radiological progression relative to control with risk difference and 95% confidence interval of -0.2 (-0.36 to -0.03). On the other hand, hydroxychloroquine did not prevent clinical COVID-19 progression, reduce 5-day mortality, or enhance viral clearance on days 5, 6, and 7. Moreover, many adverse effects were reported with hydroxychloroquine therapy. Failure of hydroxychloroquine to show viral clearance or clinical benefits with additional adverse effects outweigh its protective effect from radiological progression in nonsevere COVID-19 patients. Benefit-risk balance should determine the hydroxychloroquine use in COVID-19.
Keywords: COVID-19; Progression; hydroxychloroquine; mortality; viral clearance.
【저자키워드】 COVID-19, Mortality, Hydroxychloroquine, progression, viral clearance, 【초록키워드】 coronavirus disease, Efficacy, coronavirus, clinical trial, pandemic, Hydroxychloroquine, clinical trials, risk, Intervention, severe acute respiratory syndrome Coronavirus, viral clearance, Risk assessment, adverse effects, Severe acute respiratory syndrome, polymerase chain reaction, Patient, Case fatality rate, age, COVID-19 patients, protective effect, Coronavirus-2, Evidence, risk difference, COVID-19 progression, Pharyngeal swab, adverse effect, confidence interval, acute respiratory syndrome, Primary outcome, 95% confidence interval, Secondary outcomes, failure, usual care, clinical benefits, Primary outcomes, inclusion criteria, clinical benefit, acute respiratory syndrome coronavirus-2, data extraction, Fatality rate, secondary outcome, hydroxychloroquine therapy, clinical evidence, bias risk, clearance, being, radiological progression, Prevent, independent, radiological, polymerase chain, ENhance, significantly, reported, arising, determine, reduce, authors, COVID-19 confirmed patient, 【제목키워드】 Treatment, Meta-analysis, Hydroxychloroquine, Controlled clinical trial,