Abstract
Chloroquine or its derivative hydroxychloroquine (HCQ) combined with or without azithromycin (AZ) have been widely investigated in observational studies as a treatment option for coronavirus 2019 (COVID-19) infection. The network meta-analysis aims to summarize evidence from randomized controlled trials (RCTs) to determine if AZ or HCQ is associated with improved clinical outcomes. PubMed and Embase were searched from inception to March 7, 2021. We included published RCTs that investigated the efficacy of AZ, HCQ, or its combination among hospitalized patients with COVID-19 infection. The outcomes of interest were all-cause mortality and the use of mechanical ventilation. The pooled odds ratio was calculated using a random-effect model. A total of 10 RCTs were analyzed. Participant’s mean age ranged from 40.4 to 66.5 years. There was no significant effect on mortality associated with AZ plus HCQ (odds ratio [OR] = 0.562 [95% confidence interval {CI}: 0.168-1.887]), AZ alone (OR = 0.965 [95% CI: 0.865-1.077]), or HCQ alone (OR = 1.122 [95% CI: 0.995-1.266]; p = 0.06). Similarly, based on pooled effect sizes derived from direct and indirect evidence, none of the treatments had a significant benefit in decreasing the use of mechanical ventilation. No heterogeneity was identified (Cochran’s Q = 1.68; p = 0.95; τ 2 = 0; I 2 = 0% [95% CI: 0%-0%]). Evidence from RCTs suggests that AZ with or without HCQ was not associated with a significant effect on the mortality or mechanical ventilation rates in hospitalized patients with COVID-19. More research is needed to explore therapeutics agents that can effectively reduce the mortality or severity of COVID-19.
Keywords: azithromycin; chloroquine; coronavirus; coronavirus disease 2019; hydroxychloroquine; mechanical ventilation; mortality; network meta-analysis.
【저자키워드】 Coronavirus disease 2019, coronavirus, Chloroquine, Azithromycin, Mortality, Hydroxychloroquine, mechanical ventilation, network meta-analysis., 【초록키워드】 COVID-19, Randomized controlled trial, Treatment, coronavirus disease, Coronavirus disease 2019, Efficacy, coronavirus, Randomized controlled trials, Chloroquine, Azithromycin, Hydroxychloroquine, mechanical ventilation, Infection, Network meta-analysis, outcome, hospitalized patients, heterogeneity, observational studies, RCT, observational study, clinical outcomes, COVID-19 infection, severity of COVID-19, Research, age, HCQ, Coronavirus 2019, RCTs, Evidence, Combination, Odds ratio, confidence interval, no significant effect, significant effect, all-cause mortality, participant, effect size, inception, benefit, analyzed, investigated, calculated, searched, determine, hospitalized patient, reduce, ranged, with COVID-19, 【제목키워드】 Randomized controlled trial, Meta-analysis, Azithromycin, Hydroxychloroquine, network, Effect, patients hospitalized,