Background Populations such as healthcare workers (HCW) that are unable to practice physical distancing are at high risk of acquiring Coronavirus disease-2019 (COVID-19). In these cases pharmacological prophylaxis would be a solution to reduce severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) transmission. Hydroxychloroquine has in vitro antiviral properties against SARS CoV-2. We therefore sought to determine the efficacy and safety of hydroxychloroquine as prophylaxis for COVID-19. Methods and findings We electronically searched EMBASE, MEDLINE, the Cochrane COVID-19 Register of Controlled Trials, Epistemonikos COVID-19, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform up to September 28 th , 2020 for randomized controlled trials (RCTs). We calculated pooled relative risks (RRs) for dichotomous outcomes with the corresponding 95% confidence intervals (CIs) using a random-effect model. We identified four RCTs (n = 4921) that met our eligibility criteria. The use of hydroxychloroquine, compared to placebo, did not reduce the risks of developing COVID-19 (RR 0.82, 95% CI 0.65 to 1.04, moderate certainty), hospitalization (RR 0.72, 95% CI 0.34 to 1.50, moderate certainty), or mortality (RR 3.26, 95% CI 0.13 to 79.74, low certainty), however, hydroxychloroquine use increased the risk of adverse events (RR 2.76, 95% CI 1.38 to 5.55, moderate certainty). Conclusion Although pharmacologic prophylaxis is an attractive preventive strategy against COVID-19, the current body of evidence failed to show clinical benefit for prophylactic hydroxychloroquine and showed a higher risk of adverse events when compared to placebo or no prophylaxis.
【초록키워드】 COVID-19, Randomized controlled trial, SARS CoV-2, coronavirus disease, coronavirus, Randomized controlled trials, Healthcare workers, Mortality, Hydroxychloroquine, Hospitalization, risk, Transmission, in vitro, outcome, Prophylactic, severe acute respiratory syndrome Coronavirus, RCT, healthcare worker, Population, coronavirus disease-2019, Prophylaxis, adverse events, Severe acute respiratory syndrome, controlled trials, clinical, adverse event, Efficacy and safety, Placebo, physical distancing, eligibility criteria, respiratory, registry, moderate, RCTs, Coronavirus-2, Evidence, antiviral property, high risk, HCW, Health Organization, relative risks, World Health Organization, acute respiratory syndrome, solution, higher risk, 95% CI, acute respiratory syndrome coronavirus, 95% confidence interval, SARS CoV, clinical benefit, acute respiratory syndrome coronavirus-2, antiviral properties, pharmacologic prophylaxis, pharmacological, calculated, searched, determine, reduce, Controlled, did not reduce, CIs, increased the risk, RRs, use of hydroxychloroquine, 【제목키워드】 COVID-19, Meta-analysis, Hydroxychloroquine, randomized trial, systematic review, Efficacy and safety,