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Review
. 2020 Apr 16;10.1002/jmv.25898.
doi: 10.1002/jmv.25898. Online ahead of print.

Virological and Clinical Cure in COVID-19 Patients Treated With Hydroxychloroquine: A Systematic Review and Meta-Analysis

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Free PMC article
Review

Virological and Clinical Cure in COVID-19 Patients Treated With Hydroxychloroquine: A Systematic Review and Meta-Analysis

Phulen Sarma et al. J Med Virol. .
Free PMC article

Abstract

Following the demonstration of the efficacy of hydroxychloroquine against severe acute respiratory syndrome coronavirus 2 in vitro, many trials started to evaluate its efficacy in clinical settings. However, no systematic review and meta-analysis have addressed the issue of the safety and efficacy of hydroxychloroquine (HCQ) in coronavirus disease 2019. We conducted a systematic review and meta-analysis with the objectives of evaluation of safety and efficacy of HCQ alone or in combination in terms of "time to clinical cure," "virological cure," "death or clinical worsening of disease," "radiological progression," and safety. RevMan was used for meta-analysis. We searched 16 literature databases out of which seven studies (n = 1358) were included in the systematic review. In terms of clinical cure, two studies reported possible benefit in "time to body temperature normalization" and one study reported less "cough days" in the HCQ arm. Treatment with HCQ resulted in less number of cases showing the radiological progression of lung disease (odds ratio [OR], 0.31, 95% confidence interval [CI], 0.11-0.9). No difference was observed in virological cure (OR, 2.37, 95% CI, 0.13-44.53), death or clinical worsening of disease (OR, 1.37, 95% CI, 1.37-21.97), and safety (OR, 2.19, 95% CI, 0.59-8.18), when compared with the control/conventional treatment. Five studies reported either the safety or efficacy of HCQ + azithromycin. Although seems safe and effective, more data are required for a definitive conclusion. HCQ seems to be promising in terms of less number of cases with radiological progression with a comparable safety profile to control/conventional treatment. We need more data to come to a definite conclusion.

Keywords: 2019-nCoV; COVID-19; SARS CoV-2; hydroxychloroquine; meta-analysis.

Conflict of interest statement

All the authors declared that there are no conflict of interests.

Figures

Figure 1
Figure 1
PRISMA flow chart of the included studies. PRISMA, Preferred Reporting Items for Systematic reviews and Meta‐Analysis
Figure 2
Figure 2
Virological cure (HCQ vs control/conventional treatment). CI, confidendence of interval; df, degrees of freedom; HCQ, hydroxychloroquine
Figure 3
Figure 3
Composite endpoint of death or clinical worsening of disease/progression to severe disease (HCQ vs control/conventional treatment). CI, confidendence of interval; HCQ, hydroxychloroquine; ICU, intensive care unit
Figure 4
Figure 4
Number of cases showing evidence of radiological progression during therapy (HCQ vs control/conventional treatment). CI, confidendence of interval; HCQ, hydroxychloroquine
Figure 5
Figure 5
Safety issues (HCQ vs control/conventional treatment). CI, confidendence of interval; HCQ, hydroxychloroquine

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