An Updated Systematic Review of the Therapeutic Role of Hydroxychloroquine in Coronavirus Disease-19 (COVID-19)

Clin Drug Investig. 2020 Jul;40(7):591-601. doi: 10.1007/s40261-020-00927-1.


Background and objective: The world is currently experiencing the Coronavirus Disease-19 (COVID-19) pandemic. There is no approved drug for the definitive treatment of the disease. Various drugs are being tried for the treatment of COVID-19, including hydroxychloroquine (HCQ). This study was performed to systematically review the therapeutic role of HCQ in COVID-19 from the available literature.

Methods: PubMed, Embase,, ICTRP (WHO), Cochrane Library databases, and two pre-print servers ( and Research Square) were searched for clinical studies that evaluated the therapeutic role of HCQ on COVID-19 until 10 May 2020. The available studies were critically analyzed and the data were extracted.

Results: A total of 663 articles were screened and 12 clinical studies (seven peer-reviewed and published studies and five non-peer-reviewed studies from pre-print servers) with a total sample size of 3543 patients were included. Some of the clinical studies demonstrated good virological and clinical outcomes with HCQ alone or in combination with azithromycin in COVID-19 patients, although the studies had major methodological limitations. Some of the other studies showed negative results with HCQ therapy along with the risk of adverse reactions.

Conclusion: The results of efficacy and safety of HCQ in COVID-19, as obtained from the clinical studies, are not satisfactory, although many of these studies had major methodological limitations. Stronger evidence from well-designed robust randomized clinical trials is required before conclusively determining the role of HCQ in the treatment of COVID-19. Clinical prudence is required in advocating HCQ as a therapeutic armamentarium in COVID-19.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Azithromycin / therapeutic use
  • Clinical Trials as Topic
  • Coronavirus Infections / drug therapy*
  • Drug Therapy, Combination
  • Humans
  • Hydroxychloroquine / adverse effects
  • Hydroxychloroquine / therapeutic use*
  • Pandemics
  • Pneumonia, Viral / drug therapy*


  • Anti-Bacterial Agents
  • Hydroxychloroquine
  • Azithromycin

Supplementary concepts

  • COVID-19