Systematic review and meta-analysis of the effectiveness and safety of hydroxychloroquine in treating COVID-19 patients

J Chin Med Assoc. 2021 Feb 1;84(2):233-241. doi: 10.1097/JCMA.0000000000000425.


Background: Since COVID-19 outbreak, hydroxychloroquine (HCQ) has been tested for effective therapies, and the relevant researches have shown controversial results.

Methods: Systematic review and meta-analysis were conducted after a thorough search of relevant studies from databases. Trials that have evaluated HCQ for COVID-19 treatment were recruited for statistical analysis with fixed- and random-effect models.

Results: Nine trials involving 4112 patients were included in present meta-analysis. It was seen that HCQ-azithromycin (HCQ-AZI) combination regimen increased the mortality rate in COVID-19 (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.63-3.36) patients; however, it also showed benefits associated with the viral clearance in patients (OR, 27.18; 95% CI, 1.29-574.32). HCQ-alone when used as a therapy in COVID-19 did not reveal significant changes in mortality rate, clinical progression, viral clearance, and cardiac QT prolongation. Subsequent subgroup analysis showed that HCQ treatment could decrease mortality rate and progression to severe illness in severely infected COVID-19 patients (OR, 0.27; 95% CI, 0.13-0.58). A lower risk of mortality rate was also noted in the stratified group of >14 days follow-up period (OR, 0.27; 95% CI, 0.13-0.58) compared to ≤14 days follow-up period group that conversely showed an increased mortality rate (OR, 2.09; 95% CI, 1.41-3.10).

Conclusion: Our results indicated that HCQ-AZI combination treatment increased mortality rate in patients with COVID-19, but it also showed benefits associated with viral clearance in patients. HCQ-alone used for treatment has revealed benefits in decreasing the mortality rate among severely infected COVID-19 group and showed potential to be used for COVID-19 treatment in long-term follow-up period group. Accordingly, more rigorous, large-scale, and long follow-up period studies in patients with COVID-19 are needed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Azithromycin / administration & dosage
  • COVID-19 / drug therapy*
  • COVID-19 / mortality
  • COVID-19 / virology
  • Electrocardiography / drug effects
  • Humans
  • Hydroxychloroquine / administration & dosage
  • Hydroxychloroquine / pharmacology
  • Hydroxychloroquine / therapeutic use*
  • Publication Bias
  • Randomized Controlled Trials as Topic
  • SARS-CoV-2*


  • Hydroxychloroquine
  • Azithromycin

Supplementary concepts

  • COVID-19 drug treatment