Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Infect Chemother. 2021 Jun;27(6):882-889. doi: 10.1016/j.jiac.2021.02.021. Epub 2021 Feb 22.
Hydroxychloroquine (HCQ)/Chloroquine (CQ) has been evaluated for treatment and prophylaxis against SARS-CoV-2 infection in various studies with conflicting results. We performed a systematic review to synthesize the currently available evidence over the efficacy and safety of HCQ/CQ therapy alone against SARS-CoV-2 infection.
We searched Embase, PubMed, Web of Science, and Cochrane central for randomized controlled trials (RCTs) and prospective cohort studies published until October 15, 2020 and assessing the efficacy of HCQ alone against SARS-CoV-2 infection. We included studies evaluating HCQ/CQ alone as intervention and placebo/standard care as a control group. Retrospective studies and studies using other drugs (namely azithromycin, corticosteroids, immunomodulators, etc.) we excluded. Thirteen RCTs and three prospective cohort studies were included in this review. We pooled data using a random-effect model.
Pooled data from 12 studies (9917 participants) showed that HCQs increase mortality as compared to placebo/standard of care (RR 1.10; 95% CI:1.00-1.20). Hydroxychloroquine did not reduce the need for hospitalization in out-patients (RR 0.57; 95% CI 0.31-1.02). HCQ group has a significantly higher rate of any adverse event (RR 2.68; 95% CI 1.55-4.64), as compared to the control group. Also, using HCQ for prophylaxis against SARS-CoV-2 infection did not reduce the risk of acquiring SARS-CoV-2 infection (RR 1.04; 95% CI 0.58-1.88).
HCQ therapy for COVID-19 is associated with an increase in mortality and other adverse events. The negative effects are more pronounced in hospitalized patients. Therefore, with the available evidence, HCQ should not be used in prophylaxis or treatment of patients with COVID-19.
羟氯喹（HCQ）/氯喹（CQ）已在各种研究中评估了其治疗和预防 SARS-CoV-2 感染的效果，但结果存在冲突。我们进行了一项系统评价，以综合目前关于 HCQ/CQ 单独治疗 SARS-CoV-2 感染的疗效和安全性的证据。
我们在 Embase、PubMed、Web of Science 和 Cochrane 中心检索了截至 2020 年 10 月 15 日发表的评估 HCQ 单独治疗 SARS-CoV-2 感染的随机对照试验（RCT）和前瞻性队列研究。我们纳入了评估 HCQ/CQ 作为干预措施和安慰剂/标准护理作为对照组的研究。排除了回顾性研究和使用其他药物（即阿奇霉素、皮质类固醇、免疫调节剂等）的研究。本综述纳入了 13 项 RCT 和 3 项前瞻性队列研究。我们使用随机效应模型汇总数据。
来自 12 项研究（9917 名参与者）的汇总数据显示，与安慰剂/标准护理相比，HCQ 增加了死亡率（RR 1.10；95%CI：1.00-1.20）。HCQ 并未降低门诊患者的住院需求（RR 0.57；95%CI 0.31-1.02）。与对照组相比，HCQ 组出现任何不良事件的发生率显著更高（RR 2.68；95%CI 1.55-4.64）。此外，使用 HCQ 预防 SARS-CoV-2 感染并不能降低感染 SARS-CoV-2 的风险（RR 1.04；95%CI 0.58-1.88）。
COVID-19 患者使用 HCQ 治疗与死亡率和其他不良事件增加相关。在住院患者中，这种负面影响更为明显。因此，根据现有证据，HCQ 不应用于 COVID-19 患者的预防或治疗。
