Shetty Rajesh M, Namachivayam ArunKumar
Department of Critical Care Medicine, Manipal Hospital Whitefield, Bengaluru, Karnataka, India.
Department of Data Science, Alke Research Private Limited, Bengaluru, Karnataka, India.
Indian J Crit Care Med. 2021 Apr;25(4):441-452. doi: 10.5005/jp-journals-10071-23773.
Given the current lack of an approved and effective treatment or vaccine for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), repositioning old drugs for use as an antiviral treatment is an interesting strategy because knowledge about these drugs' safety profile, posology, and drug interactions is already known. Chloroquine and hydroxychloroquine, widely used as antimalarial and autoimmune disease drugs, have recently been reported as a potential broad-spectrum antiviral drug.
The antiviral activity of chloroquine has been identified since the late 1960s. However, antiviral mechanisms of chloroquine remain speculative. Several clinical trials have been conducted to test the efficacy and safety of chloroquine or hydroxychloroquine in the treatment of COVID-19-associated pneumonia. The quality of the studies and the outcomes are evaluated in this systematic review and meta-analysis.
Literature review revealed 23 clinical studies. Only 9 of 23 studies were randomized controlled trials. Of nine randomized controlled trials, only study by Skipper et al. was deemed to be at low risk of bias. All studies evaluated variedwith different outcomes. Mechanical ventilation and virological clearance were the only common outcomes evaluated in more than two studies. Virological clearance odds ratio (OR) was 1.25 (95% confidence interval [CI] of 0.57-2.73; Chi = 0.83; I = 0%). GRADE quality of evidence was downgraded by three levels to very low due to concerns about the risk of bias, inconsistency, and imprecision. For mechanical ventilation, OR was 1.09 (95% CI 0.80-1.50; Chi = 0; I = 0). GRADE quality of evidence was downgraded by two levels to low due to concerns about the risk of bias and imprecision. There was no statistically significant difference between the groups for these two outcomes.
As per the available evidence, based on our review, we conclude that hydroxychloroquine/chloroquine has not shown to be beneficial when used for the treatment of patients with COVID-19 pneumonia.
Shetty RM, Namachivayam A. Evidence for Chloroquine/Hydroxychloroquine in the Treatment of COVID-19. Indian J Crit Care Med 2021;25(4):441-452.
鉴于目前缺乏针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的获批有效治疗方法或疫苗，重新利用旧药作为抗病毒治疗是一种有趣的策略，因为这些药物的安全性、剂量学和药物相互作用方面的知识已经为人所知。氯喹和羟氯喹作为抗疟疾和自身免疫性疾病药物被广泛使用，最近有报道称它们是一种潜在的广谱抗病毒药物。
自20世纪60年代末以来，氯喹的抗病毒活性就已得到确认。然而，氯喹的抗病毒机制仍具有推测性。已经开展了多项临床试验来测试氯喹或羟氯喹治疗2019冠状病毒病相关肺炎的疗效和安全性。本系统评价和荟萃分析对这些研究的质量和结果进行了评估。
文献检索发现了23项临床研究。23项研究中只有9项是随机对照试验。在9项随机对照试验中，只有斯基珀等人的研究被认为偏倚风险较低。所有研究评估的结果各不相同。机械通气和病毒学清除是两项以上研究中评估的仅有的共同结果。病毒学清除优势比（OR）为1.25（95%置信区间[CI]为0.57 - 2.73；卡方 = 0.83；I² = 0%）。由于对偏倚风险、不一致性和不精确性的担忧，GRADE证据质量被下调三级至极低。对于机械通气，OR为1.09（95%CI为0.80 - 1.50；卡方 = 0；I² = 0%）。由于对偏倚风险和不精确性的担忧，GRADE证据质量被下调两级至低。这两个结果在组间无统计学显著差异。
根据现有证据，基于我们的综述，我们得出结论，羟氯喹/氯喹用于治疗2019冠状病毒病肺炎时未显示出有益效果。
谢蒂RM，纳马奇瓦亚姆A。氯喹/羟氯喹治疗2019冠状病毒病的证据。《印度重症监护医学杂志》2021年；25(4):441 - 452。
