Hydroxychloroquine and chloroquine for COVID-19 infection. Rapid systematic review

Abstract

CONTEXT: Based on the results of preliminary studies, the off-label use of hydroxychloroquine for COVID-19 infection has been observed in practice. OBJECTIVES: To identify, systematically assess and summarize the best available evidence on the efficacy and safety of the use of hydroxychloroquine and chloroquine for COVID-19 infection. METHODS: Rapid systematic review. RESULTS: After the selection process, 30 studies were included: one open-label randomized trial, one open-label non-randomized trial and 28 ongoing studies. The outcome 'detection of viral load in oral swab' (surrogate outcome) was evaluated by both studies, involving a total of 72 participants. The findings of the studies were discordant: one study observed a higher frequency of negative viral load associated with hydroxychloroquine on day-7, while the other study did not observe any difference between hydroxychloroquine and the control group (standard treatment) on day-6. Both studies have methodological limitations when evaluated by specific tools according to study design (Cochrane Bias Risk Table and ROBINS-I). CONCLUSION: This rapid systematic review identified two clinical studies (with available data), with limited methodological quality, that evaluated the effects of hydroxychloroquine for COVID-19 infection. Based on the findings of these two studies, the efficacy and safety of hydroxychloroquine and chloroquine in patients with COVID-19 is still uncertain (very low evidence certainty) and its routine use for this situation should not be recommended until the results of ongoing studies could provide a proper assessment of their effects.