Hydroxychloroquine for Non-Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

被引:1
|
作者
Lucchetta, Rosa [1 ]
Matuoka, Jessica Y. [1 ,2 ]
de Oliveira Junior, Haliton Alves [1 ]
Oliveira, Gustavo [1 ]
Cavalcanti, Alexandre Biasi [3 ]
Azevedo, Luciano [1 ,4 ]
Berwanger, Otavio [5 ]
Lopes, Renato Delascio [6 ]
Rosa, Regis Goulart [7 ]
Veiga, Viviane Cordeiro [8 ]
Avezum, Alvaro [1 ,9 ]
机构
[1] Hosp Alemao Oswaldo Cruz, Sao Paulo, SP, Brazil
[2] Inst Dante Pazzanese Cardiol, Sao Paulo, SP, Brazil
[3] Hosp Coracao, Sao Paulo, SP, Brazil
[4] Hosp Sirio Libanes, Sao Paulo, SP, Brazil
[5] Hosp Israelita Albert Einstein, Sao Paulo, SP, Brazil
[6] Duke Univ Hosp, Durham, NC USA
[7] Hosp Moinhos Vento, Porto Alegre, RS, Brazil
[8] Beneficencia Portuguesa Sao Paulo, Sao Paulo, SP, Brazil
[9] Hosp Alemao Oswaldo Cruz, R Treze Maio 1815, BR-01323020 Sao Paulo, SP, Brazil
关键词
COVID-19; drug therapy; SARS-CoV-2; Hydroxychloroquine; Randomized Controlled Trials as Topic; Meta-Analyis; QUALITY; GRADE;
D O I
10.36660/abc.20220380
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Previous systematic reviews have identified no benefit of hydroxychloroquine and chloroquine in non-hospitalized COVID-19 patients. After publication of these reviews, the results of COPE, the largest randomized trial conducted to date, became available.Objectives: To conduct a systematic review and meta-analyses of randomized clinical trials (RCTs) to synthesize the evidence on the efficacy and safety of hydroxychloroquine and chloroquine for non-hospitalized COVID-19 patients compared to placebo or standard of care. Methods: Searches were conducted in PubMed, Embase, The Cochrane Library, and ClinicalTrials.gov complemented by manual search. Pairwise meta-analyses, risk of bias, and evidence certainty assessments were conducted, including optimal information size analysis (OIS). A level of significance of 0.05 was adopted in the meta-analysis. PROSPERO: CRD42021265427. Results: Eight RCTs with 3,219 participants were included. COVID-19 hospitalization and any adverse events rates were not significantly different between hydroxychloroquine (5.6% and 35.1%) and control (7.4% and 20.4%) (risk ratio, RR, 0.77, 95% confidence interval, CI, 0.57-1.04, I2: 0%; RR 1.78, 95%-CI 0.90; 3.52, I2: 93%, respectively). The OIS (7,880) was not reached for COVID-19 hospitalization, independently of the simulation for anticipated event rate and RR reduction estimate. Conclusion: Evidence of very low certainty showed lack of benefit with hydroxychloroquine in preventing COVID-19 hospitalizations. Despite being the systematic review with the largest number of participants included, the OIS, considering pre-vaccination response to infection, has not yet been reached.
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页数:11
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