Efficacy of chloroquine and hydroxychloroquine in treating COVID-19 infection: A meta-review of systematic reviews and an updated meta-analysis

Chivese, Tawanda; Musa, Omran A.H.; Hindy, George; Al-Wattary, Noor; Badran, Saif; Soliman, Nada; Aboughalia, Ahmed T.M.; Matizanadzo, Joshua T.; Emara, Mohamed M.; Thalib, Lukman; Doi, Suhail A.R.

OBJECTIVE: To synthesize findings from systematic reviews and meta-analyses on the efficacy and safety of chloroquine (CQ) and hydroxychloroquine (HCQ) with or without Azithromycin for treating COVID-19, and to update the evidence using a meta-analysis. METHODS: A comprehensive search was carried out in electronic databases for systematic reviews, meta-analyses and experimental studies which investigated the efficacy and safety of CQ, HCQ with or without Azithromycin to treat COVID-19. Findings from the reviews were synthesised using tables and forest plots and the quality effect model was used for the updated meta-analysis. The main outcomes were mortality, the need for intensive care services, disease exacerbation, viral clearance and occurrence of adverse events. RESULTS: Thirteen reviews with 40 primary studies were included. Two meta-analyses reported a high risk of mortality, with ORs of 2.2 and 3.0, and the two others found no association between HCQ and mortality. Findings from two meta-analyses showed that HCQ with Azithromycin increased the risk of mortality, with similar ORs of 2.5. The updated meta-analysis of experimental studies showed that the drugs were not effective in reducing mortality (RR 1.1, 95%CI 1.0–1.3, I(2) = 0.0%), need for intensive care services (OR 1.1, 95%CI 0.9–1.4, I(2) = 0.0%), virological cure (OR 1.5, 95%CI 0.5–4.4, I(2) = 39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3–5.9, I(2) = 31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5–59.9, I(2) = 76.6%). CONCLUSION: There is conclusive evidence that CQ and HCQ, with or without Azithromycin are not effective in treating COVID-19 or its exacerbation. REGISTRATION: PROSPERO: CRD42020191353.