Does Adding of Hydroxychloroquine to the Standard Care Provide any Benefit in Reducing the Mortality among COVID-19 Pati
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INVITED REVIEW
Does Adding of Hydroxychloroquine to the Standard Care Provide any Benefit in Reducing the Mortality among COVID-19 Patients?: a Systematic Review Tejas K. Patel 1
&
Manish Barvaliya 2 & Bhavesh D. Kevadiya 3 & Parvati B. Patel 4
&
Hira Lal Bhalla 1
Received: 22 May 2020 / Accepted: 31 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Hydroxychloroquine has been promoted for its use in treatment of COVID-19 patients based on in-vitro evidences. We searched the databases to include randomized and observational studies evaluating the effect of Hydroxychloroquine on mortality in COVID-19 patients. The outcome was summarized as odds ratios (OR) with a 95% confidence interval (CI).We used the inversevariance method with a random effect model and assessed the heterogeneity using I2 test. We used ROBINS-I tool to assess methodological quality of the included studies. We performed the meta-analysis using ‘Review manager software version 5.3’. We identified 6 observationalstudies satisfying the selection criteria. In all studies, Hydroxychloroquine was given as add on to the standard care and effect was compared with the standard care alone. A pooled analysis observed 251 deaths in 1331 participants of the Hydroxychloroquine arm and 363 deaths in 1577 participants of the control arm. There was no difference in odds of mortality events amongst Hydroxychloroquine and supportive care arm [1.25 (95% CI: 0.65, 2.38); I2 = 80%]. A similar trend was observed with moderate risk of bias studies [0.95 (95% CI: 0.44, 2.06); I2 = 85%]. The odds of mortality were significantly higher in patients treated with Hydroxychloroquine + Azithromycin than supportive care alone [2.34 (95% CI: 1.63, 3.34); I2 = 0%]. A pooled analysis of recently published studies suggests no additional benefit for reducing mortality in COVID19 patients when Hydroxychloroquine is given as add-on to the standard care.
Keywords Hydroxychloroquine . Standard care . COVID-19 . Mortality . Meta-analysis . Azithromycin
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11481-020-09930-x) contains supplementary material, which is available to authorized users. * Tejas K. Patel [email protected] 1
Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, Uttar Pradesh 273008, India
2
Department of Pharmacology, Government Medical College, Bhavnagar, Gujarat 364001, India
3
Department of Radiology, Stanford Medicine, Stanford University, Palo Alto, CA 94304, USA
4
Department of Pharmacology, GMERS Medical College, Gotri, Vadodara, Gujarat 390021, India
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has caused the pandemic of Corona Virus Disease 2019 (COVID-19). In severe cases, it results in acute respiratory distress syndrome, multi-organ failure and death (Zhou et al. 2020). Mortality rate varies from 11.0 to 28.3% of hospitalized patients (Zhou et al. 2020; Li et al. 2020). The risk of mortality
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