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Sarma P, Kaur H, Kumar H, et al. Virological and clinical cure in COVID-19 patients treated with hydroxychloroquine: A systematic review and meta-analysis. J Med Virol. 2020 Apr 16. doi: 10.1002/jmv.25898. (Systematic review)
Abstract

Following the demonstration of the efficacy of hydroxychloroquine against severe acute respiratory syndrome coronavirus 2 in vitro, many trials started to evaluate its efficacy in clinical settings. However, no systematic review and meta-analysis have addressed the issue of the safety and efficacy of hydroxychloroquine (HCQ) in coronavirus disease 2019. We conducted a systematic review and meta-analysis with the objectives of evaluation of safety and efficacy of HCQ alone or in combination in terms of "time to clinical cure," "virological cure," "death or clinical worsening of disease," "radiological progression," and safety. RevMan was used for meta-analysis. We searched 16 literature databases out of which seven studies (n = 1358) were included in the systematic review. In terms of clinical cure, two studies reported possible benefit in "time to body temperature normalization" and one study reported less "cough days" in the HCQ arm. Treatment with HCQ resulted in less number of cases showing the radiological progression of lung disease (odds ratio [OR], 0.31, 95% confidence interval [CI], 0.11-0.9). No difference was observed in virological cure (OR, 2.37, 95% CI, 0.13-44.53), death or clinical worsening of disease (OR, 1.37, 95% CI, 1.37-21.97), and safety (OR, 2.19, 95% CI, 0.59-8.18), when compared with the control/conventional treatment. Five studies reported either the safety or efficacy of HCQ + azithromycin. Although seems safe and effective, more data are required for a definitive conclusion. HCQ seems to be promising in terms of less number of cases with radiological progression with a comparable safety profile to control/conventional treatment. We need more data to come to a definite conclusion.

Ratings
Discipline Area Score
Hospital Doctor/Hospitalists 6 / 7
Internal Medicine 6 / 7
Infectious Disease 6 / 7
Public Health 5 / 7
Pediatrics (General) 5 / 7
Family Medicine (FM)/General Practice (GP) 4 / 7
General Internal Medicine-Primary Care(US) 4 / 7
Intensivist/Critical Care Coming Soon...
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

The methodology is correct, but the conclusion is very weak.

Infectious Disease rater

Good review but with a lack of conclusive and helpful studies inclued. Waiting for an RCT.

Pediatrics (General) rater

Only a few studies included, so probably not worth a meta-analysis, plus the information is already outdated.

Public Health rater

This review was of poor quality with inadequate information retrieved from the original RCTs found. No quantitative synthesis was performed for observational studies (mostly, case series) either.

Public Health rater

This study synthesizes what is known about treatment of COVID-19 with hydroxychloroquine, but the answer is still "it might work". They find a significant benefit with radiological improvement but not much else. While the authors say they follow the PRISMA guidelines for reporting, the study was not prospectively registered in PROSPERO, which is the state of the art for systematic reviews. Not only does this raise questions about bias being introduced, it opens additional questions on the soundness of their methods. There is an ongoing review registered in PROSPERO on the same topic.
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