Hydroxychloroquine is effective, and consistently so when provided early, for COVID-19: a systematic review
C Prodromos, T Rumschlag
doi:10.1016/j.nmni.2020.100776
Hydroxychloroquine (HCQ) has shown efficacy against coronavirus disease 2019 (COVID-19) in some but not all studies. We hypothesized that a systematic review would show HCQ to be effective against COVID-19, more effective when provided earlier, not associated with worsening disease and safe. We searched PubMed, Cochrane, Embase, Google Scholar and Google for all reports on HCQ as a treatment for COVID-19 patients. This included preprints and preliminary reports on larger COVID-19 studies. We examined the studies for efficacy, time of administration and safety. HCQ was found to be consistently effective against COVID-19 when provided early in the outpatient setting. It was also found to be overall effective in inpatient studies. No unbiased study found worse outcomes with HCQ use. No mortality or serious safety adverse events were found. HCQ is consistently effective against COVID-19 when provided early in the outpatient setting, it is overall effective against COVID-19, it has not produced worsening of disease and it is safe.
Conflict of interest None declared.
References
Ada, Tavelli, Bai, Marchetti, Cozzi-Lepri, Effectiveness of hydroxychloroquine in COVID-19 disease: a done and dusted situation?, Int J Infect Dis
Ahmad, Alam, Saadi, Mahmud, Saadi, Doxycycline and hydroxychloroquine as treatment for high-risk COVID-19 patients: experience from case series of 54 patients in long-term care facilities, medRxiv
An, Kim, Kim, Kang, Kimn et al., Treatment response to hydroxychloroquine and antibiotics for mild to moderate COVID-19: a retrospective cohort study from South Korea, medRxiv
Arshad, Kilgore, Chaudhry, Jacobsen, Wang et al., Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19, Int J Infect Dis
Ashraf, Shokouhi, Shirali, Davari-Tanha, Memar et al., COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes
Bernaola, Mena, Bernaola, Lara, Carballo et al., Observational study of the efficiency of treatments in patients hospitalized with Covid-19 in
Carlucci, Ahuja, Petrilli, Rajagopalan, Jones et al., Hydroxychloroquine and azithromycin plus zinc vs. hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients, medRxiv
Cavalcanti, Zampieri, Azevedo, Rosa, Avezum et al., infection (COVID-19): rationale and design of a randomised, controlled clinical trial
Chen, Hu, Zhang, Jiang, Han et al., Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial, medRxiv
Davido, Boussaid, Vaugier, Lansaman, Bouchand et al., Impact of medical care including anti-infective agents use on the prognosis of COVID-19 hospitalized patients over time, Int J Antimicrob Agents
De Novales, Ramírez-Olivencia, Estébanez, De Dios, Herrero et al., Early hydroxychloroquine is associated with an increase of survival in COVID-19 patients: an observational study, Preprints,
doi:10.20944/preprints202005.0057.v1Drugs, Hydroxychloroquine prices, coupons, and patient assistance programs
Duan, Liu, Li, Zhang, Yu et al., Effectiveness of convalescent plasma therapy in severe COVID-19 patients, Proc Natl Acad Sci U S A
Esper, Da Silva, Oikawa, Castro, Razuk-Filho, Empirical treatment with hydroxychloroquine and azithromycin for suspected cases of COVID-19 followed-up by telemedicine
Gautret, Lagier, Parola, Meddeb, Mailhe et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents
Gautret, Lagier, Parola, Meddeb, Sevestre et al., Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: a pilot observational study, Travel Med Infect Dis
Geleris, Sun, Platt, Zucker, Baldwin et al., Observational study of hydroxychloroquine in hospitalized patients with Covid-19, N Engl J Med
Giacomelli, Pagani, Ridolfo, Oreni, Conti et al., Early administration of lopinavir/ritonavir plus hydroxychloroquine does not alter the clinical course of SARS-CoV-2 infection: a retrospective cohort study, medRxiv
Gumbien, Fox, Two coronavirus studies retracted after questions emerge about data, CNN
Guérin, Lévy, Thomas, Lardenois, Lacrosse et al., Azithromycin and hydroxychloroquine accelerate recovery of outpatients with mild/moderate COVID-19, Asian J Med Health
Horby, Mafham, Linsell, Bell, Staplin et al., Effect of hydroxychloroquine in hospitalized patients with COVID-19: preliminary results from a multi-centre, randomized, controlled trial, medRxiv
Ip, Berry, Hansen, Goy, Pecora et al., Hydroxychloroquine and tocilizumab therapy in COVID-19 patients-an observational study, medRxiv
Kalligeros, Shehadeh, Atalla, Mylona, Aung et al., Hydroxychloroquine use in hospitalized patients with COVID-19: an observational matched cohort study, J Glob Antimicrob Resist
Kim, Jang, Park, Kim, Hwang et al., Treatment response to hydroxychloroquine, lopinavir/ritonavir, and antibiotics for moderate COVID 19: a first report on the pharmacological outcomes from South Korea, medRxiv
Kim, Kim, Kwon, Jung, Kim et al., Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease, Korean J Intern Med
Lagier, Million, Gautret, Colson, Cortaredona et al., Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: a retrospective analysis, Travel Med Infect Dis
Lopez, Duclos, Pastene, Bezulier, Guilhaumou et al., Effects of hydroxychloroquine on Covid-19 in intensive care unit patients: preliminary results, Int J Antimicrob Agents
Lupkin, Remdesivir priced at more than $3,100 for a course of treatment, NPR
Magagnoli, Narendran, Pereira, Cummings, Hardin et al., Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19, Med
Mahevas, Tran, Roumier, Chabrol, Paule et al., No evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COVID-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial, medRxiv
Mallat, Hamed, Balkis, Mohamed, Mooty et al., Hydroxychloroquine is associated with slower viral clearance in clinical COVID-19 patients with mild to moderate disease: a retrospective study, medRxiv
Million, Lagier, Gautret, Colson, Fournier et al., Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: a retrospective analysis of 1061 cases in Marseille, France, Travel Med Infect Dis
Mitjà, Corbacho-Monné, Ubals, Tebe, Peñafiel et al., Hydroxychloroquine for early treatment of adults with mild COVID-19: a randomized-controlled trial, Clin Infect Dis
Molina, Delaugerre, Goffj, Lima, Ponscarme et al., No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection, Med Mal Infect
Nmni Prodromos, Rumschlag HCQ in COVID-19
Nmni Prodromos, Rumschlag HCQ in COVID-19
Paccoud, Tubach, Baptiste, Bleibtreu, Hajage et al., Compassionate use of hydroxychloroquine in clinical practice for patients with mild to severe Covid-19 in a French university hospital, Clin Infect Dis
Prodromos, Hydroxychloroquine is protective to the heart, not harmful: a systematic review, New Microbe. New Infect
Recovery Collaborative Group, Horby, Lim, Emberson, Mafham et al., Dexamethasone in hospitalized patients with Covid-19-preliminary report, N Engl J Med
Rivera, Peters, Panagiotou, Shah, Kuderer et al., Utilization of COVID-19 treatments and clinical outcomes among patients with cancer: a COVID-19 and Cancer Consortium (CCC19) cohort study, Cancer Discov
Rosenberg, Dufort, Udo, Wilberschied, Kumar et al., Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State, JAMA
Sbidian, Josse, Lemaitre, Mayer, Bernaux et al., Hydroxychloroquine with or without azithromycin and in-hospital mortality or discharge in patients hospitalized for COVID-19 infection: a cohort study of 4,642 in-patients in France
Scholz, Derwand, Zelenko, COVID-19 outpatients-early riskstratified treatment with zinc plus low dose hydroxychloroquine and azithromycin: a retrospective case series study, Preprints,
doi:10.20944/preprints202007.0025.v1Singh, Khan, Chowdhry, Chatterjee, Outcomes of hydroxychloroquine treatment among hospitalized COVID-19 patients in the United States-real-world evidence from a federated electronic medical record network, medRxiv
Skipper, Pastick, Engen, Bangdiwala, Abassi et al., Hydroxychloroquine in nonhospitalized adults with early COVID-19: a randomized trial, Ann Intern Med
Spinner, Gottlieb, Criner, López, Cattelan et al., Effect of remdesivir vs. standard care on clinical status at 11 days in patients with moderate COVID-19: a randomized clinical trial, JAMA
Tang, Cao, Han, Wang, Chen et al., Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial, BMJ
Xue, Liu, Luo, Liu, Qiu et al., Hydroxychloroquine treatment in COVID-19: a descriptive observational analysis of 30 cases from a single center in Wuhan, China, J Med Virol
Yu, Li, Chen, Li, Jiang et al., Beneficial effects exerted by hydroxychloroquine in treating COVID-19 patients via protecting multiple organs, Sci China Life Sci
Yu, Li, Chen, Zhou, Wang et al., Low dose of hydroxychloroquine reduces fatality of critically ill patients with COVID-19, Sci China Life Sci
Zelenko, Open letter describing Covid-19 treatment protocol
