BACKGROUND: Hydroxychloroquine and chloroquine are widely used to treat hospitalized COVID-19 patients primarily based on antiviral activity in in vitro studies. Our objective was to systematically evaluate their efficacy and safety in hospitalized patients with COVID-19. METHODS: We systematically reviewed PubMed, ClinicalTrials.gov, and Medrxviv for studies of hydroxychloroquine and chloroquine in COVID-19 hospitalized patients on April 26, 2020. We evaluated the quality of trials and observational studies using the Jadad criteria and Newcastle Ottawa Scale, respectively. RESULTS: After a review of 175 citations, we included 5 clinical trials (total of 345 patients), 9 observational studies (n = 2529), and 6 additional studies (n = 775) reporting on the QT interval. Three studies reported treatment benefits including two studies reporting benefit on virologic outcomes, which was statistically significant in one study, and another reported significant improvement on cough symptoms. Three studies reported that treatment was potentially harmful, including an significantly increased risk of mortality in two studies and increased need for respiratory support in another. Eight studies were unable to detect improvements on virologic outcomes (n = 3) or pneumonia or transfer to ICU/death (n = 5). The proportion of participants with critical QTc intervals of ≥ 500 ms or an increase of ≥ 60 ms from baseline ranged from 8.3% to 36% (n = 8). One clinical trial and six observational studies were of good quality. The remaining studies were of poor quality. CONCLUSIONS: Our systematic review of reported clinical studies did not identify substantial evidence to support the efficacy of hydroxychloroquine or chloroquine in hospitalized COVID-19 patients and raises questions about potential harm from QT prolongation and increased mortality.

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羟氯喹和氯喹对COVID-19的疗效和安全性：系统评价

背景：羟氯喹和氯喹主要基于体外研究中的抗病毒活性而广泛用于治疗住院的COVID-19患者。我们的目标是系统评估其在住院的COVID-19患者中的疗效和安全性。方法：我们系统地审查了PubMed，ClinicalTrials.gov和Medrxviv在2020年4月26日对COVID-19住院患者的羟氯喹和氯喹的研究。我们分别使用Jadad标准和纽卡斯尔渥太华量表评估了试验和观察性研究的质量。 。结果：在对175次引用进行了回顾之后，我们纳入了5项临床试验（总计345例患者），9项观察性研究（n = 2529）和6项关于QT间隔的其他研究（n = 775）。三项研究报告了治疗的益处，其中两项研究报告了病毒学结果的获益，一项研究在统计学上具有统计学意义，另一项报告表明咳嗽症状得到了显着改善。三项研究报告说，治疗可能有害，其中两项研究显着增加了死亡风险，另一项研究则增加了对呼吸支持的需求。八项研究无法检测到病毒学结果（n = 3）或肺炎或转入ICU /死亡（n = 5）的改善。关键QTc间隔≥500 ms或比基线增加≥60 ms的参与者比例在8.3％至36％之间（n = 8）。一项临床试验和六项观察性研究质量良好。其余研究质量较差。结论：