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, I² = 0.0%), need for intensive care services (OR 1.1, 95%CI 0.9–1.4, I² = 0.0%), virological cure (OR 1.5, 95%CI 0.5–4.4, I² = 39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3–5.9, I² = 31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5–59.9, I² = 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.

中文翻译：

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氯喹和羟氯喹治疗 COVID-19 感染的功效：系统评价的荟萃回顾和更新的荟萃分析

 客观的

综合关于氯喹 (CQ) 和羟氯喹 (HCQ) 联合或不联合阿奇霉素治疗 COVID-19 的有效性和安全性的系统评价和荟萃分析结果，并使用荟萃分析更新证据。

 方法

在电子数据库中进行了系统评价、荟萃分析和实验研究的全面检索，研究了 CQ、HCQ 联合或不联合阿奇霉素治疗 COVID-19 的有效性和安全性。使用表格和森林图综合了评论的结果，并使用质量效应模型进行更新的荟萃分析。主要结局是死亡率、重症监护服务的需求、疾病恶化、病毒清除和不良事件的发生。

 结果

纳入了 13 项综述和 40 项初步研究。两项荟萃分析报告了高死亡风险，OR 分别为 2.2 和 3.0，另外两项荟萃分析发现 HCQ 与死亡率之间没有关联。两项荟萃分析的结果表明，HCQ 联合阿奇霉素会增加死亡风险，相似的 OR 为 2.5。最新的实验研究荟萃分析表明，这些药物不能有效降低死亡率（RR 1.1，95% CI 1.0–1.3，I ² = 0.0%）、重症监护服务需求（OR 1.1，95% CI 0.9– 1.4，I ² = 0.0%），病毒学治愈（OR 1.5，95%CI 0.5–4.4，I ² = 39.6%）或疾病恶化（OR 1.2，95%CI 0.3–5.9，I ² = 31.9%），但增加不良事件的发生率（OR 12,3，95%CI 2.5–59.9，I ² = 76.6%）。

 结论

有确凿的证据表明，CQ 和 HCQ，无论联合或不联合阿奇霉素，都不能有效治疗 COVID-19 或其恶化。

 登记

普洛斯彼罗：CRD42020191353。