• Amir Shamshirian, Amirhossein Hessami, Keyvan Heydari, Reza Alizadeh Navaei, Mohammad Ali Ebrahimzadeh, George W Yip, Roya Ghasemian, Meghdad Sedaghat, Hananeh Baradaran, Soheil Mohammadi Yazdi, Elham Aboufazeli, Hamed Jafarpour, Ehsan Dadgostar, Behnaz Tirandazi, Reza Sadeghnezhad, Keyvan Karimifar, Aida Eftekhari, and Danial Shamshirian.
• Department of Medical Laboratory Sciences, Student Research Committee, School of Allied Medical Science, Mazandaran University of Medical Sciences, Sari, Iran.
• Ann Acad Med Singap. 2020 Oct 1; 49 (10): 789-800.

ObjectiveA systematic review and meta-analysis was carried out to examine the role of hydroxychloroquine (HCQ) in the treatment of COVID-19.MethodsWe performed a systematic search in PubMed, Scopus, Embase, CochraneLibrary, Web of Science, Google Scholar, and medRxiv pre-print databases using available MeSH terms for COVID-19 and hydroxychloroquine. Data from all studies that focused on the effectiveness of HCQ with or without the addition of azithromycin (AZM) in confirmed COVID-19 patients, which were published up to 12 September 2020, were collated for analysis using CMA v.2.2.064.ResultsOur systematic review retrieved 41 studies. Among these, 37 studies including 45,913 participants fulfilled the criteria for subsequent meta-analysis. The data showed no significant difference in treatment efficacy between the HCQ and control groups (RR: 1.02, 95% CI, 0.81-1.27). Combination of HCQ with AZM also did not lead to improved treatment outcomes (RR: 1.26, 95% CI, 0.91-1.74). Furthermore, the mortality difference was not significant, neither in HCQ treatment group (RR: 0.86, 95% CI, 0.71-1.03) nor in HCQ plus AZM treatment group (RR: 1.28, 95% CI, 0.76-2.14) in comparison to controls. Meta-regression analysis showed that age was the factor that significantly affected mortality (P<0.00001).ConclusionThe meta-analysis found that there was no clinical benefit of using either HCQ by itself or in combination with AZM for the treatment of COVID-19 patients. Hence, it may be prudent for clinicians and researchers to focus on other therapeutic options that may show greater promise in this disease.

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