Hydroxychloroquine in the treatment of coronavirus disease 2019: Rapid updated systematic review and meta‐analysis

Abstract

Summary Coronavirus disease 2019 (COVID‐19) caused by the novel severe acute respiratory syndrome coronavirus 2 continues to grow and spread throughout the world since being declared a pandemic. Despite extensive scientific research globally including repurposing of several existing drugs, there is no effective or proven therapy for this enigmatic disease which is still largely managed empirically This systematic review evaluated the role of hydroxychloroquine (HCQ) in the treatment of COVID‐19 infection and was conducted using Cochrane methodology for systematic reviews of interventional studies including risk of bias assessment and grading of the quality of evidence. Only prospective clinical trials randomly assigning COVID‐19 patients to HCQ plus standard of care therapy (test arm) versus placebo/standard of care (control arm) were included. Data were pooled using the random‐effects model and expressed as risk ratio (RR) with 95% confidence interval (CI). A total of 10,492 patients from 19 randomised controlled trials were included. The use of HCQ was not associated with higher rates of clinical improvement (RR = 1.00, 95% CI: 0.96–1.03, p = 0.79) or reduction in all‐cause mortality by Day14 (RR = 1.07, 95% CI: 0.97–1.19, p = 0.19) or Day28 (RR = 1.08, 95% CI: 0.99–1.19, p = 0.09) compared to placebo/standard of care. There was no significant difference in serious adverse events between the two arms (RR = 1.01, 95% CI: 0.85–1.19, p = 0.95). There is low‐to‐moderate certainty evidence that HCQ therapy is generally safe but does not reduce mortality or enhance recovery in patients with COVID‐19 infection.

Hydroxychloroquine induces apoptosis of myeloid-derived suppressor cells via up-regulation of CD81 contributing to alleviate lupus symptoms

“…Hydroxychloroquine (HCQ), belongs to the 4­aminoquinolines class with antimalarial activity and an immunomodulatory effect (Schrezenmeier and Dörner 2020 ; Munguía-Realpozo et al, 2021 ; Gupta et al 2022 ). It has also been used clinically in the treatment of systemic lupus erythematosus (SLE) (Costedoat-Chalumeau et al 2014 ; Broder et al 2021 ), downregulating pro-inflammatory cytokines and immunoglobulin, eliminating autoreactive lymphocytes, ultimately improves patient survival and relieves severe lupus symptoms (Takamasu et al 2019 ; Ponticelli and Moroni 2017 ; Willis et al 2012 ; Rainsford et al 2015 ).…”

Baseline NT-proBNP levels as a predictor of short-and long-term prognosis in COVID-19 patients: a prospective observational study

“…In our cohort, while differences were observed in the administration of hydroxychloroquine or corticosteroids among those with baseline high or low NT-proBNP values, subsequent studies have revealed that the use of hydroxychloroquine in the acute phase does not reduce mortality [ 33 – 34 ], nor do corticosteroids benefit non-severe patients [ 33 , 35 ]. As a result, their widespread use is no longer recommended.…”

COVID-19 in patients with systemic lupus erythematosus: A systematic review

“… 68 Previous meta-analysis has proved that although HCQ treatment is safe, it could not decrease mortality or promote clinical/virological recovery in COVID-19 patients. 69 Whereas the evidence supporting the HCQ treatment for COVID-19 is not clear, HCQ has shown great efficacy against immune-mediated diseases. Therefore, physicians and individuals should avoid misuse of HCQ for the prophylaxis of COVID-19.…”