Efficacy of chloroquine and hydroxychloroquine in treating COVID-19 infection: a meta-review of systematic reviews and an updated meta-analysis

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, I 2 =0.0%), need for intensive care services (OR 1.1, 95%CI 0.9-1.4, I 2 =0.0%), virological cure (OR 1.5, 95%CI 0.5-4.4, I 2 =39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3-5.9, I 2 =31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5-59.9, I 2 =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