Hydroxychloroquine has been promoted for its use in treatment of COVID-19 patients based on in-vitro evidences. We searched the databases to include randomized and observational studies evaluating the effect of Hydroxychloroquine on mortality in COVID-19 patients. The outcome was summarized as odds ratios (OR) with a 95% confidence interval (CI).We used the inverse-variance method with a random effect model and assessed the heterogeneity using I2 test. We used ROBINS-I tool to assess methodological quality of the included studies. We performed the meta-analysis using 'Review manager software version 5.3'. We identified 6 observationalstudies satisfying the selection criteria. In all studies, Hydroxychloroquine was given as add on to the standard care and effect was compared with the standard care alone. A pooled analysis observed 251 deaths in 1331 participants of the Hydroxychloroquine arm and 363 deaths in 1577 participants of the control arm. There was no difference in odds of mortality events amongst Hydroxychloroquine and supportive care arm [1.25 (95% CI: 0.65, 2.38); I2 = 80%]. A similar trend was observed with moderate risk of bias studies [0.95 (95% CI: 0.44, 2.06); I2 = 85%]. The odds of mortality were significantly higher in patients treated with Hydroxychloroquine + Azithromycin than supportive care alone [2.34 (95% CI: 1.63, 3.34); I2 = 0%]. A pooled analysis of recently published studies suggests no additional benefit for reducing mortality in COVID-19 patients when Hydroxychloroquine is given as add-on to the standard care. Graphical Abstract.

译文

基于体外证据,羟氯喹已被推广用于新型冠状病毒肺炎患者。我们搜索了数据库,包括评估羟氯喹对新型冠状病毒肺炎患者死亡率影响的随机和观察性研究。结果总结为具有95% 置信区间 (CI) 的优势比 (OR)。我们使用具有随机效应模型的逆方差方法,并使用I2检验评估异质性。我们使用ROBINS-I工具评估纳入研究的方法学质量。我们使用 “审查管理器软件版本5.3” 进行了荟萃分析。我们确定了6项符合选择标准的观察性研究。在所有研究中,将羟氯喹作为标准护理的补充,并将效果与单独的标准护理进行比较。汇总分析观察到羟氯喹组1331例参与者的251例死亡和对照组1577例参与者的363例死亡。羟氯喹和支持性护理组的死亡事件发生率无差异 [1.25 (95% CI: 0.65,2.38); I2 =   80%]。在中等偏倚风险研究中观察到类似的趋势 [0.95 (95% CI: 0.44,2.06); I2 =   85%]。羟氯喹 + 阿奇霉素治疗患者的死亡率显著高于单独支持治疗 [2.34 (95% CI: 1.63,3.34); I2 =   0%]。对最近发表的研究的汇总分析表明,当羟氯喹作为标准护理的补充时,对于降低新型冠状病毒肺炎患者的死亡率没有额外的益处。图形摘要。

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