An umbrella review of systematic reviews with meta-analyses evaluating positive and negative outcomes of Hydroxychloroquine and chloroquine therapy

International Journal of Infectious Diseases

Shahina Pardhan¹  Jacopo Demurtas²  Erik Lagolio³  Roberto Tonelli⁴  Peter Konstantin Kurotschka⁵  Nicola Veronese⁶  Mario Barbagallo⁶  Stefano Celotto⁷  Pınar Soysal⁸  Francesca Ometto⁹  Petre Cristian Ilie^1,10  Lee Smith^1,11  Yvonne Barnett^1,12 

[1] Corresponding author at: The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK.;Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy;Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey;Department of Medical Sciences and Public Health, University of Cagliari, Italy;Emergency Medicine (A&E) - Asl2 - H Santa Corona, Pietra Ligure and First Aid, H Santa Maria Misericordia, Albenga, Italy;Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy;Primary Care Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy;Research and Innovation Department, The Queen Elizabeth Hospital Foundation Trust, King's Lynn, United Kingdom;Rheumatological Unit, Local Health Unit 1, 6, Veneto Region, Italy;School of Life Scinces, Anglia Ruskin University, Cambridge, United Kingdom;The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom;Vision and Eye Research Institute, School of Medicine, Anglia Ruskin Univerity, Cambridge, United Kingdom;

关键词: Hydroxychloroquine;    Chloroquine;    COVID-19;    umbrella review;   

DOI  :  

来源: DOAJ

【 摘 要 】

BACKGROUND & AIMS: Hydroxychloroquine (HCQ) and chloroquine (CQ) are anti-malarial drugs frequently used in the rheumatologic field. They were recently identified as potential therapeutic options for Coronavirus Disease (COVID-19). The present study aims to map and grade the diverse health outcomes associated with HCQ/CQ using an umbrella review approach. METHODS: Umbrella review of systematic reviews of observational and intervention studies. For observational studies, random-effects summary effect size, 95% confidence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence for small-study effect, and evidence for excess significance bias. The quality of evidence was then graded using validated criteria from highly convincing to weak. The evidence from randomized controlled trials (RCTs) was graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. RESULTS: From 313 articles returned in the literature search, six meta-analyses were included (n = 25 outcomes). Among meta-analyses (MAs) of observational studies, HCQ/CQ are weakly associated with a reduced risk for cardiovascular events and diabetes when used for autoimmune diseases and with spontaneous abortion; they are also associated with a higher risk of death in COVID-19 patients. Among MAs of RCTs, HCQ/CQ are associated with an improvement of articular manifestations of rheumatic diseases. CONCLUSIONS: There is high evidence of the efficacy of HCQ/CQ in the rheumatologic field. The lack of evidence for efficacy and the risk of death associated with the use of HCQ/CQ for COVID-19 indicate the inappropriateness of their inclusion in recent COVID-19 therapy guidelines and the urgent need for RCTs to determine eventual appropriateness as a COVID-19 therapy.

【 授权许可】

Unknown