Hydroxychloroquine with or without Macrolide and Standard of Care versus Standard of Care Alone for COVID-19 Cases: A Systematic Review and Meta-Analysis

Abstract

Background: The specific treatment has not yet been approved for the therapy of COVID-19 pandemic. In this review, we aimed at assessing the role of hydroxychloroquine with/without macrolide in terms of efficacy and adverse effects against the standard of care (SOC).
 Methods: PubMed, Medline, Google Scholar, Cochrane Library, and Clinicaltrials.gov were searched for the quantitative and qualitative synthesis of 13 studies using PRISMA guidelines. Assessment of heterogeneity was done using I-squared (I2) test and fixed/random effect analysis was done to determine the odds/risk ratio among selected studies.
 Results: Our study demonstrated no significant differences in improvement for virological cure (RR 0.95, 0.67-1.34), whereas a significant relationship was there in radiological progression (RR 1.40, 1.03-1.91) between the two arms. There are 1.52 times the odds of intubation during treatment (CI 0.61-3.77), 1.08 times the risk of mortality (CI 0.65-1.79), and about 2.21 times increased risk of development of adverse effect (OR 2.21, 0.95-5.17). Among randomized controlled trials, the treatment group has 3.5 times (OR 3.48, 1.64-7.42) higher risk of developing adverse effects. There is 2.5 times the likelihood of severe arrhythmias and QT prolongation (OR 2.49, 1.67-3.70) on the treatment arm compared to control.
 Conclusions: Hydroxychloroquine with/without macrolide demonstrated no beneficial effect in viral clearance and survival rates while showed significant relation in radiological improvement compared to SOC. The increased risk of intubation, overall side effects, and cardiac complications like arrhythmias and QT prolongation suggests utilizing such treatment to be judged with clinical relevance and proper monitoring.