The efficacy and safety of hydroxychloroquine in treatment of COVID-19-a systemic review and meta-analysis

Introduction: The treatment of SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) also known as COVID-19 (coronavirus disease 2019) continues to remain an enigma even after six months of the pandemic Hydroxychloroquine (HCQ) has been one of the most widely tested drugs for SARS-CoV-2 on account of its antiviral properties However, the results so far have been far from categorical The meta-analyzes conducted to date are also lacking in precision and appropriateness This systematic review and meta-analysis addresses the efficacy and safety of HCQ in SARS-CoV-2 by overcoming the limitations of earlier meta-analysis Materials and methods: A total of five prominent medical databases were searched and fourteen studies (n = 12,455) were included in the systematic review and metaanalyzes The data on survival, alleviation of symptoms, conversion of RT-PCR positivity to negativity, use and efficacy in presence of comorbidities (hypertension, diabetes, and heart disease), and cardiac and gastrointestinal side effects were extracted Metaanalysis was applied to calculate the pooled estimates Fixed-effects model results were chosen since I2 was <25% Meta-analysis was conducted using STATA version 13 (StataCorp LP, College Station, TX, USA) Results: The pooled estimates showed that HCQ treatment did not significantly affect survival at 14 and 28 days in COVID-19 patients with respect to the control population (RR: 1 003, 95% CI: 0 98-1 02), alleviation of symptoms at day 10 (RR: 1 04, 95% CI: 0 91-1 19), success in presence of co-morbidities (RR: 1 06, 95% CI: 1 04-1 08) and conversion from RT PCR positive to RT PCR negative on day 6 (RR:1 12, 95% CI: 1 04-1 21) There was higher risk for cardiac side effects (RR: 2 01, 95% CI: 1 43-2 83) and gastrointestinal side effects (RR: 1 32, 95% CI: 0 73-2 38) in HCQ recipients Discussions: Our study is the most recent update on the safety and efficacy of HCQ in SARS-CoV-2 infection and an in-depth analysis of its survival benefits and alleviation of symptoms This large systematic review and meta-analysis of 12,455 patients encompassing 14 studies has clearly demonstrated the lack of benefit of HCQ treatment for SARS-CoV-2 infection It has additionally found higher cardiovascular side effects in the recipients of HCQ It has assessed the benefits of using HCQ in the presence of heart disease, hypertension, and diabetes which no other meta-analysis has investigated so far It has found that use of this drug is used more commonly in patients with these diseases but did not improve the outcome as compared to control Conclusion: There is no evidence on the safety and efficacy of HCQ either alone or in combination with other drug treatments in SARS-CoV-2 infection