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Is (hydroxychloroquine) an (effective treatment) for (adults infected with COVID-19)?
A 55-year-old man attends the ED with worsening breathlessness having had a positive COVID-19 swab in the community 6 days ago. You wonder if initiation of hydroxychloroquine treatment will be effective?
Ovid Medline 2016 to June week 1 2020, EMBASE 1974 to 2020 June were both searched and hand searched for literature. The following search strategy was used:
[exp hydroxychloroquine OR hydroxychloroquine$.mp] AND [(exp coronavirus) OR (corona$.mp) OR (exp covid-19) OR (exp covid-19 19) OR (covid-19$.mp) OR (SARS$.mp)]
Limit to English, and year of publication after 2019.
Ovid Medline produced 675 results and EMBASE revealed 94 results of which nine papers were considered relevant (see table 2).
The literature review found nine relevant studies, five randomised controlled trials (RCTs), two observational studies and a single-centre single-arm study. A reanalysis of an original trial has also been included which demonstrated no effect in contrast to the original analysis. It is significant that two of these trials have been stopped before completion, one due to significant safety concerns with hydroxychloroquine and another because no benefit was found. The trials that looked at mortality as an outcome showed variable results, with the largest multicentre RCT showing no statistical difference. A number of trials used non-patient-centred outcomes such as the development of negative COVID-19 swabs, while the Huang et al study did show a significant reduction in time to undetectable RNA, this is not clinically significant for the patient. None of the papers demonstrated strong statistical evidence that length of stay, ITU admissions or mortality are reduced by treatment with hydroxychloroquine.
Clinical bottom line
Hydroxychloroquine has not been proven to be an effective treatment for COVID-19.
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