Chloroquine and hydroxychloroquine effectiveness in human subjects during coronavirus: a systematic review

  1. Salman Rawaf
  2. Mohammed N Al-Saffar
  3. Harumi Quezada-Yamamoto
  4. Mashael Alshaikh
  5. Michael Pelly
  6. David Rawaf
  7. Elizabeth Dubois
  8. Azeem Majeed

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Abstract

In a search to find effective treatments for COVID-19, chloroquine and hydroxychloroquine have gained attention. We aim to provide evidence to support clinical decision-making regarding medication for the treatment of COVID-19 by carrying out a systematic review of the literature. The electronic databases MEDLINE, EMBASE, Global Health, and HMIC were searched up to April 2020. Eligible study outcomes included: extubation or patient recovery. Relevant data were extracted and analysed by narrative synthesis. Our results included six studies in the review of which four studies were of good or fair quality. All eligible studies included were for coronavirus involving the use of either chloroquine or hydroxychloroquine to treat common symptoms such as fever, cough, shortness of breath and fatigue. Outcomes most commonly reported were improved lung function, viral clearance, and hospital discharge. Strong evidence to support the use of chloroquine and hydroxychloroquine in the treatment of COVID-19 is lacking. Fast track trials are riddled with bias and may not conform to rigorous guidelines which may lead to inadequate data being reported. The use of these drugs in combination with other medications may be useful but without knowing which groups they are suited for and when they may cause more harm than good.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.07.20094326: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Literature search: Literature searches with medical electronic databases were conducted for studies published from 1950 onwards: Ovid MEDLINE, EMBASE, Global Health, and HMIC.
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    The search included MeSH terms.
    MeSH
    suggested: (MeSH, RRID:SCR_004750)
    Title and abstract screening followed by full texts were performed using Covidence software against eligibility criteria.
    Covidence
    suggested: (Covidence, RRID:SCR_016484)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: To our knowledge, this systematic review is the first attempt to gather evidence from fully published studies that focus on the treatment, to date, of coronavirus outbreaks in human subjects. Contrasting to ours, previous research explores the suitability of either chloroquine or hydroxychloroquine in treating coronavirus by relying on findings from animal studies and dosage recommendations from unpublished trials. Our search identified six eligible studies. Two scored highly in the methodological quality assessment. This may be due to small sample size, unclear or absent randomisation, concealment, blinding, ambiguous research question and objectives to help readers understand the purpose of the studies. Comparison with existing literature: Two studies (15,16) outline key information on socio-demographic and clinical characteristics; both used comparison groups to test the effectiveness of the drugs. Patients were tested before hospital admission and then prior to being administered the specific dosage of chloroquine and hydroxychloroquine. In both studies, patients were monitored and given treatment for 10 days with reported outcomes focused on viral clearance and lung improvement. Our review also included a case-report (18) identifying two patients from the same household discharged from hospital following combination therapy of antibiotics and hydroxychloroquine (18). The results found no previous research on treatments using hydroxychloroquine ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.07.20094326 on medRxiv