Evidence map›Paper›PMID 32860962›Full record

SynthesisClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2021

Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis.

Thibault Fiolet, Anthony Guihur, Mathieu Edouard Rebeaud, Matthieu Mulot, Nathan Peiffer-Smadja, Yahya Mahamat-Saleh

Open access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 176 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
176citing papers in PubMed, 14 pooled it
7.1field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

176 citing papers in PubMed, 14 syntheses or guidelines pooled it, 311 citations in OpenAlex.

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  4. The Association Between the Use of Statins and Clinical Outcomes in Patients with COVID-19: A Systematic Review and Meta-analysis.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2022
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  12. Chloroquine or hydroxychloroquine for prevention and treatment of COVID-19.The Cochrane database of systematic reviews · 2021
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  13. Bayesian meta-analysis now - let's do it.Croatian medical journal · 2020
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  17. Hydroxychloroquine in mild-to-moderate coronavirus disease 2019: a placebo-controlled double blind trial.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021
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116 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 3 countries.

Thibault FioletCESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France. Electronic address: Thibault.fiolet@gustaveroussy.fr.
Anthony GuihurDepartment of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland.
Mathieu Edouard RebeaudDepartment of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland.
Matthieu MulotLaboratory of Soil Biodiversity, Faculty of Science, University of Neuchâtel, Switzerland.
Nathan Peiffer-SmadjaUniversité de Paris, IAME, INSERM, Paris, France; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France.
Yahya Mahamat-SalehCESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France.
University of Lausanne · CHCentre de recherche en Epidémiologie et Santé des Populations · FRImperial College London · GBInstitut Gustave Roussy · FRUniversity of Neuchâtel · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHydroxychloroquine or chloroquine with or without azithromycin have been widely promoted to treat coronavirus disease 2019 (COVID-19) following early in vitro antiviral effects against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

objectiveThe aim of this systematic review and meta-analysis was to assess whether chloroquine or hydroxychloroquine with or without azithromycin decreased COVID-19 mortality compared with the standard of care. DATA SOURCES: PubMed, Web of Science, Embase Cochrane Library, Google Scholar and MedRxiv were searched up to 25 July 2020. STUDY ELIGIBILITY CRITERIA: We included published and unpublished studies comparing the mortality rate between patients treated with chloroquine or hydroxychloroquine with or without azithromycin and patients managed with standard of care.

participantsPatients ≥18 years old with confirmed COVID-19.

interventionsChloroquine or hydroxychloroquine with or without azithromycin.

methodsEffect sizes were pooled using a random-effects model. Multiple subgroup analyses were conducted to assess drug safety.

resultsThe initial search yielded 839 articles, of which 29 met our inclusion criteria. All studies except one were conducted on hospitalized patients and evaluated the effects of hydroxychloroquine with or without azithromycin. Among the 29 articles, three were randomized controlled trials, one was a non-randomized trial and 25 were observational studies, including 11 with a critical risk of bias and 14 with a serious or moderate risk of bias. After excluding studies with critical risk of bias, the meta-analysis included 11 932 participants for the hydroxychloroquine group, 8081 for the hydroxychloroquine with azithromycin group and 12 930 for the control group. Hydroxychloroquine was not significantly associated with mortality: pooled relative risk (RR) 0.83 (95% CI 0.65-1.06, n = 17 studies) for all studies and RR = 1.09 (95% CI 0.97-1.24, n = 3 studies) for randomized controlled trials. Hydroxychloroquine with azithromycin was associated with an increased mortality (RR = 1.27; 95% CI 1.04-1.54, n = 7 studies). We found similar results with a Bayesian meta-analysis.

conclusionHydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients but the combination of hydroxychloroquine and azithromycin significantly increased mortality.

Indexed as

COVID-19 Drug TreatmentAntiviral AgentsAzithromycinBayes TheoremBiasChloroquineCOVID-19Drug RepositioningHumansHydroxychloroquineRiskSARS-CoV-2Standard of CareSurvival AnalysisAntiviral AgentsAzithromycinChloroquineHydroxychloroquineAzithromycinChloroquineCoronavirusCoronavirus disease 2019HydroxychloroquineMeta-analysisMortalitySevere acute respiratory syndrome coronavirus 2

Identifiers

PMID32860962
PMCPMC7449662
OpenAlexW3080857519

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.