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Posted on: December 2, 2021 at 11:22:53 CT
Say_What MU
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Not crap from a year ago.
Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis
Zakariya Kashour, Muhammad Riaz, Musa A Garbati, Oweida AlDosary, Haytham Tlayjeh, Dana Gerberi, M Hassan Murad, M Rizwan Sohail, Tarek Kashour, Imad M Tleyjeh
Journal of Antimicrobial Chemotherapy 76 (1), 30-42, 2021
Objectives
Clinical studies of chloroquine (CQ) and hydroxychloroquine (HCQ) in COVID-19 disease reported conflicting results. We sought to systematically evaluate the effect of CQ and HCQ with or without azithromycin on outcomes of COVID-19 patients.
Methods
We searched multiple databases, preprints and grey literature up to 17 July 2020. We pooled only adjusted-effect estimates of mortality using a random-effect model. We summarized the effect of CQ or HCQ on viral clearance, ICU admission/mechanical ventilation and hospitalization.
Results
Seven randomized clinical trials (RCTs) and 14 cohort studies were included (20 979 patients). Thirteen studies (1 RCT and 12 cohort studies) with 15 938 hospitalized patients examined the effect of HCQ on short-term mortality. The pooled adjusted OR was 1.05 (95% CI 0.96–1.15, I2 = 0%). Six cohort studies examined the effect of the HCQ+azithromycin combination with a pooled adjusted OR of 1.32 (95% CI 1.00–1.75, I2 = 68.1%). Two cohort studies and four RCTs found no effect of HCQ on viral clearance. One small RCT demonstrated improved viral clearance with CQ and HCQ. Three cohort studies found that HCQ had no significant effect on mechanical ventilation/ICU admission. Two RCTs found no effect for HCQ on hospitalization risk in outpatients with COVID-19.
Conclusions
Moderate certainty evidence suggests that HCQ, with or without azithromycin, lacks efficacy in reducing short-term mortality in patients hospitalized with COVID-19 or risk of hospitalization in outpatients with COVID-19.
View at academic.oup.com
[HTML] nih.gov
Cited by 83
Related articles
All 16 versions
researchgate.net
Hydroxychloroquine as Post-Exposure Prophylaxis for Covid-19: Why simple data analysis can lead to the wrong conclusions from well-designed studies
J Luco
ResearchGate, 2020
Researchers of the University of Minnesota Medical School reported the first prospective randomized placebo-controlled trial (RCT) in evaluating the role of hydroxychloroquine (HCQ) as post-exposure prophylaxis (PEP) against COVID‐19. The trial's primary result reported by the authors was that, within four days after moderate or high-risk exposure to Covid-19, HCQ did not show benefit over placebo to prevent illnesses compatible with Covid-19 or confirmed infection (P= 0.351, Fisher exact test). In this re-analysis, we show why the authors’ oversimplified analysis led to an incorrect conclusion from the data.
We re-analyzed the dataset by applying multiple correspondence analysis (MCA) and hierarchical cluster analysis (HCA), which are noise reduction methods used in large data sets. We used the same primary outcome measures as the authors (incidence of COVID-19-compatible disease by day 14) and the same statistical test that the authors used, such as the two-sided Fisher's exact test and others. The results obtained indicate that the individuals' age is a determining factor in the chemopreventive efficacy exerted by HCQ. Thus, in contradiction to the original authors' conclusions, the full data set's risk analysis shows that HCQ exhibits a chemopreventive effect for the group of subjects of≤ 50 yrs that does not reach significance (P= 0.083). However, not considering the analysis of the moderate-risk exposure group, we confirm that the high-risk exposure group (N= 719) demonstrates a significant effect of HCQ in the under 50 age group (p= 0.025). We also show, using MCA and the Mantel test, systematic differences between the treatment and placebo groups in their clinical characteristics, specifically asthma, and other-comorbidities which act as confounders that add noise to the data, such that the genuine effect of the drug is not seen in a standard analysis. After correcting these differences, the risk analysis showed that HCQ is also useful as a prophylactic agent for people over 50 years of age. This study, therefore, provides evidence of the necessity for higher-order analytics (such as MCA) in the presence of large data sets that include unknown confounders. In this case, it shows that the published conclusion of the group–that HCQ does not prevent COVID-type infective symptoms–was fundamentally flawed and should be reconsidered.
Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis
Zakariya Kashour, Muhammad Riaz, Musa A Garbati, Oweida AlDosary, Haytham Tlayjeh, Dana Gerberi, M Hassan Murad, M Rizwan Sohail, Tarek Kashour, Imad M Tleyjeh
Journal of Antimicrobial Chemotherapy 76 (1), 30-42, 2021
Objectives
Clinical studies of chloroquine (CQ) and hydroxychloroquine (HCQ) in COVID-19 disease reported conflicting results. We sought to systematically evaluate the effect of CQ and HCQ with or without azithromycin on outcomes of COVID-19 patients.
Methods
We searched multiple databases, preprints and grey literature up to 17 July 2020. We pooled only adjusted-effect estimates of mortality using a random-effect model. We summarized the effect of CQ or HCQ on viral clearance, ICU admission/mechanical ventilation and hospitalization.
Results
Seven randomized clinical trials (RCTs) and 14 cohort studies were included (20 979 patients). Thirteen studies (1 RCT and 12 cohort studies) with 15 938 hospitalized patients examined the effect of HCQ on short-term mortality. The pooled adjusted OR was 1.05 (95% CI 0.96–1.15, I2 = 0%). Six cohort studies examined the effect of the HCQ+azithromycin combination with a pooled adjusted OR of 1.32 (95% CI 1.00–1.75, I2 = 68.1%). Two cohort studies and four RCTs found no effect of HCQ on viral clearance. One small RCT demonstrated improved viral clearance with CQ and HCQ. Three cohort studies found that HCQ had no significant effect on mechanical ventilation/ICU admission. Two RCTs found no effect for HCQ on hospitalization risk in outpatients with COVID-19.
Conclusions
Moderate certainty evidence suggests that HCQ, with or without azithromycin, lacks efficacy in reducing short-term mortality in patients hospitalized with COVID-19 or risk of hospitalization in outpatients with COVID-19.
View at academic.oup.com
[HTML] nih.gov
Cited by 83
Related articles
All 16 versions
researchgate.net
Hydroxychloroquine as Post-Exposure Prophylaxis for Covid-19: Why simple data analysis can lead to the wrong conclusions from well-designed studies
J Luco
ResearchGate, 2020
Researchers of the University of Minnesota Medical School reported the first prospective randomized placebo-controlled trial (RCT) in evaluating the role of hydroxychloroquine (HCQ) as post-exposure prophylaxis (PEP) against COVID‐19. The trial's primary result reported by the authors was that, within four days after moderate or high-risk exposure to Covid-19, HCQ did not show benefit over placebo to prevent illnesses compatible with Covid-19 or confirmed infection (P= 0.351, Fisher exact test). In this re-analysis, we show why the authors’ oversimplified analysis led to an incorrect conclusion from the data.
We re-analyzed the dataset by applying multiple correspondence analysis (MCA) and hierarchical cluster analysis (HCA), which are noise reduction methods used in large data sets. We used the same primary outcome measures as the authors (incidence of COVID-19-compatible disease by day 14) and the same statistical test that the authors used, such as the two-sided Fisher's exact test and others. The results obtained indicate that the individuals' age is a determining factor in the chemopreventive efficacy exerted by HCQ. Thus, in contradiction to the original authors' conclusions, the full data set's risk analysis shows that HCQ exhibits a chemopreventive effect for the group of subjects of≤ 50 yrs that does not reach significance (P= 0.083). However, not considering the analysis of the moderate-risk exposure group, we confirm that the high-risk exposure group (N= 719) demonstrates a significant effect of HCQ in the under 50 age group (p= 0.025). We also show, using MCA and the Mantel test, systematic differences between the treatment and placebo groups in their clinical characteristics, specifically asthma, and other-comorbidities which act as confounders that add noise to the data, such that the genuine effect of the drug is not seen in a standard analysis. After correcting these differences, the risk analysis showed that HCQ is also useful as a prophylactic agent for people over 50 years of age. This study, therefore, provides evidence of the necessity for higher-order analytics (such as MCA) in the presence of large data sets that include unknown confounders. In this case, it shows that the published conclusion of the group–that HCQ does not prevent COVID-type infective symptoms–was fundamentally flawed and should be reconsidered.
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Let's try using up to date data - Say_What MU - 12/2 11:22:53