Effect of azithromycin and hydroxychloroquine in patients hospitalized with COVID-19: Network meta-analysis of randomized controlled trials.

Abstract

Chloroquine or its derivative hydroxychloroquine (HCQ) combined with or without azithromycin (AZ) have been widely investigated in observational studies as a treatment option for coronavirus 2019 (COVID-19) infection. The network meta-analysis aims to summarize evidence from randomized controlled trials (RCTs) to determine if AZ or HCQ is associated with improved clinical outcomes. PubMed and Embase were searched from inception to March 7, 2021. We included published RCTs that investigated the efficacy of AZ, HCQ, or its combination among hospitalized patients with COVID-19 infection. The outcomes of interest were all-cause mortality and the use of mechanical ventilation. The pooled odds ratio was calculated using a random-effect model. A total of 10 RCTs were analyzed. Participant's mean age ranged from 40.4 to 66.5 years. There was no significant effect on mortality associated with AZ plus HCQ (odds ratio [OR] = 0.562 [95% confidence interval {CI}: 0.168-1.887]), AZ alone (OR = 0.965 [95% CI: 0.865-1.077]), or HCQ alone (OR = 1.122 [95% CI: 0.995-1.266]; p = 0.06). Similarly, based on pooled effect sizes derived from direct and indirect evidence, none of the treatments had a significant benefit in decreasing the use of mechanical ventilation. No heterogeneity was identified (Cochran's Q = 1.68; p = 0.95; τ2  = 0; I2  = 0% [95% CI: 0%-0%]). Evidence from RCTs suggests that AZ with or without HCQ was not associated with a significant effect on the mortality or mechanical ventilation rates in hospitalized patients with COVID-19. More research is needed to explore therapeutics agents that can effectively reduce the mortality or severity of COVID-19.

• Authors: Gerald Chi, Sahar Memar Montazerin, Jane J Lee, Syed Hassan A Kazmi, Fahimehalsadat Shojaei, Clara Fitzgerald, C Michael Gibson
• Journal: Journal of medical virology (J Med Virol) Vol. 93 Issue 12 Pg. 6737-6749 (Dec 2021) ISSN: 1096-9071 [Electronic] United States
• PMID: 34370328 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: © 2021 Wiley Periodicals LLC.

Chemical References

• Antiviral Agents
• Hydroxychloroquine
• Azithromycin
• Chloroquine

Topics

• Adult
• Aged
• Antiviral Agents (therapeutic use)
• Azithromycin (therapeutic use)
• Chloroquine (therapeutic use)
• Female
• Humans
• Hydroxychloroquine (therapeutic use)
• Male
• Middle Aged
• Network Meta-Analysis
• Randomized Controlled Trials as Topic
• Respiration, Artificial (methods)
• COVID-19 Drug Treatment