The efficacy and safety of hydroxychloroquine at different doses and courses for COVID-19 prevention: a systematic review and network meta-analysis

Wang Hang; Yang Qiyuan; Mao Yinjun; Ding Haibo; Huang Pinfang; Zhan Zhikun

Hang Wang, Qiyuan Yang, Yinjun Mao, Haibo Ding, Pinfang Huang, Zhikun Zhan

Expert Review of Anti-infective Therapy, doi:10.1080/14787210.2024.2413419

Background: The optimal strategy for using hydroxychloroquine to prevent coronavirus disease 2019 in patients, either before or after exposure, remains unclear. We evaluated the safety and efficacy of different doses and treatment durations of hydroxychloroquine for COVID-19 prevention. Method: Databases including PubMed, Web of Science, Cochrane Library, EMBASE, Medline, and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) comparing different doses of hydroxychloroquine for COVID-19 prevention, from their inception to February 2024. Results: A total of 20 RCTs involving 12,372 patients were included. Meta-analysis results showed no significant difference between the hydroxychloroquine and control groups in reducing the incidence of syndrome coronavirus type 2 (SARS-CoV-2) positivity (OR = 0.83, 95% CI = 0.67, 1.03). However, the subgroup receiving a daily dose of 200-400 mg (OR = 0.62, 95% CI = 0.51, 0.75) and a treatment duration of 5-8 weeks (OR = 0.52, 95% CI = 0.31, 0.88) showed statistically significant reductions in SARS-CoV-2 positivity. According to the surface under the cumulative ranking curve (SUCRA), the most effective intervention was a 200-400 mg dose for 5-8 weeks. Conclusions: A hydroxychloroquine dose of 200-400 mg for a duration of 5-8 weeks may moderately reduce the risk of COVID-19 with a relatively low risk of adverse events.

Declaration of interest The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Author contributions Hang Wang, Qiyuan Yang, and Zhikun Zhan conceptualized and designed the study. Hang Wang, Qiyuan Yang, Yinjun Mao, and Pinfang Huang collected the data. Haibo Ding and Zhikun Zhan performed the data analyses. Hang Wang checked the statistical consistency. Qiyuan Yang and Zhikun Zhan contributed to data interpretation and drafted the manuscript. Yinjun Mao, Haibo Ding, Pinfang Huang, and Zhikun Zhan critically reviewed the manuscript. All authors have agreed on the submission of the final version of the manuscript for publication.

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