Hydroxychloroquine treatment in patients with COVID-19: Rapid Health Technology Assessment Report

Abstract

INTRODUCTION: the COVID-19 pandemic has already caused hundreds of thousands of deaths and there is no specific treatment. OBJECTIVE: we intend to answer whether, in patients with severe pneumonia caused by COVID-19, treatment with  chloroquine/hydroxychloroquine compared to the usual support treatment reduces the risk of mortality, the time for clinical  improvement, and to evaluate its safety. METHODS: An independent multidisciplinary team was formed to conduct a health  technology assessment including a systematic review and meta-analysis. Studies published in Spanish, Portuguese and English  until June 2020 were included. RESULTS: 169 studies were identified. 6 were included in the qualitative review, 4 in the meta- analysis and 14 as other documents. In the quantitative analysis we found a relative risk (RR) of 1.52, 95% confidence interval  (95%CI) of 1.14-2.04 for clinical or tomographic improvement before 14 days, with low certainty in the evidence. Adverse events  at 7 and 28 days had a RR of 2.22 (95%CI: 0.45-10.91) with low certainty of evidence. The recommendations of scientific societies  and health authorities were heterogeneous. CONCLUSIONS: the evidence found is from low to very low confidence,  therefore any estimated result is highly uncertain. On the other hand, no data were found on mortality or on the reduction of time in mechanical respiratory support, so more studies are required that include these outcomes. The informed consent process is essential, whether it is used in the context of an investigation or as an off-label use in routine practice.