BMJ Open (Jun 2023)

Safety and efficacy of hydroxychloroquine as prophylactic against COVID-19 in healthcare workers: a meta-analysis of randomised clinical trials

  • Adrian F Hernandez,
  • David R Boulware,
  • Radha Rajasingham,
  • Christopher W Woods,
  • Kevin J Anstrom,
  • Ravi Amaravadi,
  • Benjamin S Abella,
  • Hwanhee Hong,
  • Anne Friedland,
  • Mengyi Hu,
  • Susan Halabi,
  • John E McKinnon,
  • Jorge Rojas-Serrano,
  • Angélica Margarita Portillo-Vázquez,
  • Susanna Naggie

DOI
https://doi.org/10.1136/bmjopen-2022-065305
Journal volume & issue
Vol. 13, no. 6

Abstract

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Objective We studied the safety and efficacy of hydroxychloroquine (HCQ) as pre-exposure prophylaxis for COVID-19 in healthcare workers (HCWs), using a meta-analysis of randomised controlled trials (RCTs).Data sources PubMed and EMBASE databases were searched to identify randomised trials studying HCQ.Study selection Ten RCTs were identified (n=5079 participants).Data extraction and synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this systematic review and meta-analysis between HCQ and placebo using a Bayesian random-effects model. A pre-hoc statistical analysis plan was written.Main outcomes The primary efficacy outcome was PCR-confirmed SARS-CoV-2 infection and the primary safety outcome was incidence of adverse events. The secondary outcome included clinically suspected SARS-CoV-2 infection.Results Compared with placebo, HCWs randomised to HCQ had no significant difference in PCR-confirmed SARS-CoV-2 infection (OR 0.92, 95% credible interval (CI): 0.58, 1.37) or clinically suspected SARS-CoV-2 infection (OR 0.78, 95% CI: 0.57, 1.10), but significant difference in adverse events (OR 1.35, 95% CI: 1.03, 1.73).Conclusions and relevance Our meta-analysis of 10 RCTs investigating the safety and efficacy of HCQ as pre-exposure prophylaxis in HCWs found that compared with placebo, HCQ does not significantly reduce the risk of confirmed or clinically suspected SARS-CoV-2 infection, while HCQ significantly increases adverse events.PROSPERO registration number CRD42021285093.