What is the role of hydroxychloroquine/chloroquine in the treatment of COVID-19?

Updated: Jan 12, 2021
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Both chloroquine and hydroxychloroquine are antimalarial drugs that have been used in the treatment and prophylaxis of malaria as well as autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. Both of these drugs have also shown efficacy against viruses such as HIV, Zika virus, and even SARS-CoV. [28] Based on this, hydroxychloroquine and chloroquine have been used in SARS-CoV-2 infection. [29]

In the Recovery trial, hospitalized patients randomized hydroxychloroquine had a 27% mortality rate at 28 days as compared with 25% in the usual care group. [30] Patients assigned to the hydroxychloroquine group were less likely to be discharged from the hospital alive within 28 days and had a higher rate of mechanical ventilation need or death as compared with the usual care group. In the Solidarity trial, hydroxychloroquine was not associated with improvement in mortality as compared with the usual care group. [31]

In another randomized controlled trial of hospitalized mild-to-moderate COVID-19 patients (with no oxygen requirement or maximal oxygen requirement up to 4 liters), hydroxychloroquine with or without azithromycin was not associated with improvement in clinical status at 15 days as compared with standard care. [32]

Skipper et al studied the effect of hydroxychloroquine in nonhospitalized adults with early COVID-19. [33] In this randomized controlled trial, hydroxychloroquine did not reduce symptom severity when compared with placebo.

In a randomized controlled trial for postexposure prophylaxis after moderate-to-high–risk exposure, hydroxychloroquine use within 4 days after the exposure did not prevent illness compatible with COVID-19. [34]


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