A large meta-analysis confirms the ineffectiveness of hydroxychloroquine to treat Covid-19. Its association with azithromycin, recommended by Professor Didier Raoult, would even increase the risk of mortality.
- The hydroxychloroquine-azithromycin combination is associated with an increased risk of mortality in patients infected with Covid-19.
- The researchers examined 839 scientific publications and selected the 24 most serious to reach their conclusions.
Is this the end of the debate around chloroquine? A major meta-analysis carried out by Inserm researchers concluded on the ineffectiveness of hydroxychloroquine to treat Covid-19 and on an increased risk of mortality if it is associated with azithromycin, such as the suggests Professor Didier Raoult. This study was published on August 26 in the journal Clinical Microbiology and Infection.
The largest meta-analysis on the subject of hydroxychloroquine
For the study, the researchers compared hydroxychloroquine with or without azithromycin against standard treatments to treat patients with Covid-19. The results revealed that the combination of the two drugs leads to a higher risk of mortality than conventional care. “It is actually a relative risk, a ratio of the occurrence of death between those who receive the treatment and those who do not.says Thibault Fiolet, doctoral student in epidemiology at Inserm / Paris-Saclay University and main author of the study. To be more precise, it is necessary to calculate the absolute risk which takes into account the basic mortality for hospitalized patients for all treatments combined. In this case, the risk of mortality for patients treated with hydroxychloroquine + azithromycin drops from 27% to 7%. The effect is less but still deleterious.”
To arrive at these results, the researchers carried out significant work. “In this analysis, we have collected and examined 839 scientific articles published in recent months and selected 29, taking into account certain criteria.”, indicates Mathieu Rebeaud, doctoral student in biochemistry at the University of Lausanne (Switzerland) and co-author of the publication. Among the studies retained, five were subsequently excluded because they presented excessive risks of bias that could affect the final analysis. In the end, therefore, 24 publications were studied, including 17 which compared hydroxychloroquine and standard care and 7 which compared them to the hydroxychloroquine + azithromycin combination. In total, they concerned 12,000 patients treated with hydroxychloroquine, 8,000 treated with the combination of the two drugs and 13,000 who received standard care. “These are the largest numbers gathered in a meta-analysis on Covid-19. Previous meta-analyses brought together less than 6 or 7 studies”, confirms Thibault Fiolet.
Some limits but a trend
The researchers admit some limitations to their study, however. Most of the studies selected are observational, therefore carried out afterwards on hospital data and are therefore not impervious to bias. Among them, the fact that the patients did not receive the treatment at the same time: some received it as soon as they entered the hospital while others had it after several days of hospitalization. Another bias may relate to the fact that in addition to the hydroxychloroquine-azithromycin combination, other drugs may have been prescribed to them, such as corticosteroids. In these cases, it is difficult to know which molecule is responsible for the increased risk of mortality.
Despite these limitations, this meta-analysis confirms other studies, including one conducted by the National Medicines Safety Agency, on the harmful side effects of this treatment. The WHO had suspended all clinical trials in which it is a partner and prescriptions for this drug were suspended in France on May 27.
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