| Outcome |
Relative effect
(95% CI) |
Absolute effect
(95% CI)1 |
Certainty of the Evidence
(GRADE) |
Clinical improvement
D28 |
Outcome not yet measured or reported
|
|
Clinical improvement
D60 |
Outcome not yet measured or reported
|
|
WHO progression score (level 7 or above)
D28 |
RR: 1.16
(0.73 - 1.84) |
29 more per 1000
(from 48 fewer to 150 more)
|
Low certainty
Reasons to downgrade
Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious
Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Very serious
due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
|
| 1 trials
Ader F, 2021
301 participants
|
|
Lopinavir-Ritonavir
207 per 1,000
(131 - 329) |
Hydroxychloroquine
179
per 1,000 |
|
WHO progression score (level 7 or above)
D60 |
RR: 1.02
(0.66 - 1.55) |
7 more per 1000
(from 111 fewer to 180 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention and missing data Inconsistency: Not serious Indirectness: Not serious
Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Very serious
due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
|
| 1 trials
Arabi Y, 2021
320 participants
|
|
Lopinavir-Ritonavir
333 per 1,000
(216 - 507) |
Hydroxychloroquine
327
per 1,000 |
|
All-cause mortality
D28 |
RR: 1.28
(0.60 - 2.73) |
20 more per 1000
(from 29 fewer to 126 more)
|
Low certainty
Reasons to downgrade
Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious
Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Very serious
due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
|
| 1 trials
Ader F, 2021
301 participants
|
|
Lopinavir-Ritonavir
93 per 1,000
(44 - 199) |
Hydroxychloroquine
73
per 1,000 |
|
All-cause mortality
D60 |
Outcome not yet measured or reported
|
|
Viral negative conversion
D7 |
RR: 1.12
(0.84 - 1.49) |
43 more per 1000
(from 57 fewer to 175 more)
|
Low certainty
Reasons to downgrade
Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious
Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Very serious
due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
|
| 1 trials
Ader F, 2021
301 participants
|
|
Lopinavir-Ritonavir
401 per 1,000
(300 - 533) |
Hydroxychloroquine
358
per 1,000 |
|
Adverse events
|
RR: 1.10
(0.97 - 1.25) |
72 more per 1000
(from 22 fewer to 180 more)
|
Low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level: some concerns regarding outcome measurement and selection of reported results Inconsistency: Not serious Indirectness: Not serious
Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Serious
due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
|
| 1 trials
Ader F, 2021
301 participants
|
|
Lopinavir-Ritonavir
794 per 1,000
(700 - 902) |
Hydroxychloroquine
722
per 1,000 |
|
Serious adverse events
|
RR: 1.20
(0.94 - 1.52) |
65 more per 1000
(from 20 fewer to 169 more)
|
Low certainty
Reasons to downgrade
Risk of bias: Not serious
Despite some concerns with deviation from intended interventions and outcome measurement, not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious
due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
|
| 2 trials
Ader F, 2021; Arabi Y, 2021
621 participants
|
|
Lopinavir-Ritonavir
390 per 1,000
(306 - 494) |
Hydroxychloroquine
325
per 1,000 |
|
1The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
