| Outcome |
Relative effect
(95% CI) |
Absolute effect
(95% CI)1 |
Certainty of the Evidence
(GRADE) |
Clinical improvement
D28 |
RR: 0.92
(0.74 - 1.16) |
51 fewer per 1000
(from 167 fewer to 103 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level:some concerns due to deviation from intended intervention, outcome measurement and selection of reported results Inconsistency: Serious
I²=72.10% Indirectness: Serious
studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Serious
due to wide confidence interval consistent with the possibility for harm and the possibility for no effect and low number of events
|
| 2 trials
Cavalcanti AB, 2020; Furtado RHM, 2020
885 participants
|
|
Hydroxychloroquine + Azithromycin
591 per 1,000
(476 - 746) |
Hydroxychloroquine
643
per 1,000 |
|
Clinical improvement
D60 |
Outcome not yet measured or reported
|
|
WHO progression score (level 7 or above)
D28 |
RR: 1.08
(0.90 - 1.30) |
21 more per 1000
(from 26 fewer to 77 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level: some concerns regarding deviations from intended interventions and selection of reported results Inconsistency: Not serious Indirectness: Serious
studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious
due to wide confidence interval consistent with the possibility for harm and the possibility for no effect and low number of events
|
| 2 trials
Cavalcanti AB, 2020; Furtado RHM, 2020
885 participants
|
|
Hydroxychloroquine + Azithromycin
278 per 1,000
(232 - 335) |
Hydroxychloroquine
258
per 1,000 |
|
WHO progression score (level 7 or above)
D60 |
Outcome not yet measured or reported
|
|
All-cause mortality
D28 |
RR: 0.88
(0.44 - 1.76) |
24 fewer per 1000
(from 113 fewer to 153 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious
studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious
due to wide confidence interval consistent with the possibility for benefit and the possibility for harm and low number of participants
|
| 2 trials
Cavalcanti AB, 2020; Furtado RHM, 2020
885 participants
|
|
Hydroxychloroquine + Azithromycin
178 per 1,000
(89 - 355) |
Hydroxychloroquine
202
per 1,000 |
|
All-cause mortality
D60 |
Outcome not yet measured or reported
|
|
Viral negative conversion
D7 |
Outcome not yet measured or reported
|
|
Adverse events
|
RR: 1.13
(0.88 - 1.45) |
44 more per 1000
(from 40 fewer to 151 more)
|
Low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention and outcome measurement Inconsistency: Not serious Indirectness: Not serious
We presume that the adverse event rates and the corresponding relative risks, are similar across diverse settings, therefore not downgraded for indirectness Imprecision: Serious
due to wide confidence interval consistent with the possibility for no effect and the possibility for harm and low number of participants
|
| 1 trials
Calvicanti AB, 2020
438 participants
|
|
Hydroxychloroquine + Azithromycin
378 per 1,000
(295 - 486) |
Hydroxychloroquine
335
per 1,000 |
|
Serious adverse events
|
RR: 1.20
(0.95 - 1.51) |
36 more per 1000
(from 9 fewer to 92 more)
|
Low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level:some concerns regarding deviation from intended intervention and outcome measurement Inconsistency: Not serious Indirectness: Not serious
We presume that the adverse event rates, and the corresponding relative risks, is similar across diverse settings; therefore not downgraded for indirectness Imprecision: Serious
due to wide confidence interval consistent with the possibility for no effect and the possibility for harm and low number of participants
|
| 2 trials
Cavalcanti AB, 2020; Furtado RHM, 2020
885 participants
|
|
Hydroxychloroquine + Azithromycin
217 per 1,000
(172 - 273) |
Hydroxychloroquine
181
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
