Glycemic efficacy and safety of hydroxychloroquine in type 2 diabetes mellitus: A systematic review and meta.analysis of relevance amid the COVID-19 pandemic

ABSTRACT

Aims: Hydroxychloroquine (HCQ) is approved for use as an oral anti-diabetic drug (OAD) in patients with uncontrolled type 2 diabetes mellitus (T2DM);however, robust data are lacking. The present meta-analysis was conducted to provide precise effect estimates regarding the efficacy and safety of HCQ in patients with T2DM. Methods: PubMed/Cochrane Library and grey literature were systematically searched till August 25, 2020, to identify randomized controlled trials (RCTs) with duration =12 weeks, evaluating the efficacy and safety of HCQ (400 mg/day) in patients with T2DM and glycated hemoglobin (HbA1c) =7.0%-7.5% already on a combination of metformin/sulfonylurea compared to either placebo or another OAD. Results: We identified eight eligible RCTs, pooling data retrieved from 1763 patients with T2DM. HCQ resulted in significant decrease in HbA1c by 0.88% (95% confidence interval [CI] -1.01 to - 0.75) compared to placebo and by 0.32% (95% CI -0.37 to -0.26) compared to an OAD. Besides, there were significant reductions in fasting blood glucose, postprandial blood glucose, body weight, triglycerides, and low-density lipoprotein. A small but significant increase in high-density lipoprotein was also noted. An increase in the risk of any episode of symptomatic hypoglycemia (whether documented or not) was observed (risk ratio = 1.34 [95% CI 1.10-1.63]). No other safety issues were identified. Conclusions: The meta-analysis suggests that HCQ, used as an add-on drug in patients with T2DM exerts significant beneficial effects on glycemic control, body weight, and lipid profile, however, increasing the risk for symptomatic hypoglycemia. HCQ might be useful amid the ongoing pandemic, as the drug has also been found to be beneficial in COVID-19.