The ongoing World Health Organization (WHO) Solidarity Trial of hydroxychloroquine, remdesivir, lopinavir, or interferon-beta-1a for the treatment of COVID-19 were found not to prevent in-hospital death, reduce need for ventilation, or shorten duration of hospitalization. The results have been published in the New England Journal of Medicine.
The open-label study involved 11,330 patients in 405 hospitals in all six WHO regions, who were randomly assigned to receive one of these drugs, or standard hospital-specific care. Out of 947 patients receiving hydroxychloroquine, 104 died, as compared to 84 deaths out of 906 patients in the control group. Out of 2,743 patients receiving remdesivir, 301 died, compared to 303 deaths out of 2,708 patients in the control group. Out of 1,399 patients receiving lopinavir, 148 died, as compared to 146 deaths out of 1,372 patients in the control group. And, among 2,050 patients receiving interferon, 243 died, as compared to 216 deaths among 2,050 patients in the control group.
The authors concluded that none of the four drugs definitely reduced overall (or any subgroup) mortality, or reduced need of ventilation, or hospitalization duration. Hydroxychloroquine, lopinavir, and interferon were dropped from the trial in June, July, and October, respectively, because they were found to show no benefit, and had no place in the treatment of COVID-19. However, due to results of another study, the Adaptive COVID-19 Treatment Trial, researchers stated that remdesivir could be still useful, since the trial indicated that it hastened recovery (10 days vs. 15 for a placebo) and reduced hospitalization stay to 12 days, as compared to 17 with placebo. But, no benefit in terms of preventing death was shown.
The authors have called for more trials to determine whether remdesivir should be used for patients with specific risk factors, find the most effective dosing time, and see if results can be improved if given in combination with other drugs. They concluded, “How to answer these more complicated and nuanced questions quickly remains a challenge for the scientific community. It will not be simple to achieve clarity on when and how—or even whether—to use remdesivir.