In this study, patients were randomized to receive either hydroxychloroquine, hydroxychloroquine and azithromycin, or usual care. At day 15, there were no differences in clinical status, as adjudicated by a seven-point scale (from complete recovery to death). There were also no signals of benefit in secondary outcomes, including fraction of patients requiring intubation. While believers in hydroxychloroquine have advanced excuses explaining why none of the trials assessing this drug have detected a benefit—ranging from time from onset to randomization to whether or not random ingredients from the periodic table of elements were also included (the most common hail-Mary being zinc)—the fact remains that this treatment has failed to even hint at a benefit in any rigorous analysis.

Summary

Dexamethasone and remdesivir appear to help patients with severe or critical COVID-19, while hydroxychloroquine does not help those with mild to moderate illnesses—and preprint data suggest no benefit in more severe cases, as well. However, dexamethasone should not be given to all COVID-19 patients, as there may be harm among patients with less severe illness.

References

1. RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with Covid-19—preliminary report [published online ahead of print, 2020 Jul 17]. N Engl J Med. 2020. doi:10.1056/NEJMoa2021436.
2. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19—preliminary report [published online ahead of print, 2020 May 22]. N Engl J Med. 2020. doi:10.1056/NEJMoa2007764.
3. Cavalcanti AB, Zampieri FG, Rosa RG, et al. Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19 [published online ahead of print, 2020 Jul 23]. N Engl J Med. 2020. doi:10.1056/NEJMoa2019014.

Dr. Niforatos is emergency medicine resident at The Johns Hopkins School of Medicine in Baltimore and research editor of Brief19.com. Follow him @ReverendofDoubt and follow Brief19 @Brief_19.