More data have been published from the WHO SOLIDARITY trial of repurposed antivirals (remdesivir, hydroxychloroquine, lopinavir, and interferon) to improve in-hospital mortality among patients with COVID-19.
In the trial, COVID-19 inpatients were randomised equally to whichever study drugs were locally available or to open controls. Of 11,266 participants, 2,750 were allocated to remdesivir, 954 to hydroxychloroquine, 1,411 to lopinavir, 651 to interferon plus lopinavir, 1,412 to interferon only, and 4,088 received no study drug. The main outcomes were overall mortality, initiation of ventilation, and duration of hospital stay.
There were 1,253 deaths, with a Kaplan-Meier 28-day mortality of 12 per cent. Death rate ratios were 0.95 for remdesivir, 1.19 for hydroxychloroquine, 1.00 for lopinavir, and 1.16 for interferon.
No study drug definitely reduced mortality (in unventilated patients or any other subgroup of entry characteristics), initiation of ventilation or hospitalisation duration. The mortality findings cannot have been markedly biased by the open-label design without placebos, or by variation in patient characteristics or local care.
The mortality findings contain most of the randomised evidence on remdesivir and interferon, and are consistent with meta-analyses of mortality in all major trials, the authors conclude.
"As an exception during this period of health crisis, some of the publications mentioned are at the time of writing still in pre-publication, undergoing peer review and subject to change. The results of this pre-print study should be interpreted with utmost caution."