The WHO's Solidarity Trial, a large-scale international study, has concluded that remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a offer little to no benefit in reducing mortality, initiation of ventilation, or duration of hospital stay for patients hospitalized with COVID-19. The trial, conducted across 405 hospitals in 30 countries, involved 11,330 adult participants.
The study, the results of which were published in The New England Journal of Medicine, randomly assigned patients to receive either one of the trial drug regimens or standard care. The primary outcome assessed was in-hospital mortality, with comparisons made between each trial drug and its control group. Key secondary outcomes included the need for ventilation and the length of hospital stay.
Trial Design and Results
The trial design involved a pairwise comparison of each drug against a control group receiving standard care. Of the participants, 2750 received remdesivir, 954 received hydroxychloroquine, 1411 received lopinavir (without interferon), 2063 received interferon (including 651 to interferon plus lopinavir), and 4088 received no trial drug.
The 28-day mortality rate was 11.8% overall. Specifically, death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% CI, 0.81 to 1.11; P = 0.50). For hydroxychloroquine, death occurred in 104 of 947 patients receiving the drug and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23). Lopinavir resulted in 148 deaths out of 1399 patients, compared to 146 deaths out of 1372 in the control group (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97). Finally, interferon was associated with 243 deaths out of 2050 patients, while the control group had 216 deaths out of 2050 patients (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11).
Implications for COVID-19 Treatment
These findings suggest that remdesivir, hydroxychloroquine, lopinavir, and interferon regimens are not effective in treating hospitalized COVID-19 patients. The study's authors noted that no drug definitively reduced mortality, overall or in any subgroup, nor did they reduce the initiation of ventilation or hospitalization duration. These results have significant implications for clinical practice and research, suggesting that resources should be directed towards evaluating other therapeutic interventions for COVID-19.
