Hydroxychloroquine Failed to Prevent COVID-19 Hospitalizations

The JAMA published an Original Investigation on April 22, 2021, evaluating if hydroxychloroquine or lopinavir-ritonavir, administered as a 9-day course, prevent COVID-19–associated hospitalization in patients with COVID-19.

In this phase 3 clinical trial that included 685 patients, rates of COVID-19–associated hospitalization in patients treated with hydroxychloroquine or lopinavir-ritonavir were not significantly different compared with those who received placebo.

The proportion of patients hospitalized for COVID-19 was 3.7% (8 participants) in the hydroxychloroquine group, 5.7% (14 participants) in the lopinavir-ritonavir group, and 4.8% (11 participants) in the placebo group.

This investigation found no significant differences between interventions for COVID-19–associated hospitalization (hydroxychloroquine: hazard ratio [HR], 0.76 [95% CI, 0.30-1.88]; lopinavir-ritonavir: HR, 1.16 [95% CI, 0.53-2.56] as well as for the secondary outcome of viral clearance through day 14 (hydroxychloroquine: odds ratio [OR], 0.91 [95% CI, 0.82-1.02]; lopinavir-ritonavir: OR, 1.04 [95% CI, 0.94-1.16]).

At the end of the trial, there were 3 fatalities recorded, 1 in the placebo group and 2 in the lopinavir-ritonavir intervention group.

While evidence emerges to evaluate these drugs as prophylaxis, as a COVID-19 treatment for both outpatients and inpatients, hydroxychloroquine and lopinavir-ritonavir do not appear to confer any clinical benefit. These results might affect several countries deciding whether to offer both drug regimens for ambulatory patients presenting with mild COVID-19.

The Bill and Melinda Gates Foundation supported the trial. Conflict of Interest Disclosures: None reported.

In the USA, Plaquenil (Hydroxychloroquine) is FDA-approved to treat certain types of malaria and autoimmune conditions, such as chronic discoid lupus erythematosus, systemic lupus erythematosus in adults, and rheumatoid arthritis.