Hydroxychloroquine did not prevent healthy people exposed to COVID-19 from getting the disease caused by the coronavirus, according to a study being published Wednesday in the New England Journal of Medicine.
The study is the first randomized clinical trial that tested the antimalarial drug, touted by President Donald Trump, as a preventive measure. It showed that hydroxychloroquine was no more effective than a placebo - in this case, a vitamin - in protecting people exposed to COVID-19.
"As we say in Tennessee, 'That dog won't hunt' - it didn't work," said William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center. Schaffner, who was not involved in the trial, praised it as "rigorously done."
The results were the latest development on a highly charged medical and political issue - the efficacy of hydroxychloroquine in combating COVID-19. Trump has repeatedly touted the drug as a "game changer" for COVID-19, and recently said he took it for several days. But federal regulators have said it should be used only for hospitalized patients or in clinical trials because of possible side effects, including serious heart-rhythm issues.
Researchers at the University of Minnesota Medical School launched the trial in mid-March. They enrolled more than 800 adults in the United States and Canada who were exposed to someone with COVID-19 because of their jobs as health care workers or first responders, or because they lived with someone with the disease. The study was a randomized placebo-controlled trial, and was double-blinded, meaning neither the participants nor the researchers knew what the participants received. Such a study is considered the gold standard for clinical trials.
Adding to the controversy surrounding the drug, a large observational study on hydroxychloroquine that warned of dangerous side effects has come under fire in recent days. The study, published May 22 by the medical journal Lancet, was based on records from hundreds of hospitals and involved 96,000 hospitalized coronavirus patients on six continents. It found that those who received hydroxychloroquine, or a closely related drug, chloroquine, had a significantly higher risk of death than those who did not. Shortly after its publication, the World Health Organization suspended the use of hydroxychloroquine in a large international trial testing therapies for the disease, and France banned it as a treatment for COVID-19.
In recent days, scientists have raised questions about the validity of the data used for the study. On Tuesday, The Lancet published an "expression of concern" about the study. The researchers said in a statement they are conducting an independent review of the data, which came from an outside company. Among other things, critics are skeptical that so many health records could have been collected in such a short period of time and have cited inconsistencies about dosing information. In addition, the company has not explained its methodology, scientists say. The WHO, meanwhile, resumed its trial of hydroxychloroquine, saying its safety experts concluded there was no reason to discontinue it.
The prevention trial released Wednesday showed 40 percent of the participants who took the drug developed side effects that weren't serious - mostly nausea, upset stomach and diarrhea. The study found no serious side effects or cardiac complications, the researchers said.
Its findings reinforced those of previous studies showing the drug does not provide benefit against COVID-19. "It's not surprising given that there has not been efficacy established for this drug in any meaningful way." said Eric Topol, director of the Scripps Research Translational Institute in San Diego. "It's not a large study but it extends the spectrum from the most severely ill patients to mildly ill and now preventive."
Jeanne Marrazzo, an infectious disease expert at the University of Alabama at Birmingham, said the results "should provide a very big nail in the coffin" for the idea that hydroxychloroquine can help prevent COVID-19.
David Boulware, an infectious disease specialist at the University of Minnesota and senior investigator of the study, said he launched the trial because hydroxychloroquine had shown activity in a lab setting against the coronavirus.
About two-thirds of the trial participants were health care workers and the rest were a mix of other people exposed to someone with COVID, he said. They were given either hydroxychloroquine or a placebo for five days and then followed for two weeks to see who developed the disease.
The participants were recruited on the internet through social media. Their eligibility was confirmed with documents, and the team sent medications overnight via Federal Express. Given the political sensitivities of the issue, Boulware said, it was important the participants did not know who was getting the drug and who was getting the placebo.
"So if some were for Trump, and some were not Trump supporters, all that would be washed out because the trial was blinded," he said.
Overall, about 12 percent given the drug developed COVID-19, while 14 percent given the placebo also did - not a statistical difference. There was no benefit for people who also took zinc or vitamin C, the researchers said.
Boulware said that the analysis tried to drill down on whether any subgroups, by race, occupation, age, or co-morbidities, had any hint of benefit. But they could not find any, he said.