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A preprint, an unpublished non peer-reviewed study, from the World Health Organisation (WHO) and reported by the FT, looked at the effect of repurposed drugs for COVID-19 treatment on 28-day mortality or the in-hospital course of COVID-19 among hospitalised patients.
Prof Martin Landray, Professor of Medicine & Epidemiology, Nuffield Department of Population Health, University of Oxford, said:
“The results of the WHO SOLIDARITY trial published as a pre-print today are important but sobering. Four different drugs were studied in over 11,000 patients at 405 hospitals in 30 countries. The trial is beautiful in its simplicity and clarity of purpose – large, randomised and focused on the ultimate clinical outcome of survival. None of the four treatments studied – hydroxychloroquine, lopinavir, interferon, remdesivir – showed worthwhile benefits. The results for hydroxychloroquine and lopinavir are completely in line with those of the UK RECOVERY trial and are therefore not surprising. The result for interferon is interesting and there will doubtless be some debate about whether different doses or routes of administration (for example, by nebuliser) might be more effective. Such hypotheses would require rigorous testing in future, large clinical trials. But the big story is the finding that remdesivir produces no meaningful impact on survival.
“Remdesivir has received plenty of attention over the past few months. The results of a trial run by the National Institutes of Health were announced at the White House in June, showing that it shortened hospital stay but with inconclusive information on mortalilty. Recently, remdesivir was one of a number of treatments given to President Trump. It is now recommended in some clinical guidelines. But there have been significant concerns about supply, cost, and access. Just 8 days ago, the European Commission signed a joint procurement framework contract with the pharmaceutical company Gilead for the supply of up to 500,000 treatment courses of remdesivir. The cost varies around the world but is around $2,000 per course.
“The WHO SOLIDARITY trial found that remdesivir had no meaningful effect on mortality. Even when the results of this large randomised trial are combined with the previous, smaller trials there is still no evidence that it improves survival. People will argue about the need for earlier use but even if there were modest benefits (say, an improvement in survival of one-fifth), people with mild disease are at low risk so the absolute numbers of lives saved would be small. Remember too that this is a drug that has to be given by intravenous infusion for 5 to 10 days and costs around £2000 per course.
“COVID affects millions of people and their families around the world. It is not a rare disease. We need scalable, affordable, and equitable treatments. The WHO SOLIDARITY trial has done the world a huge favour by producing clear, independent and robust results, showing once more the value of large randomised trials in providing the knowledge we need to tackle the worst consequences of this pandemic.”
Preprint: https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1
WHO press release: https://www.who.int/news/item/15-10-2020-solidarity-therapeutics-trial-produces-conclusive-evidence-on-the-effectiveness-of-repurposed-drugs-for-covid-19-in-record-time
FT article: https://www.ft.com/content/ee9b611f-2b4b-4572-afe1-b0b804d17a94
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Prof Martin Landray: “- Co-chief investigator of the RECOVERY trial of potential treatments for COVID-19 (funded by UKRI and NIHR; contributions to supply of study treatment from Abbvie, Roche, and Regeneron).
– Research funding to University of Oxford received from Novartis, Boehringer Ingelheim, and Merck Sharp & Dohme.
– Infrastructure and core funding received from Health Data Research UK, NIHR Oxford Biomedical Research Centre, UK Biobank Ltd, MRC Population Health Research Unit, and British Heart Foundation Centre for Research Excellence.
– Employee of University of Oxford with salary supported by Li Ka Shing Foundation, Health Data Research UK, NIHR Oxford Biomedical Research Centre, Wellcome Trust, and National Health Service.
– I do not accept personal honoraria payments directly or indirectly from the pharmaceutical, biotechnology, or food industries although reimbursement to the University of Oxford for the costs of travel and accommodation to participate in scientific meetings may be accepted. I hold no shares in and receive no consultancy payments directly or indirectly from tobacco, pharmaceutical, biotechnology, or food companies. I comply with the Independence of Research Policy of the Nuffield Department of Population Health, Universityy of Oxford. For details see: https://www.ndph.ox.ac.uk/files/about/ndph-independence-of-research-policy-jun-20.pdf/@@download.”