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COVID-19 news from Annals of Internal Medicine

All coronavirus-related content published in Annals is free

American College of Physicians

Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

1. Hydroxychloroquine shows no benefit to patients with early, mild COVID-19 in randomized trial

Full text: https://www.acpjournals.org/doi/10.7326/M20-4207

Editorial: https://www.acpjournals.org/doi/10.7326/M20-5041

In a randomized trial, hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19. These findings may not inform whether an effect would be observed in populations at higher risk for severe COVID-19. Results from a randomized clinical trial are published in Annals of Internal Medicine.

Currently, there are no effective treatments for COVID-19. The majority of previous clinical studies investigating therapies for COVID-19 were small in size and examined hospitalized patients with moderate to severe disease.

Researchers from the University of Minnesota hypothesized that starting hydroxychloroquine within the first few days of symptoms could alter the course of COVID-19 by reducing symptom severity, symptom duration, and preventing hospitalizations. They randomly assigned symptomatic, non-hospitalized adults with lab-confirmed or probable COVID-19 to either oral hydroxychloroquine 800 mg once, followed by 600 mg in 6-8 hours, then 600mg daily for 4 more days, or masked placebo. Of 423 patients with available end-point data, 82 percent had lab-confirmed infection, and 56 percent were enrolled within 1 day of symptoms starting. Change in symptom severity over 14 days did not differ between hydroxychloroquine and placebo groups. At 14 days, 24 percent receiving hydroxychloroquine had ongoing symptoms compared with 30 percent receiving placebo. Side effects were mild, but more common with hydroxychloroquine than with placebo. The researchers note that the study was limited by severe U.S. testing shortages. Only 58 percent of participants received SARS-COV-2 testing.

The author of an accompanying editorial from New York Medical College calls the saga of hydroxychloroquine and COVID-19 a cautionary tale. Research standards should not be lowered during a pandemic. These findings, taken together with other published randomized controlled trials, provide strong evidence that hydroxychloroquine offers no benefit in patients with mild illness. If the peer-reviewed findings confirm the preliminary reports of no benefit in sicker patients in the National Institutes of Health and RECOVERY trials, the saga of hydroxychloroquine and COVID-19 will likely reach its sad end, the author writes.

Media contacts: PDFs for these articles are not yet available. Please click the links above to read full text. The lead authors, Caleb P Skipper MD or David R. Boulware MD MPH, can be reached through Kelly Glynn at glynn040@umn.edu. The editorialist, Neil W. Schluger, MD can be reached at nschluge@nymc.edu.

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