WHO strongly recommended against using hydroxychloroquine or lopinavir/r at any stage of COVID-19

Simon Collins, HIV i-Base

On 17 December 2020, the World Health Organization (WHO) issued important new guidelines that reverse previous support for using either hydroxychloroquine or lopinavir/r for COVID-19. [1]

Early in the epidemic both drugs were thought by some researchers to have potential activity against COVID-19. However, results from randomised controlled studies throughout 2020 convincingly proved that neither drug has any role in preventing or treating COVID-19.

This third update to the guidelines were based on a meta-analysis of 30 trials with 10 921 participants for hydroxychloroquine and seven trials with 7429 participants for lopinavir-ritonavir, including the WHO SOLIDARITY study. [2]

Importantly, “contextual factors including resources, feasibility, acceptability, and equity for countries and health care systems did not alter the recommendation”.

The guidelines made a strong recommendation supporting the use of corticosteroids in severe and critical COVID-19 and a weak recommendation against their use in earlier non-severe infection.

More controversially, the document also includes a weak recommendation against using remdesivir at any stage, even though this is approved in Europe and the US where it is included in the standard of care for reducing recovery time in people hospitalised with COVID-19.

comment

The decision by WHO to withdraw the earlier support for both hydroxychloroquine and lopinavir/r is a clear signal that continued use is now clearly unethical.

Although few studies continue using either drug, the proposal to include both in a widely publicised international study in 13 African countries launched in December, justified continued use by their inclusion in WHO recommendations. [3]

The publication in BMJ has several confusing contradictions, likely proofing errors, including apparent contradictions between the body text and the simplified graphics and not updating the date of webpages (still showing 20 September initial version).

Reference

1. A living WHO guideline on drugs for covid-19. BMJ 2020;370:m3379. DOIi: 10.1136/bmj.m3379 (17 December 2020).
   https://www.bmj.com/content/370/bmj.m3379
2. WHO SOLIDARITY study published in NEJM. https://i-base.info/htb/39498
   https://i-base.info/htb/39498
3. International COVID-19 study launches in Africa but with drugs that have little chance of working (ANTICOV). HTB (9 December 2020).
   https://i-base.info/htb/39419

This report was first posted on 7 January 2021.