No evidence yet for effective COVID-19 treatments, review shows

(NEW YORK) — Although would-be COVID-19 therapies like the malaria drug hydroxychloroquine and the failed Ebola drug remdesivir have drummed up excitement as potentially life-saving treatments, a comprehensive review of available data finds that it’s still too early to tell.

The review, published in JAMA on April 13, 2020, summarizes what’s currently known about medical therapies used to treat COVID-19, concluding that “no therapies have been shown effective to date.”

Researchers at the University of Texas analyzed evidence on major proposed COVID-19 treatments published by the end of March 2019 and written in English. They found no strong evidence that any potential COVID-19 therapy is effective.

They also found that there’s no proven therapy to help ward off COVID-19 in patients who are not already infected.

“The article is a refreshing reminder that no therapy is yet proven to work, including drugs like chloroquine that we have heard so much about,” said Dr. Kathryn Stephenson, director of the Center for Virology and Vaccine Research Clinical Trials Unit at Beth Israel Deaconess Medical Center in Boston.

The JAMA review serves as a stark reminder that despite the hype, there have been no large randomized controlled trials, which are considered the gold standard of medical research.

A randomized controlled trial is an experiment in which researchers compare half of a group that receives a new drug to half who receive a placebo. This allows researchers to accurately compare the performance of new, experimental therapies. Without a placebo group for comparison, there’s no way to know for sure if a drug really makes a difference.

President Donald Trump, during a meeting with patients who have recovered from the disease on Tuesday, repeated his assertion that patients with COVID-19 should try the unproven anti-malaria drug hydroxychloroquine.

However, the JAMA review found no high-quality evidence demonstrating efficacy of hydroxychloroquine or its chemical cousin, chloroquine, to treat COVID-19. Although one small study in France revealed promising results that chloroquine may help — touted by Trump — the authors of the JAMA paper contend that the study suffered from serious design flaws.

“The number of problems in that paper is just staggering,” said Dr. Dan Culver, a pulmonologist and director of clinical COVID trials at Cleveland Clinic. “It’s a good case study of how to not do a medical study.”

The authors of the JAMA paper found that additional studies on chloroquine/hydroxychloroquine, antiretrovirals, and immunoglobulin therapy were poorly designed, offered inaccurate comparisons, exposed safety concerns, or included too few patients to draw any conclusions.

Experts explained that the urgency of the pandemic may be compelling medical journals to cut corners, minimizing the typically rigorous, months-long peer-review process for the sake of getting information out to the public faster.

“Frankly, medical journals have also been stuck in a hard situation. They want to carry the key information and get data out,” Culver said. “But I think standards for publishing have been dramatically lowered in this pandemic. Flimsy data is published in medical journals in a way that would normally undergo much more scrutiny.”

The JAMA study recommends that patients with COVID should not receive steroids. Additionally, authors echo guidelines that patients should continue their ACE-inhibitors, a type of blood pressure medication. Finally, there is promising test tube data to suggest that the antiviral drug remdesivir might successfully treat COVID-19, although studies in people are still too limited to draw any conclusions.

Beyond that, medical experts have said everyone should remain cautiously optimistic about the many COVID-19 treatments currently being tested, noting that the virus has only been known about for four months and that rigorous scientific inquiry takes time.

Scientists continue working hard on developing and evaluating therapies. Drugs including remdesivir and chloroquine/hydroxychloroquine are being further tested among 300 other ongoing COVID-19 clinical trials, many of which are placebo-controlled, high -quality studies.

“It is important to remember that this paper doesn’t say that these drugs are not effective — only that they have not yet been proven effective,” Stephenson added. “We are hopeful that we will get some positive answers from these rigorous studies in the near future.”

This article was written by Tiffany Kung, M.D., a resident physician at Presbyterian/St. Luke’s Hospital in Denver, is a contributor to the ABC News Medical Unit.

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