WHO SOLIDARITY open-label trial with 954 very late stage (64% on oxygen/ventilation) HC
Q patients, mortality relative risk RR 1.19 [0.89-1.59], p
Q dosage very high as in RECOVERY, 1.6g in the first 24 hours, 9.6g total over 10 days, only 25% less than the high dosage that Borba et al. show greatly increases risk (OR 2.8) .
Authors state they do not know the weight or obesity status of patients to analyze toxicity (since they do not adjust dosage based on patient weight, toxicity may be higher in patients of lower weight).
KM curves show a spike in HC
Q mortality days 5-7, corresponding to ~90% of the total excess seen at day 28 (a similar spike is seen in the RECOVERY trial).
Almost all excess mortality is from ventilated patients.
Authors refer to a lack of excess mortality in the first few days to suggest a lack of toxicity, but they are ignoring the very long half-life of HC
Q and the dosing regimen - much higher levels of HC
Q will be reached later. Increased mortality in Borba et al. occurred after 2 days.
An unspecified percentage used the more toxic C
Q. No placebo used.
death, ↑19.0%, p=0.23