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Clinical trials are always sort of strange tradeoff between confidence in the response vs. ethical dubiousness due to treating one or the other arm less well as the confidence in the answer grows. The confidence doesn’t flip from no idea perfect clinical equipoise to complete certainty in the trial result instantly. The truth is, confidence grows as data increases, so in a rolling trial for example, one always has to lose perfect clinical equipoise as statistical confidence in a meaningful effect grows. Too small, too hospital-focused, too expensive, too complicated. In order to show an affect, most of the trials must have been outpatient to catch the disease in its early stages and incredibly large in order showing significance when most patients in the placebo arm will do fine.
The RECOVERY trial initiated medication only after hospitalization, not upon presentation of initial symptoms. The usual dose for arthritis and other autoimmune diseases is about 200 mg per day. Most non-RCT studies of HCQ effects on covid19 that I came across, mostly foreign to the USA, indicated modest effects, reducing hospitalization for severe infections with a few days. Regarding HCQ I believe bias and political view did influence clinical trials, at the look stage. On the other hand, can we have a discussion about remdesivir?
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