• Shehnoor Azhar, Javed Akram, Waqas Latif, Naomi Cano Ibanez, Samiullah Mumtaz, Ali Rafi, Usman Aftab, Somia Iqtadar, Muhammad Shahzad, Fibhaa Syed, Bilal Zafar, Nighat Fatima, Saleh Saadat Afridi, Shehla Javed Akram, Muhammad Afzal Chaudhary, Farah Sadiq, Saifullah Goraya, Muhammad Hanif, Verda Ashraf, Saadia Ashraf, Humaira Akram, and Tanwir Khaliq.
• Shehnoor Azhar (BDS, MPH) Doctoral candidate in Epidemiology and Public Health, University of Granada.
• Pak J Med Sci. 2024 May 1; 40 (5): 800810800-810.

ObjectiveWe assessed the effectiveness of oral Hydroxychloroquine (HC), Azithromycin (AZ) and Oseltamivir (OS), alone or combined, among patients hospitalized with mildly symptomatic coronavirus infectious disease (COVID-19).MethodsFollowing the approval of the National Bioethics Committee and prospective registration (clinicaltrials.gov NCT04338698), a multicenter randomized clinical trial of adaptive design was conducted at 10 multispecialty hospitals in Pakistan. Patients were randomized into seven treatment groups. Starting April 15, 2020, consenting, eligible, otherwise healthy adult patients or those with co-morbidities under control, were recruited if they presented with mildly symptomatic COVID-19 (scored 3 on a 7-point ordinal scale anchored between 1 = not hospitalized, able to undertake normal activities, to 7 = death) confirmed by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). Two primary outcomes were assessed by day seven: Turning qRT-PCR negative; and clinical improvement of two points from the baseline. Outcome rates were compared using a chi-square test. Multiple imputations were applied to handle missing data. An interim data analysis was carried out on July 19, 2020, following which the study continued without treatment group changes. Data Safety and Monitoring Board advised to stop recruitment due to its futility on January 18, 2021.ResultsOf 471 patients randomized, a total of 426 (90.4%) completed the follow-up for primary outcomes. Based on imputed data analyses at day seven: Total qRT-PCR negative cases were 137/471 (29%, 95% CI 25.0 - 33.4). By day seven, a total of 111/471 (23.5%, 95% CI 19.8 - 27.6) showed clinical improvement. No serious or non-serious adverse event was reported.ConclusionsAmong patients with mild COVID-19, there was no statistically significant difference in the effectiveness of oral antimalarial, antiviral, or antibiotic treatments.Clinicaltrials.gov ID: NCT04338698.Copyright: © Pakistan Journal of Medical Sciences.

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