Hydroxychloroquine has not been shown to be effective in any large and well designed clinical trial. A large number of studies have shown no benefit to hydroxychloroquine for COVID-19 patients.
There was initial excitement when positive results were shown very early in the pandemic, when an open-label non-randomized trial (https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub) including only 36 hospitalized patients purported to show “a rapid and effective speeding up of their healing process, and a sharp decrease in the amount of time they remained contagious.”
From there, the treatment became highly politicised, as it was endorsed by President Trump despite no health official in the United States endorsing the drug.
In June 2020, the FDA revoked the emergency use authorization (EUA) of oral hydroxychloroquine and chloroquine phosphate for the treatment of COVID-19.
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-revokes-emergency-use-authorization-chloroquine-and
"HCQ use was associated with an 11% increase in the mortality rate in a meta-analysis of randomized trials. The number of hydroxychloroquine related deaths in hospitalised patients is estimated at 16,990 in six countries."
https://www.sciencedirect.com/science/article/pii/S075333222301853X (2024-01)
The paper:
Chloroquine is a potent inhibitor of SARS coronavirus infection and spread
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/ (2005-08-22)
Dr. Fauci is not an author of this paper. The paper describes an in-vitro study. It is common for drugs to work in-vitro and this fails to translate to a living organism. This study does not provide any evidence that HCQ works in humans (or any animal) against SARS.
In-vitro studies cited by HCQ believers show that high concentrations of hydroxychloroquine are required to have an effect. The dosing was selected to maximize the likelihood of success (based on safety and efficacy) based on available evidence.
See page 22 of the RECOVERY trial supplementary appendex for rationale:
https://www.nejm.org/doi/suppl/10.1056/NEJMoa2022926/suppl_file/nejmoa2022926_appendix.pdf
Trials have been done with many different dosing regimens. None have been shown to work:
400mg/day
"Hydroxychloroquine (HC) use did not reduce the risk of ventilation or death. HC with azithromycin (AZ) did not reduce the risk of ventilation or death. HC, with or without AZ, was associated with longer length of hospital stay."
https://www.cell.com/med/fulltext/S2666-6340(20)30006-4 (2020-06-05)
Misinformation Wiki is not aware of any clinical trial that shows this.
"Among adults hospitalized with respiratory illness from COVID-19, treatment with hydroxychloroquine, compared with placebo, did not significantly improve clinical status at day 14. These findings do not support the use of hydroxychloroquine for treatment of COVID-19 among hospitalized adults."
https://jamanetwork.com/journals/jama/fullarticle/2772922 (2020-11-09)
RCT w/491 patients: "Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19."
https://www.acpjournals.org/doi/10.7326/M20-4207 (2020-10-20)
RCT w/4716 patients: "Patients in the hydroxychloroquine group had a longer duration of hospitalization than those in the usual-care group and a lower probability of discharge alive within 28 days"
https://www.nejm.org/doi/full/10.1056/nejmoa2022926 (2020-10-08)
RCT w/667 patients: "Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care."
https://www.nejm.org/doi/full/10.1056/NEJMoa2019014 (2020-07-23)
RCT w/4674 patients: "We have concluded that there is no beneficial effect of hydroxychloroquine in patients hospitalised with COVID-19. We have therefore decided to stop enrolling participants to the hydroxychloroquine arm of the RECOVERY trial with immediate effect."
https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf (2020-06-05)
Misguided Use of Hydroxychloroquine for COVID-19: The Infusion of Politics Into Science (2020-11-09)
https://jamanetwork.com/journals/jama/fullarticle/2772921