Time to Stop Using Ineffective Covid-19 Drugs

In this issue of the Journal, Bramante et al.6 report the results of the COVID-OUT randomized, controlled trial of oral metformin, ivermectin, and fluvoxamine for the early treatment of SARS-CoV-2 infection in 1323 outpatients. The investigators found no reductions in hypoxemia, emergency department visits, hospitalization, or death associated with any of the three drugs. A strength of the trial is the selection of adults between the ages of 30 and 85 years who were at high risk for severe Covid-19 because of overweight or obesity. However, as a result, the trial may not be readily generalizable to patients at lower risk for severe disease. One secondary analysis, which should be interpreted with caution, suggested that metformin may reduce a composite of emergency department visit, hospitalization, or death in this population with overweight or obesity, a finding that indicates no more than the need for further investigation at this time.