A clinical trial in the UK is now testing whether the common drug hydroxychloroquine can keep older people with suspected COVID-19 out of hospital. The problem is stark: no treatments exist for COVID-19 patients managed at home, and those over 65—or over 50 with underlying conditions—face the highest risk of complications. Without evidence, doctors cannot know whether drugs like hydroxychloroquine help or harm. The PRINCIPLE trial aims to fill that gap by recruiting 3,000 people from these high-risk groups, randomly assigning them to either standard care alone or standard care plus hydroxychloroquine. If the drug works, the impact would be immediate and practical. A cheap, widely available tablet could reduce hospital admissions and speed recovery for millions of older patients, easing pressure on the NHS and keeping people out of intensive care. If it does not work, the trial will provide clear evidence to stop using it, preventing wasted effort and false hope. The platform design also allows future drugs to be added, making the trial a rapid testing system for community COVID-19 treatments throughout the pandemic.
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We do not yet have any treatments for COVID-19 patients, so we are now running a clinical trial to test out drugs which may work. Most COVID 19 cases are managed in the community and it is essential that we find treatments that help reduce hospital admission and speed recovery. The risk of complications from suspected COVID-19 infection is generally greater in people aged 50 years and older with underlying health conditions and in those aged 65 years and older. Therefore, we will ask these two groups to take part in our trial. The first drug we will evaluate is hydroxychloroquine, which is already used for other illnesses, but but it has not been tested in patients with suspected COVIS-19 in the community. Therefore, we do not yet know if hydroxychloroquine, (or any future treatments that we include in the trial), given to COVID-19 patients, will help reduce the need for hospitalisation or speed up recovery. All people initially included in the study will have a test for COVID-19, and will either receive usual best care, or usual best care plus the drug we are testing, currently hydroxychloroquine. We will include 3000 people in the study in the first instance.
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