Hypothesis
Because of its immunomodulatory effects, azithromycin 500 mg daily for up to 10 days would lower 28-day mortality in patients hospitalised with COVID-19.
What failed
In the RECOVERY platform trial, 7763 patients were randomised (2582 azithromycin, 5181 usual care); 22% died within 28 days in each arm (rate ratio 0.97, 95% CI 0.87-1.07, p = 0.50). Length of stay and the proportion discharged alive within 28 days also did not differ.
Broken assumption
Azithromycin's anti-inflammatory activity is strong enough to change survival in hospitalised COVID-19.
Why
The abstract reports no benefit and does not offer a mechanistic explanation.
From the published paper: Abaleke et al. The Lancet, 2021. ↗CC BY