Just published @TheLancet
The largest study of hydroxychloroquine shows a significant increase in death (~35%) and >2-fold increase of serious heart arrhythmias. ~96,000 patients, ~15,000 on HCQ or CQ from 671 hospitals, 6 continents.
https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620311806.pdf

It's no longer that hydroxychloroquine has no sign of efficacy—it is associated with an increase in mortality.
This is not a randomized trial but larger than all the preceding 10 studies and 3 randomized trials in aggregate.
Chloroquine was even worse for risk than HCQ.

The significant increase in deaths among HCQ of CQ treated patients cannot be directly attributed to the *2-5 fold increase* in ventricular tachycardia (a malignant arrhythmia) but that must be playing a role.

Extensive coverage of the results @washingtonpost
https://www.washingtonpost.com/health/2020/05/22/hydroxychloroquine-coronavirus-study/ by @arianaeunjung and @lauriemcginley2

HCQ failed efficacy in the spectrum of mild to severe #COVID19, but now the higher mortality & VT in hospitalized patients (where arrhythmias get Dx'd and treated) raises 2 questions:
1. Is it ethical to proceed with ongoing RCTs?
2. How can the drug be given to outpatients?

Just 2 footnotes
1. This report is >6X the N of Rx'd patients cumulatively reported on cf prior studies (includes 3=RCTs)
2. The addition of a macrolide antibiotic (1 of which was azithromycin) added substantially to risk of ventricular tachycardia: HCQ 2.3X-> H+M 5.1X risk