In seriously ill patients with COVID-19, does treatment with the drug lopinavir-ritonavir improve clinical outcomes?

Bottom Line:

Seriously ill patients with COVID-19 who received lopinavir-ritonavir did not experience any clinical improvement or decreased mortality compared to patients who received standard of care alone.

Reference:

Cao, B. et al. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. New England Journal of Medicine (2020).  doi: 10.1056/NEJMoa2001282. [Epub ahead of print]

Date Published:

March 18, 2020

Synopsis:

Lopinavir-ritonavir is an antiretroviral drug that has previously been used to treat HIV. Some earlier studies showed that it may have some benefit in treating coronaviruses, such as SARS and MERS. In this trial published in China, outcomes for seriously ill COVID-19 patients who received a 14-day course of lopinavir-ritonavir did not differ from patients who received standard of care alone in terms of clinical improvement, mortality rate, and total amount of virus in them. Gastrointestinal adverse events were more common in patients receiving lopinavir-ritonavir, but serious adverse effects such as kidney failure were more common in patients receiving standard of care. A limitation of this study was that on average, patients were given lopinavir-ritonavir therapy about 13 days after they began developing symptoms. This may have been too late for the drug to be started, and future studies should investigate the effects of this drug when given immediately after patients develop symptoms.

Summary by: Louis Huynh