tetano
Editor, Senior Moderator
Korean J Intern Med
. 2020 Jun 16.
doi: 10.3904/kjim.2020.224. Online ahead of print.
Lopinavir-ritonavir Versus Hydroxychloroquine for Viral Clearance and Clinical Improvement in Patients With Mild to Moderate Coronavirus Disease 2019
Ji-Won Kim[SUP] 1 [/SUP], Eun Jin Kim[SUP] 2 [/SUP], Hyun Hee Kwon[SUP] 3 [/SUP], Chi Young Jung[SUP] 2 [/SUP], Kyung Chan Kim[SUP] 2 [/SUP], Jung-Yoon Choe[SUP] 1 [/SUP], Hyo-Lim Hong[SUP] 3 [/SUP]
Affiliations
Abstract
Background/aims: The efficacies of lopinavir-ritonavir or hydroxychloroquine remain to be determined in patients with coronavirus disease 2019 (COVID-19). To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients.
Methods: This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up.
Results: Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median duration of symptoms before treatment was 7 days and 26 patients (40%) required oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21) and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients (median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients.
Conclusions: Lopinavir-ritonavir was associated with more rapid viral clearance than hydroxychloroquine in mild to moderate COVID-19, despite comparable clinical responses. These findings should be confirmed in randomized, controlled trials.
Keywords: COVID-19; Hydroxychloroquine; Lopinavir-ritonavir; Severe acute respiratory syndrome coronavirus 2.
. 2020 Jun 16.
doi: 10.3904/kjim.2020.224. Online ahead of print.
Lopinavir-ritonavir Versus Hydroxychloroquine for Viral Clearance and Clinical Improvement in Patients With Mild to Moderate Coronavirus Disease 2019
Ji-Won Kim[SUP] 1 [/SUP], Eun Jin Kim[SUP] 2 [/SUP], Hyun Hee Kwon[SUP] 3 [/SUP], Chi Young Jung[SUP] 2 [/SUP], Kyung Chan Kim[SUP] 2 [/SUP], Jung-Yoon Choe[SUP] 1 [/SUP], Hyo-Lim Hong[SUP] 3 [/SUP]
Affiliations
- PMID: 32536150
- DOI: 10.3904/kjim.2020.224
Abstract
Background/aims: The efficacies of lopinavir-ritonavir or hydroxychloroquine remain to be determined in patients with coronavirus disease 2019 (COVID-19). To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients.
Methods: This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up.
Results: Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median duration of symptoms before treatment was 7 days and 26 patients (40%) required oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21) and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients (median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients.
Conclusions: Lopinavir-ritonavir was associated with more rapid viral clearance than hydroxychloroquine in mild to moderate COVID-19, despite comparable clinical responses. These findings should be confirmed in randomized, controlled trials.
Keywords: COVID-19; Hydroxychloroquine; Lopinavir-ritonavir; Severe acute respiratory syndrome coronavirus 2.