tetano
Editor, Senior Moderator
J Med Virol
. 2020 Aug 10.
doi: 10.1002/jmv.26407. Online ahead of print.
Early administration of lopinavir/ritonavir plus hydroxychloroquine does not alter the clinical course of SARS-CoV-2 infection: a retrospective cohort study
Andrea Giacomelli[SUP] 1 2 [/SUP], Gabriele Pagani[SUP] 1 2 [/SUP], Anna Lisa Ridolfo[SUP] 1 [/SUP], Letizia Oreni Bit[SUP] 1 [/SUP], Federico Conti[SUP] 1 2 [/SUP], Laura Pezzati[SUP] 1 2 [/SUP], Lucia Bradanini[SUP] 1 2 [/SUP], Giacomo Casalini[SUP] 1 2 [/SUP], Cinzia Bassoli[SUP] 1 2 [/SUP], Valentina Morena[SUP] 1 2 [/SUP], Simone Passerini[SUP] 1 [/SUP], Giuliano Rizzardini[SUP] 1 3 [/SUP], Chiara Cogliati[SUP] 4 [/SUP], Elisa Ceriani[SUP] 4 [/SUP], Riccardo Colombo[SUP] 5 [/SUP], Stefano Rusconi[SUP] 1 2 [/SUP], Cristina Gervasoni[SUP] 1 [/SUP], Dario Cattaneo[SUP] 6 [/SUP], Spinello Antinori[SUP] 1 2 [/SUP], Massimo Galli[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: As it has been shown that lopinavir (LPV) and hydroxychloroquine (HCQ) have in vitro activity against coronaviruses, they were used to treat COVID-19 during the first wave of the epidemic in Lombardy, Italy.
Methods: To compare the rate of clinical improvement between those who started LPV/ritonavir (LPV/r)+HCQ within five days of symptom onset (early treatment, ET) and those who started later (delayed treatment, DT). This was a retrospective intent-to-treat analysis of the hospitalized patients who started LPV/r+HCQ between 21 February and 20 March 2020. The association between the timing of treatment and the probability of 30-day mortality was assessed using uni- and multivariable logistic models.
Results: The study involved 172 patients: 43 (25%) in the ET and 129 (75%) in the DT group. The rate of clinical improvement increased over time to 73.3% on day 30, without any significant difference between the two groups (Gray's test P=0.213). After adjusting for potentially relevant clinical variables, there was no significant association between the timing of the start of treatment and the probability of 30-day mortality (adjusted odds ratio [aOR] ET vs DT=1.45, 95% confidence interval 0.50-4.19). Eight percent of the patients discontinued the treatment because of severe gastrointestinal disorders attributable to LPV/r.
Conclusion: The timing of the start of LPV/r+HCQ treatment does not seem to affect the clinical course of hospitalised patients with COVID-19. Together with the severe adverse events attributable to LPV/r, this raises concerns about the benefit of using this combination to treat COVID-19. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; antiviral treatment; early; hydroxychloroquine; lopinavir; mortality.
. 2020 Aug 10.
doi: 10.1002/jmv.26407. Online ahead of print.
Early administration of lopinavir/ritonavir plus hydroxychloroquine does not alter the clinical course of SARS-CoV-2 infection: a retrospective cohort study
Andrea Giacomelli[SUP] 1 2 [/SUP], Gabriele Pagani[SUP] 1 2 [/SUP], Anna Lisa Ridolfo[SUP] 1 [/SUP], Letizia Oreni Bit[SUP] 1 [/SUP], Federico Conti[SUP] 1 2 [/SUP], Laura Pezzati[SUP] 1 2 [/SUP], Lucia Bradanini[SUP] 1 2 [/SUP], Giacomo Casalini[SUP] 1 2 [/SUP], Cinzia Bassoli[SUP] 1 2 [/SUP], Valentina Morena[SUP] 1 2 [/SUP], Simone Passerini[SUP] 1 [/SUP], Giuliano Rizzardini[SUP] 1 3 [/SUP], Chiara Cogliati[SUP] 4 [/SUP], Elisa Ceriani[SUP] 4 [/SUP], Riccardo Colombo[SUP] 5 [/SUP], Stefano Rusconi[SUP] 1 2 [/SUP], Cristina Gervasoni[SUP] 1 [/SUP], Dario Cattaneo[SUP] 6 [/SUP], Spinello Antinori[SUP] 1 2 [/SUP], Massimo Galli[SUP] 1 2 [/SUP]
Affiliations
- PMID: 32776534
- DOI: 10.1002/jmv.26407
Abstract
Background: As it has been shown that lopinavir (LPV) and hydroxychloroquine (HCQ) have in vitro activity against coronaviruses, they were used to treat COVID-19 during the first wave of the epidemic in Lombardy, Italy.
Methods: To compare the rate of clinical improvement between those who started LPV/ritonavir (LPV/r)+HCQ within five days of symptom onset (early treatment, ET) and those who started later (delayed treatment, DT). This was a retrospective intent-to-treat analysis of the hospitalized patients who started LPV/r+HCQ between 21 February and 20 March 2020. The association between the timing of treatment and the probability of 30-day mortality was assessed using uni- and multivariable logistic models.
Results: The study involved 172 patients: 43 (25%) in the ET and 129 (75%) in the DT group. The rate of clinical improvement increased over time to 73.3% on day 30, without any significant difference between the two groups (Gray's test P=0.213). After adjusting for potentially relevant clinical variables, there was no significant association between the timing of the start of treatment and the probability of 30-day mortality (adjusted odds ratio [aOR] ET vs DT=1.45, 95% confidence interval 0.50-4.19). Eight percent of the patients discontinued the treatment because of severe gastrointestinal disorders attributable to LPV/r.
Conclusion: The timing of the start of LPV/r+HCQ treatment does not seem to affect the clinical course of hospitalised patients with COVID-19. Together with the severe adverse events attributable to LPV/r, this raises concerns about the benefit of using this combination to treat COVID-19. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; antiviral treatment; early; hydroxychloroquine; lopinavir; mortality.