Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

Choi, Min Joo; Kang, Minsun; Shin, So Youn; Noh, Ji Yun; Cheong, Hee Jin; Jung, Jaehun; Song, Joon Young

doi:10.1016/j.ijid.2020.10.062

Cited by 9 publications

(12 citation statements)

References 39 publications

(46 reference statements)

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“…The same occurs in the retrospective cohort study by Choi et al, where the median viral shedding duration was longer in patients treated with lopinavir/ritonavir (23 days) compared to those who only received standard of care (18 days) ( p < 0.0001) [ 61 ].…”

Section: Resultssupporting

confidence: 54%

“…The majority of the observational studies included in this systematic review coincide with the results proposed by the RCTs and neither did they find benefits regarding the use of lopinavir/ritonavir compared to standard of care [ 59 , 60 , 61 , 63 , 64 , 67 ]. In fact, in three of them standard therapy was even more effective [ 60 , 61 , 64 ].…”

Section: Discussionmentioning

confidence: 75%

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Antiviral Therapeutic Approaches for SARS-CoV-2 Infection: A Systematic Review

2021

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Background: Due to the lack of an etiologic treatment for SARS-CoV-2 and the difficulties involved in developing new drugs, some drugs already approved for other diseases or with efficacy against SARS and MERS, have been used in patients with COVID-19. This systematic review aims to summarize evidence on the efficacy and safety of five antivirals applied to patients with COVID-19, that have proven to be effective either in vitro studies or in studies on SARS-CoV and MERS.; Methods: An intensive search of different databases (Pub Med, WoS, MEDLINE and Cochrane COVID-19 Study Register) has been carried out until the end of April 2021. This systematic review has been conducted according to the PRISMA statement. From each of the included studies, the characteristics of the intervention and comparison groups, demographic data and results were extracted independently; Results: Remdesivir is well tolerated and helps to accelerate clinical improvement but is ineffective in reducing mortality. Favipiravir is safe and shows promising results regarding symptom resolution but does not improve viral clearance. The use of lopinavir/ritonavir has been associated with an increased risk of gastrointestinal adverse events and it has not proven to be effective. No significant differences were observed between patients treated with ribavirin or umifenovir and their respective control groups; Conclusions: Remdesivir and favipiravir are well tolerated and effective in accelerating clinical improvement. This systematic review does not support the use of lopinavir/ritonavir, ribavirin and umifenovir in hospitalized patients with COVID-19.

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Section: Resultssupporting

confidence: 54%

Section: Discussionmentioning

confidence: 75%

Antiviral Therapeutic Approaches for SARS-CoV-2 Infection: A Systematic Review

2021

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“…Another meta-analysis demonstrated no significant difference in terms of negative polymerase chain reaction (PCR) results between patients treated with lopinavir/ritonavir and those treated with the standard care (Wang et al, 2020a). Data from observational studies revealed no differences between lopinavir/ritonavir and hydroxychloroquine administered in patients with severe or mild-moderate COVID-19 (Choi et al, 2020;Karolyi et al, 2020;Lecronier et al, 2020). A retrospective study, conducted instead in non-severe patients with COVID-19, also showed no improvement in the prognosis or shortening of clinical course with lopinavir/ritonavir treatment (Gao et al, 2020).…”

Section: Clinical Evidence Of Antiviral Agentsmentioning

confidence: 99%

Therapeutic strategies to fight COVID-19: which is the status artis?

Scavone

Mascolo

Rafaniello

et al. 2021

Preprint

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COVID-19 is a complex disease and many difficulties are faced today especially in the proper choice of pharmacological treatments. The role of antiviral agents for COVID-19 is still being investigated. The evidence for immunomodulatory and anti-inflammatory drugs is quite conflicting, while the use of corticosteroids is supported by robust evidence. The use of heparins in hospitalized critically ill patients is preferred over other anticoagulants. Lastly, conflicting data were found regarding to the use of convalescent plasma and vitamin D. According to data shared by the WHO, many vaccines are under phase 3 clinical trials and some of them already received the marketing approval in EU countries and in the US. In conclusion, drugs repurposing has represented the main approach recently used in the treatment of patients with COVID-19. At this moment, the analysis of efficacy and safety data of drugs and vaccines used in real life context is strongly needed.

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“…Initial retrospective reports described a reduced viral shedding in patients treated with LPV/r plus interferon-α [ 13 ], but subsequent larger studies of the same type reported opposite results [ 14 ]. In a multicentre, prospective, open-label, randomized, phase 2 trials conducted in Hong Kong, an early triple antiviral therapy with LPV/r plus ribavirin plus interferon-β-1b was safe and more efficacious than LPV/r alone in alleviating symptoms and shortening the duration of viral shedding (7 days vs. 12 days) and hospital stay (9 days vs. 14.5 days) in patients with mild to moderate COVID-19 [ 15 ].…”

Section: Lopinavir/ritonavirmentioning

confidence: 99%

Antiviral treatment selection for SARS-CoV-2 pneumonia

Bassetti

Corcione

Dettori

et al. 2021

Expert Review of Respiratory Medicine

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Introduction Therapy of coronavirus disease 2019 (COVID-19) involves evolving algorithms that include drugs aimed at reducing disease progression by counteracting two different, but intertwined processes: ( i ) the damage caused by the virus (with antivirals); ( ii ) the damage caused by a dysregulated host response (with immunomodulatory agents). Areas covered Herein, we discuss the available evidence on the efficacy and safety of antiviral agents employed over the past months for the treatment of COVID-19, and the reasons to be considered for antiviral selection. Expert opinion The available evidence from randomized controlled trials (RCT) currently discourages the use of lopinavir/ritonavir, hydroxychloroquine, and interferons, which did not show improved efficacy compared to standard care or placebo. Regarding remdesivir, the current body of evidence may conditionally support its use in COVID-19 patients requiring oxygen supplementation but still not requiring invasive mechanical ventilation. Finally, neutralizing monoclonal antibodies have been proven efficacious in reducing the risk of severe disease development if administered early in the course of the disease to patients at risk of progression. The results of the ongoing RCT will certainly be crucial to further improve our understanding of the optimal place in therapy of antiviral agents for COVID-19.

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Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

Cited by 9 publications

References 39 publications

Antiviral Therapeutic Approaches for SARS-CoV-2 Infection: A Systematic Review

Antiviral Therapeutic Approaches for SARS-CoV-2 Infection: A Systematic Review

Therapeutic strategies to fight COVID-19: which is the status artis?

Antiviral treatment selection for SARS-CoV-2 pneumonia

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