Slower Recovery with Early Lopinavir/Ritonavir use in Pediatric COVID-19 Patients: A Retrospective Observational Study

Abstract

Objectives There was initially insufficient understanding regarding suitable pharmacological treatment for pediatric Coronavirus Disease 2019 (COVID-19) patients. Lopinavir-ritonavir (LPV/r) was originally used for the treatment of Human Immunodeficiency Virus-1 (HIV-1) infection. It was also used in patients with severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) with positive results. Nonetheless, results from recent randomized controlled trials and observational studies on COVID-19 patients were unfavorable. We sought to evaluate the clinical outcomes associated with early treatment with LPV/r for pediatric COVID-19 patients. Study Design A total of 933 COVID-19 patients aged ≤ 18 years were admitted between 21 January 2020 and 31 January 2021 in Hong Kong. Exposure was receiving LPV/r within the first two days of admission. Time to clinical improvement, hospital discharge, seroconversion and hyperinflammatory syndrome, cumulative costs, and hospital length of stay were assessed. Multivariable Cox proportional hazard and linear models were performed to estimate hazard ratios (HR) and their 95% confidence intervals (CI) of time-to-event and continuous outcomes, respectively. Results LPV/r users were associated with longer time to clinical improvement (HR 0.51, 95% CI 0.38–0.70; p < 0.001), hospital discharge (HR 0.51, 95% CI 0.38–0.70; p < 0.001) and seroconversion (HR 0.59, 95% CI 0.43–0.80; p < 0.001) when compared with controls. LPV/r users were also associated with prolonged hospital length of stay (6.99 days, 95% CI 6.23–7.76; p < 0.001) and higher costs at 30 days (US$11,709 vs US$8270; p < 0.001) as opposed to controls. Conclusion Early treatment with LPV/r for pediatric COVID-19 patients was associated with longer time to clinical improvement. Our study advocates the recommendation against LPV/r use for pediatric patients across age groups. Supplementary Information The online version contains supplementary material available at 10.1007/s40272-022-00500-7.

Initiation of Tocilizumab or Baricitinib Were Associated With Comparable Clinical Outcomes Among Patients Hospitalized With COVID-19 and Treated With Dexamethasone

“…Electronic medical records of all admitted patients with COVID-19 confirmed by positive reverse transcription polymerase chain reaction (RT-PCR) test were collected from the Hospital Authority database for the study period from January 21st, 2020 to January 31st, 2021, including patient demographics, deaths, diagnoses, procedures, drug prescription and dispensing history, and laboratory test results. The Hospital Authority database has been used extensively for the evaluation of drug therapies for COVID-19 ( Wong et al, 2021a ; Wong et al, 2021b ; Wong et al, 2022a ; Wong et al, 2022b ). The follow-up period lasted until April 30th, 2021.…”

Drugs for COVID-19: An Update

“…However, Elmekaty et al [ 41 ] showed that early treatment with LPV/r is associated with a faster clinical improvement and/or virological clearance than the darunavir/cobicistat therapy in patients with COVID-19 pneumonia, and that the safety profile was quite comparable. Finally, Wong et al [ 42 ] discourage the use of LPV/r for pediatric COVID-19 cases because of their negative clinical outcomes, reporting a longer time for clinical improvement, seroconversion, hospital discharge, together with a higher risk of a hyperinflammation.…”