Lopinavir with ritonavir is a combination therapy approved by the U.S. Food and Drug Administration (FDA) for the treatment of Human Immunodeficiency Virus (HIV) infection. This combination therapy helps block a key pathway that a virus uses to replicate. These drugs are used in combination to increase their effectiveness.
When there are no therapeutic treatments proven to be effective against a disease, medications that are already developed may be tested to see if they can be an effective treatment. Repurposing a drug is a much faster way of providing treatment than finding a novel drug. Due to the anti-viral properties of lopinavir-ritonavir, the combination therapy was tested for the treatment of the 2003 coronavirus outbreak that caused severe acute respiratory syndrome (SARS). Studies demonstrated that the therapy might be able to prevent SARS from maturing and replicating as well as Middle East respiratory syndrome (MERS). This evidence suggested that lopinavir-ritonavir may also be helpful in treating COVID-19.
A clinical trial in China tested the effectiveness of lopinavir-ritonavir treatment in adults hospitalized with severe illness from COVID-19. The study recruited 199 participants where 100 participants were randomized to standard of care treatment and 99 were randomized to study treatment, lopinavir-ritonavir. Participants randomized to the study drug were administered the medication orally twice a day for 14 days in addition to their standard of care. All participants were observed for their duration of hospitalization and intensive care, viral load, mortality, and symptom management. The study concluded that lopinavir-ritonavir did not demonstrate a significant benefit to patients with severe illness from COVID-19.
It should be noted that 5 patients in the lopinavir-ritonavir group passed away before starting treatment, and the physician of 2 patients refused to treat them with the study drug. Also, 14% of patients were not able to complete the full course of treatment due to gastrointestinal issues caused by treatment. While some patients in the lopinavir-ritonavir group had a shorter stay in the intensive care unit (ICU) than those in the standard-care group, no overall significant benefits were proven.
The use of lopinavir-ritonavir treatment in COVID-19 should be further studied. The drug may still prove to be effective in different populations, or effective when used in combination with other treatments such as an interferon beta drug. There are currently 11 studies listed on ClinicalTrials.gov testing the effectiveness of lopinavir–ritonavir therapy for the treatment of COVID-19.
By: Randy Astaiza
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