Abstract
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. To compare the rate of clinical improvement between those who started LPV/ritonavir (LPV/r)+HCQ within 5 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 univariable and multivariable logistic models. 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 = .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 becausebecause of severe gastrointestinal disorders attributable to LPV/r. The timing of the start of LPV/r + HCQ treatment does not seem to affect the clinical course of hospitalized 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.
Keywords: COVID-19; antiviral treatment; early; hydroxychloroquine; lopinavir; mortality.
【저자키워드】 COVID-19, Mortality, Hydroxychloroquine, Lopinavir, Antiviral treatment, early, 【초록키워드】 Treatment, Coronaviruses, Mortality, Hydroxychloroquine, Antiviral, Lopinavir, Ritonavir, Antiviral treatment, Italy, hospitalized patients, Probability, Clinical course, early treatment, Clinical improvement, HCQ, First wave, association, 30-Day mortality, retrospective, Combination, in vitro activity, Analysis, lombardy, symptom onset, Logistic, clinical variables, adjusted odds ratio, significant difference, two groups, 95% confidence interval, treat, severe adverse events, disorder, Gray, Affect, benefit, the epidemic, multivariable, raise, shown, involved, the patient, were used, hospitalized patient, two group, intent-to-treat, LPV, severe adverse event, the timing, univariable, with COVID-19, 【제목키워드】 SARS-CoV-2, Hydroxychloroquine, administration, retrospective cohort study, Alter,