Lopinavir-ritonavir is not associated with improved outcomes in patients hospitalized with COVID-19, a new trial shows. Dr. Peter W. Horby from the RECOVERY Central Coordinating Office, Oxford, UK and colleagues assessed whether lopinavir-ritonavir improves outcomes in their randomized trial of 5,040 hospitalized patients (1616 allocated to lopinavir-ritonavir and 3424 allocated to usual care). There was no significant difference in the proportion of patients who met the primary outcome of 28-day mortality between the lopinavir-ritonavir group (23%) and the usual care group (22%), according to the report in The Lancet. Results were similar in a post hoc exploratory analysis restricted to the 4,423 patients who tested positive for SARS-CoV-2. There was no difference between the groups in the time until discharge alive from hospital, the probability of discharge alive from hospital within 28 days, or the number of patients who progressed to the prespecified composite secondary outcome of invasive mechanical ventilation or death. "The results of this large randomized trial indicate that lopinavir-ritonavir is not an effective treatment for patients admitted to hospital with COVID-19," the authors conclude. In a related editorial, Dr. Bin Cao from Chinese Academy of Medical Sciences, Beijing, China and Dr. Frederick G. Hayden from University of Virginia School of Medicine, Charlottesville, say antiviral monotherapy for moderately to severely ill hospitalized COVID-19 patients "might not be enough." They add, "The evaluation of efficacy and safety of combination therapy with antivirals and immunomodulators for severe COVID-19 should be a priority for ongoing and future clinical trials." Dr. Horby was not available for comment. —Will Boggs MD Source
