Arising Medicines for Coronavirus

An oral antiretroviral protease inhibitor currently approved for the treatment of HIV Infection. Lopinavir/ritonavir has been used in clinical trials for the treatment of COVID-19. Results from one small case series found that evidence of clinical benefit with lopinavir/ ritonavir was equivocal. A randomized controlled trial of 200 patients with severe disease found that treatment with lopinavir/ritonavir plus standard care (i.e., oxygen, noninvasive and invasive ventilation, antibiotics, vasopressors, renal replacement therapy, and extracorporeal membrane oxygenation, as necessary) was not associated with an decreased time to clinical improvement compared with standard care alone, and 28-day mortality was similar in both groups. Preliminary results from the UK RECOVERY trial found that there is no beneficial eوٴect of lopinavir/ritonavir in hospitalized patients with COVID-19. Нere was no significant diوٴerence in 28-day mortality, risk of progression to mechanical ventilation, or duration of hospital stay between the two treatment arms (lopinavir/ritonavir versus usual care alone), and the results were consistent in diوٴerent subgroups of patients. Lopinavir/ritonavir may increase the risk of bradycardia, especially in older, critically ill patients. Lopinavir/ ritonavir should only be used in the context of a clinical trial.