Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease 2019
Kim et al.,
Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with..,
Korean J Intern Med, doi:10.3904/kjim.2020.224
Small retrospective study of hospitalized patients with 31 lopinavir-ritonavir and 34 HCQ patients, HCQ 400mg once per day, finding no significant difference in clinical response, but more rapid viral clearance with lopinavir-ritonavir.
Kim et al., 16 Jun 2020, retrospective, South Korea, peer-reviewed, 7 authors.
Abstract: ORIGINAL ARTICLE
Korean J Intern Med 2021;36(Suppl 1):S253-S263
https://doi.org/10.3904/kjim.2020.224
Lopinavir-ritonavir versus hydroxychloroquine for
viral clearance and clinical improvement in patients
with mild to moderate coronavirus disease 2019
Ji-Won Kim1, Eun Jin Kim2, Hyun Hee Kwon3, Chi Young Jung2, Kyung Chan Kim2, Jung-Yoon Choe1,
and Hyo-Lim Hong 3
Divisions of 1Rheumatology,
2
Pulmonology, and 3Infectious
Diseases, Department of Internal
Medicine, Daegu Catholic University
School of Medicine, Daegu, Korea
Received : May 13, 2020
Revised : May 27, 2020
Accepted : May 27, 2020
Correspondence to
Hyo-Lim Hong, M.D.
Department of Internal
Medicine, Daegu Catholic
University Medical Center, 33
Duryugongwon-ro 17-gil,
Nam-gu, Daegu 42472, Korea
Tel: +82-53-650-4899
Fax: +82-53-623-7507
E-mail: hlhong@cu.ac.kr
https://orcid.org/0000-00032147-1381
Background/Aims: The efficacies of lopinavir-ritonavir or hydroxychloroquine
remain to be determined in patients with coronavirus disease 2019 (COVID-19).
To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients.
Methods: This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea
from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and
hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or
hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up.
Results: Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with
lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median
duration of symptoms before treatment was 7 days and 26 patients (40%) required
oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with
hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21)
and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients
(median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more
frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients.
Conclusions: Lopinavir-ritonavir was associated with more rapid viral clearance
than hydroxychloroquine in mild to moderate COVID-19, despite comparable
clinical responses. These findings should be confirmed in randomized, controlled trials.
Keywords: COVID-19; Severe acute respiratory syndrome coronavirus 2; Lopinavir-ritonavir; Hydroxychloroquine
Copyright © 2021 The Korean Association of Internal Medicine
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The Korean Journal of Internal Medicine Vol. 36, Suppl 1, March..
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