Comparison of hydroxychloroquine, lopinavir/ritonavir, and standard of care in critically ill patients with SARS-CoV-2 pneumonia: an opportunistic retrospective analysis
Marie Lecronier, Alexandra Beurton, Sonia Burrel, Luc Haudebourg, Robin Deleris, Julien Le Marec, Sara Virolle, Safaa Nemlaghi, Côme Bureau, Pierre Mora, Martin De Sarcus, Olivier Clovet, Baptiste Duceau, Paul Henri Grisot, Marie Hélène Pari, Jérémy Arzoine, Ulrich Clarac, David Boutolleau, Mathieu Raux, Julie Delemazure, Morgane Faure, Maxens Decavele, Elise Morawiec, Julien Mayaux, Alexandre Demoule, Martin Dres
Critical Care, doi:10.1186/s13054-020-03117-9
Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak is spreading worldwide. To date, no specific treatment has convincingly demonstrated its efficacy. Hydroxychloroquine and lopinavir/ ritonavir have potential interest, but virological and clinical data are scarce, especially in critically ill patients. Methods: The present report took the opportunity of compassionate use and successive drug shortages to compare the effects of two therapeutic options, lopinavir/ritonavir and hydroxychloroquine, as compared to standard of care only. The primary outcomes were treatment escalation (intubation, extra-corporeal membrane oxygenation support, or renal replacement therapy) after day 1 until day 28. Secondary outcomes included ventilator-free days at day 28, mortality at day 14 and day 28, treatment safety issues and changes in respiratory tracts, and plasma viral load (as estimated by cycle threshold value) between admission and day 7.
Abbreviations ICU: Intensive care unit; SAPS II: Simplified Acute Physiology Score II; SOFA: Sequential Organ Failure Assessment; SARS-CoV-2: Severe acute respiratory syndrome coronavirus-2; ECMO: Extra-corporeal membrane oxygenation; IQR: Interquartile range; CT: Cycle threshold; RT-PCR: Reverse transcription polymerase chain reaction Authors' contributions ML, LH, RD, and AB collected the patient's data. ML and MD analyzed the patient's data and have written the manuscript. All authors contributed to drafting the manuscript or critically revising it for important intellectual content and approved the final version of the manuscript.
Ethics approval and consent to participate The Research Ethics Committee of Sorbonne University approved the project (CER 2020-36). Oral information about this retrospective analysis was given to patients or relatives.
Consent for publication Not applicable
Competing interests Martin Dres received fees from Lungpacer (expertise, lectures). A Demoule reports personal fees from Medtronic; grants, personal fees, and non-financial support from Philips; personal fees from Baxter; personal fees from Hamilton; personal fees and non-financial support from Fisher & Paykel; grants from French Ministry of Health; personal fees from Getinge; grants and personal fees from Respinor; and grants and non-financial support from Lungpacer, outside the submitted work. The other authors have no conflicts of interest to declare.
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