Lopinavir and ritonavir may bind to Mpro, a key enzyme for coronavirus replication. This may suppress coronavirus activity.
Approved for HIV.
Pre-clinical data show activity for other coronaviruses.
A randomized, controlled, open-label trial involving hospitalized patients with confirmed SARS-CoV-2 infection (n = 199), analyzed treatment with lopinavir; ritonavir.
- Treatment with lopinavir; ritonavir for 14 days was not associated with a difference from standard of care in the time to clinical improvement (hazard ratio 1.24; 95% CI, 0.9 to 1.72).
- Mortality at 28 days was similar between groups (19.2% vs. 25%, respectively).
- The percentages of patients with detectable viral RNA were similar. In a modified ITT analysis, lopinavir; ritonavir had a median time to clinical improvement that was shorter by 1 day (hazard ratio, 1.39%; 95% CI, 1 to 1.91).
A retrospective cohort study of hospitalized patients reviewing clinical course and risk factors for mortality included 29 patients who received lopinavir; ritonavir.
- No difference was noted in the duration of viral shedding after treatment with lopinavir; ritonavir.
- Risk of cardiac arrhythmias (e.g., QT prolongation)
- Caution in patients with hepatic disease or hepatitis
- Significant drug interactions
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