COVID-19: no benefit with lopinavir-ritonavir in moderate-severe disease

  • RECOVERY Collaborative Group.
  • Lancet
  • 6 Oct 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Lopinavir-ritonavir monotherapy appears to confer no clinical benefit vs standard care for treatment of patients admitted to the hospital for COVID-19.

Why this matters

  • Editorial: This second open-label study confirms findings of an earlier open-label trial, which together indicate "that lopinavir-ritonavir is not effective in improving outcomes for patients admitted to hospital with COVID-19."

Key results

  • Intent to treat: 5040 patients (1616 lopinavir-ritonavir, 3424 usual care).
    • Mean age: 66.2 (standard deviation, 15.9) years.
  • 87% of patients receiving lopinavir-ritonavir who completed follow-up received >1 dose.
    • Median treatment duration: 5 (interquartile range [IQR], 2-8) days.
  • 28-day mortality:
    • 23% lopinavir-ritonavir vs 22% usual care.
    • Rate ratio (RR): 1.03 (P=.60).
  • 28-day mortality in post-hoc analysis of 4423 patients with positive SARS-CoV-2 test, lopinavir-ritonavir vs usual care: 
    • RR: 1.05 (P=.49).
  • Time to discharge for both groups: median, 11 (IQR, 5 to >28) days.
  • Discharge alive
    • RR: 0.98 (P=.53).
  • Progression to invasive mechanical ventilation or death, lopinavir-ritonavir vs usual care:
    • RR: 1.09 (P=.092).

Study design

  • Randomized, controlled, open-label platform trial (RECOVERY) assessing outcomes with lopinavir-ritonavir in UK patients hospitalized with COVID-19.
  • Primary outcome: 28-day all-cause mortality.
  • Funding: Medical Research Council; National Institute for Health Research.

Limitations

  • Uncollected data (adverse reactions, discontinuations, physiological/laboratory/virological parameters).
  • Limited numbers of intubated patients.