Timely antiviral therapy may slow COVID-19 progression; more study needed
Researchers in China found that hospitalized patients with milder cases of COVID-19 were treated earlier with an assortment of antivirals compared with patients who experienced more severe disease, suggesting that the timing of antiviral therapy may significantly slow COVID-19 progression.
However, the study was underpowered to evaluate the therapeutic effect of the drugs, which included ribavirin, lopinavir and ritonavir.
“The guideline for diagnosis and treatment of COVID-19 issued by WHO and National Health Commission of the People's Republic of China suggests that ribavirin, lopinavir/ritonavir antiviral therapy should be used in COVID-19 patients,” the researchers wrote in the Journal of Internal Medicine.
Aaron E. Glatt, MD, FACP, FIDSA, FSHEA, a spokesperson for the Infectious Diseases Society of America (IDSA), stressed that there are no data supporting the routine use of those three drugs.
“The IDSA does not recommend their empirical use. I would only recommend they be used in a study setting,” he told Healio Primary Care.
The researchers conducted a retrospective study of 280 patients from four hospitals in Jiangsu and Anhui provinces. They said all patients received antiviral treatment, and 67.14% were treated empirically with a single antibiotic, primarily moxifloxacin. Additionally, 63.21% were supported with noninvasive ventilators (ie, a face mask).
According to the researchers, the ICU admission rate among all patients was 29.64%; the median length from symptom onset to ICU stay was 6 days (interquartile range [IQR] = 4-10); and the median length of ICU stay was 18 days (IQR = 7-37.9). The 197 patients with mild COVID-19 received antiviral treatment earlier than the 83 patients who had severe COVID-19 (1.19 ± 0.45 days vs. 2.65 ± 1.06 days; P < .001) and needed noninvasive ventilation. A significantly higher proportion of patients with severe COVID-19 had diabetes (51.81% vs. 7.11%) or cardiovascular diseases (33.73% vs. 3.05%) compared with those who had mild COVID-19.
The researchers suggested that well-designed clinical trials should evaluate the potential of ribavirin, lopinavir and ritonavir in treating COVID-19. Currently, researchers at the University of Hong Kong are testing whether the combination of the antivirals expedite recovery.
Glatt, who is also the chairman of the department of medicine and chief of the division of infectious diseases at Mount Sinai South Nassau in New York, said that in the absence of those data, clinicians “must weigh the available evidence and decide whether a trial of therapy with either an IL-6 inhibitor, plasma therapy and or other compassionate use drugs such as remdesivir are appropriate.” – by Janel Miller
Reference: Clinicaltrials.gov. Lopinavir/ Ritonavir, Ribavirin and IFN-beta combination for nCoV Treatment. https://clinicaltrials.gov/ct2/show/NCT04276688. Accessed April 20, 2020.
Disclosures: Glatt reports no relevant financial disclosures. Please see the study for all authors’ relevant financial disclosures.