Use of lopinavir-ritonavir has no clinical benefit in patients with COVID-19

The RECOVERY trial has determined that there is no clinical benefit to using the HIV treatment lopinavir-ritonavir to treat patients with COVID-19.

The results for this arm of the trial showed that use of lopinavir-ritonavir had no effect on the primary endpoint of 28-day mortality regardless of whether patients required invasive mechanical ventilation, oxygen alone, or no respiratory intervention. In addition, use of lopinavir-ritonavir demonstrated no beneficial effects on the risk of progression to mechanical ventilation or length of hospital stay.

Because of the difficulty of administering lopinavir-ritonavir patients on ventilators, the number of patients in this subgroup was small; therefore, the authors were unable to make conclusions about the efficacy of the treatment in mechanically ventilated patients, and further evidence must be gathered in this population.

The Executive Chair of the Medical Research Council, Professor Fiona Watt, stated, ‘It is very important that we test potential therapies in randomised clinical trials so that we can find out whether re-purposed drugs work or not. The UK’s RECOVERY trial is the world’s largest randomised trial of potential COVID-19 treatments and has worked with unprecedented speed to start delivering the answers we need. Whilst it is disappointing that lopinavir/ritonavir, like hydroxychloroquine, has been found to be ineffective, the earlier findings with dexamethasone were positive. Researchers and health professionals are now focusing their efforts, and patient care, on other promising drugs.’