Lopinavir/ritonavir: A rapid review of effectiveness in COVID-19

Abstract

There are currently no pharmacological treatments for COVID-19. Due to the urgent need for effective treatments, there has been increased interest in re-purposing currently available drugs for immediate use. The antiretroviral drug lopinavir is a protease inhibitor, which is widely used for the treatment of HIV and is a potential candidate for the treatment of COVID-19. Lopinavir is formulated in combination with another protease inhibitor, ritonavir (lopinavir/ritonavir, branded as Kaletra or Aluvia). Ritonavir inhibits the metabolising enzyme cytochrome P450 3A and therefore increases the half-life of lopinavir. There are some preliminary evidence of the effectiveness of lopinavir/ritonavir against other coronaviruses. In vivo, an open-label, non-randomised study found a reduced risk of severe hypoxia or death in 41 SARS-CoV patients who were treated with lopinavir/ritonavir and ribavirin, compared to 111 historical controls treated with ribavirin alone. There has been no evidence from randomised trials of the efficacy of lopinavir/ritonavir in treating SARS-CoV or MERS-CoV. We review the evidence for the use of lopinavir/ritonavir (LPVr) as a treatment for COVID-19.