Lopinavir/ritonavir for the treatment of SARS, MERS and COVID-19: a systematic review

Eur Rev Med Pharmacol Sci. 2020 Aug;24(16):8592-8605. doi: 10.26355/eurrev_202008_22659.

Abstract

Objective: Lopinavir/ritonavir has been used for the treatment of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) coronavirus infections. It has been suggested that, based on this experience, this drug should also be studied in SARS-CoV2 infection.

Materials and methods: We performed a systematic review of the literature regarding the use of lopinavir/ritonavir for the treatment of these three infections. We systematically searched the PubMed database from inception to April 30th, 2020, to identify in-vitro and animal studies and any reports of human use of lopinavir/ritonavir for the treatment of SARS, MERS and COVID-19. We also searched the Clinicatrial.gov to identify ongoing trials.

Results: Five in-vitro studies evaluated the effect of lopinavir/ritonavir in SARS. Three additional in-vitro studies reported the EC50 of the antiviral activity of lopinavir/ritonavir in MERS. We identified no in vitro studies evaluating the effect of lopinavir/ritonavir on the novel coronavirus. Two retrospective matched-cohort studies reported the use of lopinavir/ritonavir in combination with ribavirin for SARS patients. Three case reports and one retrospective study described the use of lopinavir/ritonavir in MERS. Twenty-two papers describe the use of lopinavir/ritonavir in adult patients with COVID-19.

Conclusions: The existing literature does not suffice for assessing whether Lopinavir/ritonavir has any benefit in SARS, MERS or COVID-19.

Publication types

  • Systematic Review

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Betacoronavirus / isolation & purification
  • Clinical Studies as Topic
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / pathology
  • Coronavirus Infections / virology
  • Databases, Factual
  • Humans
  • Lopinavir / therapeutic use*
  • Middle East Respiratory Syndrome Coronavirus / drug effects*
  • Middle East Respiratory Syndrome Coronavirus / metabolism
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / pathology
  • Pneumonia, Viral / virology
  • Ritonavir / therapeutic use*
  • Severe Acute Respiratory Syndrome / drug therapy*
  • Severe Acute Respiratory Syndrome / pathology

Substances

  • Antiviral Agents
  • Lopinavir
  • Ritonavir

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2