Effectiveness of early treatment of lopinavir-ritonavir in patients with severe COVID-19: a case series

Clin Med (Lond). 2021 Jan;21(1):e80-e83. doi: 10.7861/clinmed.2020-0348. Epub 2020 Dec 18.


Aim: The inconsistent effects of lopinavir-ritonavir (LPV/r) on COVID-19 seem to be caused by the therapeutic window. In the present study, we aim to present the effects of early LPV/r treatment on patients with severe COVID-19.

Methods: The demographics, characteristics, treatments, SARS-CoV-2 test results and outcomes of 19 patients with severe COVID-19 treated with LPV/r within 12 days of onset of symptoms were retrospectively assessed.

Results: Within 3 days of admission, three (15.79%) patients received noninvasive ventilation, and 16 (84.21%) patients received high-flow oxygen support. The median duration between the onset of symptoms and initiating LPV/r therapy was 9 (range 2-12) days. The median course of LPV/r treatment was 11 (range 7-17) days. One of the 19 patients (5.26%) died. Of the 18 patients discharged, the median hospital stay was 17 (range 11-45) days. At day 6 after LPV/r therapy was initiated, 68.42% of patients were virologically cured, increasing to 84.22% at day 12.

Conclusion: In this cohort of patients with severe COVID-19 who were treated with LPV/r within 12 days of the onset of symptoms, clinical improvement was observed in 18/19 patients (94.74%). Randomised controlled trials are urgently needed to further evaluate this strategy.

Keywords: COVID-19; SARS-CoV-2; lopinavir–ritonavir.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology
  • COVID-19 Drug Treatment*
  • Cytochrome P-450 CYP3A Inhibitors / therapeutic use
  • Drug Combinations
  • Female
  • Humans
  • Lopinavir / therapeutic use*
  • Male
  • Middle Aged
  • Pandemics
  • Retrospective Studies
  • Ritonavir / therapeutic use*
  • SARS-CoV-2*
  • Treatment Outcome
  • Young Adult


  • Cytochrome P-450 CYP3A Inhibitors
  • Drug Combinations
  • Lopinavir
  • Ritonavir