A team of doctors and researchers in China have found that drugs that are effective in treating HIV patients are ineffective against COVID-19. In their work published in the New England Journal of Medicine, the group describes the clinical study that they conducted with patients in Wuhan, China, and what they learned from them. Lindsey Baden and Eric Rubin from Brigham and Women’s Hospital, (Rubin is also editor-in-chief of NEJM) have published an editorial in the same issue of the magazine discussing the team’s work in China.
Recently, it has been found in the medical community that the viruses behind COVID-19 and HIV both require an enzyme called protease to be infectious. And previous research has shown that the protease inhibitors lopinavir and ritonavir are effective in treating HIV patients, prompting many to wonder if they are also effective against SARS-CoV-2, which is used to 19 responsible virus that could be effective. To find out whether this could be the case, the team in Wuhan initiated a clinical study.
The study assigned 199 patients with advanced cases of COVID-19 to one of two groups – one receiving standard treatment (including additional oxygen) and the other receiving standard treatment plus lopinavir and ritonavir administration. In the end, 94 of the patients received the protease inhibitors. Unfortunately, the researchers found no benefit in the use of the medication. Those who received the drug fared no better than those who did not.
But there were some reservations. First, all patients were in advanced stages of the disease, which reduces the likelihood that therapy could help them. Second, the study size was very small. The researchers also found that the medication reduced the time that patients who survived experienced clinical improvement by one day. Unfortunately, this one-day improvement was only seen in patients who were given the medication within 12 days of the onset of symptoms. The positive thing about the results of the study, according to Baden and Rubin, is that the same drugs still offer the opportunity to help people who received them earlier after the infection. They also find that the courage the team has shown in China has also allowed other teams around the world to use their data in future studies.