Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients : Results from a real-life patient cohort.
Identifieur interne : 000F19 ( Main/Corpus ); précédent : 000F18; suivant : 000F20Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients : Results from a real-life patient cohort.
Auteurs : Mario Karolyi ; Erich Pawelka ; Theresa Mader ; Sara Omid ; Hasan Kelani ; Sarah Ely ; Bernd Jilma ; Sebastian Baumgartner ; Hermann Laferl ; Clemens Ott ; Marianna Traugott ; Michael Turner ; Tamara Seitz ; Christoph Wenisch ; Alexander ZoufalySource :
- Wiener klinische Wochenschrift [ 1613-7671 ] ; 2021.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Hydroxychloroquine, Lopinavir, Ritonavir.
- drug therapy : COVID-19.
- Adolescent, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, SARS-CoV-2.
Abstract
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a high mortality. To date no trial comparing hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/RTV) has been performed.
METHODS
Hospitalized patients ≥18 years old with severe coronavirus disease 2019 (COVID-19) were treated with either HCQ or LPV/RTV if they had either respiratory insufficiency (SpO
RESULTS
Of 156 patients (41% female) with a median age of 72 years (IQR 55.25-81) admitted to our department, 67 patients fulfilled the inclusion criteria (20 received HCQ, 47 LPV/RTV). Groups were comparable regarding most baseline characteristics. Median time from symptom onset to treatment initiation was 8 days and was similar between the groups (p = 0.727). There was no significant difference (HCQ vs. LPV/RTV) in hospital mortality (15% vs. 8.5%, p = 0.418), ICU admission rate (20% vs. 12.8%, p = 0.470) and length of stay (9 days vs. 11 days, p = 0.340). A PCR negativity from nasopharyngeal swabs was observed in approximately two thirds of patients in both groups. Side effects led to treatment discontinuation in 15% of patients in the LPV/RTV group.
CONCLUSION
No statistically significant differences were observed in outcome parameters in patients treated with HCQ or LPV/RTV but patients in the LPV/RTV group showed a numerically lower hospital mortality rate. Additionally, in comparison to other studies we demonstrated a lower mortality in patients treated with LPV/RTV despite having similar patient groups, perhaps due to early initiation of treatment.
DOI: 10.1007/s00508-020-01720-y
PubMed: 32776298
PubMed Central: PMC7416584
Links to Exploration step
pubmed:32776298Le document en format XML
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<author><name sortKey="Seitz, Tamara" sort="Seitz, Tamara" uniqKey="Seitz T" first="Tamara" last="Seitz">Tamara Seitz</name>
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<author><name sortKey="Wenisch, Christoph" sort="Wenisch, Christoph" uniqKey="Wenisch C" first="Christoph" last="Wenisch">Christoph Wenisch</name>
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<author><name sortKey="Zoufaly, Alexander" sort="Zoufaly, Alexander" uniqKey="Zoufaly A" first="Alexander" last="Zoufaly">Alexander Zoufaly</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients : Results from a real-life patient cohort.</title>
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</author>
<author><name sortKey="Pawelka, Erich" sort="Pawelka, Erich" uniqKey="Pawelka E" first="Erich" last="Pawelka">Erich Pawelka</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Mader, Theresa" sort="Mader, Theresa" uniqKey="Mader T" first="Theresa" last="Mader">Theresa Mader</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Omid, Sara" sort="Omid, Sara" uniqKey="Omid S" first="Sara" last="Omid">Sara Omid</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Kelani, Hasan" sort="Kelani, Hasan" uniqKey="Kelani H" first="Hasan" last="Kelani">Hasan Kelani</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Ely, Sarah" sort="Ely, Sarah" uniqKey="Ely S" first="Sarah" last="Ely">Sarah Ely</name>
<affiliation><nlm:affiliation>Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Jilma, Bernd" sort="Jilma, Bernd" uniqKey="Jilma B" first="Bernd" last="Jilma">Bernd Jilma</name>
<affiliation><nlm:affiliation>Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Baumgartner, Sebastian" sort="Baumgartner, Sebastian" uniqKey="Baumgartner S" first="Sebastian" last="Baumgartner">Sebastian Baumgartner</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Laferl, Hermann" sort="Laferl, Hermann" uniqKey="Laferl H" first="Hermann" last="Laferl">Hermann Laferl</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Ott, Clemens" sort="Ott, Clemens" uniqKey="Ott C" first="Clemens" last="Ott">Clemens Ott</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Traugott, Marianna" sort="Traugott, Marianna" uniqKey="Traugott M" first="Marianna" last="Traugott">Marianna Traugott</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Turner, Michael" sort="Turner, Michael" uniqKey="Turner M" first="Michael" last="Turner">Michael Turner</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Seitz, Tamara" sort="Seitz, Tamara" uniqKey="Seitz T" first="Tamara" last="Seitz">Tamara Seitz</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Wenisch, Christoph" sort="Wenisch, Christoph" uniqKey="Wenisch C" first="Christoph" last="Wenisch">Christoph Wenisch</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Zoufaly, Alexander" sort="Zoufaly, Alexander" uniqKey="Zoufaly A" first="Alexander" last="Zoufaly">Alexander Zoufaly</name>
<affiliation><nlm:affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</nlm:affiliation>
</affiliation>
</author>
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<series><title level="j">Wiener klinische Wochenschrift</title>
<idno type="eISSN">1613-7671</idno>
<imprint><date when="2021" type="published">2021</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term>
<term>Aged (MeSH)</term>
<term>Aged, 80 and over (MeSH)</term>
<term>COVID-19 (drug therapy)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Hydroxychloroquine (therapeutic use)</term>
<term>Lopinavir (therapeutic use)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Ritonavir (therapeutic use)</term>
<term>SARS-CoV-2 (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Hydroxychloroquine</term>
<term>Lopinavir</term>
<term>Ritonavir</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>COVID-19</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adolescent</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>SARS-CoV-2</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a high mortality. To date no trial comparing hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/RTV) has been performed.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>Hospitalized patients ≥18 years old with severe coronavirus disease 2019 (COVID-19) were treated with either HCQ or LPV/RTV if they had either respiratory insufficiency (SpO</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Of 156 patients (41% female) with a median age of 72 years (IQR 55.25-81) admitted to our department, 67 patients fulfilled the inclusion criteria (20 received HCQ, 47 LPV/RTV). Groups were comparable regarding most baseline characteristics. Median time from symptom onset to treatment initiation was 8 days and was similar between the groups (p = 0.727). There was no significant difference (HCQ vs. LPV/RTV) in hospital mortality (15% vs. 8.5%, p = 0.418), ICU admission rate (20% vs. 12.8%, p = 0.470) and length of stay (9 days vs. 11 days, p = 0.340). A PCR negativity from nasopharyngeal swabs was observed in approximately two thirds of patients in both groups. Side effects led to treatment discontinuation in 15% of patients in the LPV/RTV group.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>No statistically significant differences were observed in outcome parameters in patients treated with HCQ or LPV/RTV but patients in the LPV/RTV group showed a numerically lower hospital mortality rate. Additionally, in comparison to other studies we demonstrated a lower mortality in patients treated with LPV/RTV despite having similar patient groups, perhaps due to early initiation of treatment.</p>
</div>
</front>
</TEI>
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<Month>04</Month>
<Day>27</Day>
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<DateRevised><Year>2021</Year>
<Month>04</Month>
<Day>27</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1613-7671</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>133</Volume>
<Issue>7-8</Issue>
<PubDate><Year>2021</Year>
<Month>Apr</Month>
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<Title>Wiener klinische Wochenschrift</Title>
<ISOAbbreviation>Wien Klin Wochenschr</ISOAbbreviation>
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<ArticleTitle>Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients : Results from a real-life patient cohort.</ArticleTitle>
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</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1007/s00508-020-01720-y</ELocationID>
<Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a high mortality. To date no trial comparing hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/RTV) has been performed.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">Hospitalized patients ≥18 years old with severe coronavirus disease 2019 (COVID-19) were treated with either HCQ or LPV/RTV if they had either respiratory insufficiency (SpO<sub>2</sub>
≤ 93% on room air or the need for oxygen insufflation) or bilateral consolidations on chest X‑ray and at least 2 comorbidities associated with poor COVID-19 prognosis. Outcomes investigated included in-hospital mortality, intensive care unit (ICU) admission, length of stay, PCR (polymerase chain reaction) negativity and side effects of treatment.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Of 156 patients (41% female) with a median age of 72 years (IQR 55.25-81) admitted to our department, 67 patients fulfilled the inclusion criteria (20 received HCQ, 47 LPV/RTV). Groups were comparable regarding most baseline characteristics. Median time from symptom onset to treatment initiation was 8 days and was similar between the groups (p = 0.727). There was no significant difference (HCQ vs. LPV/RTV) in hospital mortality (15% vs. 8.5%, p = 0.418), ICU admission rate (20% vs. 12.8%, p = 0.470) and length of stay (9 days vs. 11 days, p = 0.340). A PCR negativity from nasopharyngeal swabs was observed in approximately two thirds of patients in both groups. Side effects led to treatment discontinuation in 15% of patients in the LPV/RTV group.</AbstractText>
<AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">No statistically significant differences were observed in outcome parameters in patients treated with HCQ or LPV/RTV but patients in the LPV/RTV group showed a numerically lower hospital mortality rate. Additionally, in comparison to other studies we demonstrated a lower mortality in patients treated with LPV/RTV despite having similar patient groups, perhaps due to early initiation of treatment.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Karolyi</LastName>
<ForeName>Mario</ForeName>
<Initials>M</Initials>
<Identifier Source="ORCID">http://orcid.org/0000-0002-9870-2339</Identifier>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria. mario.karolyi@gesundheitsverbund.at.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Pawelka</LastName>
<ForeName>Erich</ForeName>
<Initials>E</Initials>
<Identifier Source="ORCID">http://orcid.org/0000-0003-0199-0539</Identifier>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Mader</LastName>
<ForeName>Theresa</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Omid</LastName>
<ForeName>Sara</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kelani</LastName>
<ForeName>Hasan</ForeName>
<Initials>H</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ely</LastName>
<ForeName>Sarah</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Jilma</LastName>
<ForeName>Bernd</ForeName>
<Initials>B</Initials>
<Identifier Source="ORCID">http://orcid.org/0000-0001-5652-7977</Identifier>
<AffiliationInfo><Affiliation>Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Baumgartner</LastName>
<ForeName>Sebastian</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Laferl</LastName>
<ForeName>Hermann</ForeName>
<Initials>H</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ott</LastName>
<ForeName>Clemens</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Traugott</LastName>
<ForeName>Marianna</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Turner</LastName>
<ForeName>Michael</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Seitz</LastName>
<ForeName>Tamara</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wenisch</LastName>
<ForeName>Christoph</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zoufaly</LastName>
<ForeName>Alexander</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>08</Month>
<Day>10</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>Austria</Country>
<MedlineTA>Wien Klin Wochenschr</MedlineTA>
<NlmUniqueID>21620870R</NlmUniqueID>
<ISSNLinking>0043-5325</ISSNLinking>
</MedlineJournalInfo>
<ChemicalList><Chemical><RegistryNumber>2494G1JF75</RegistryNumber>
<NameOfSubstance UI="D061466">Lopinavir</NameOfSubstance>
</Chemical>
<Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber>
<NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance>
</Chemical>
<Chemical><RegistryNumber>O3J8G9O825</RegistryNumber>
<NameOfSubstance UI="D019438">Ritonavir</NameOfSubstance>
</Chemical>
</ChemicalList>
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