Lopinavir-ritonavir (LPV/r) for the Treatment of SARS-CoV-2 (COVID-19): A Systematic Review

Abstract

Background: SARS-CoV-2 is the pathogenic agent of COVID-19, which has affected more than 200 countries; infected over 4 million people and declared a global pandemic. At the time of writing, no approved definitive therapeutic treatment for COVID-19 is available. Many studies are still on-going. Lopinavir-ritonavir (LPV/r), or its combination has been advocated as a potential treatment. This study reviews the evidence of LPV/r usage in the treatment of SARS-CoV-2 infection.

Methods: A systematic review protocol was written based on the PRISMA Statement Article for review selected from electronic databases (PubMed, Embase and Medline). Inclusion criteria were: full English articles published between 2019 and 2020, accessible and peer-reviewed. The search keywords were: Lopinavir, COVID, and SARS-CoV-2. Studies fulfilling the inclusion criteria were included, regardless of study designs. Data were extracted from published reports.

Findings: As of 9 May 2020, 243 manuscripts were identified. Thirteen studies were included with a total of 494 patients. These consisted of clinical trials (n=2), case reports (n=5), case series (n=3), and retrospective cohort studies (n=3). In the thirteen studies, the use of LPV/r shortened the PCR negativeconversion time for SARS-CoV-2, the earliest as being 5 days (Range: 5 to 28 days), and clinical improvement was expected as early as 2 days (Range: 2 to 28 days).

Interpretation: Our review shows that the use of LPV/r may be an effective treatment for non-severe COVID-19 patients, while only limited benefits were observed in severe COVID-19 patients.