Abstract
A life-threatening respiratory illness (COVID-19) due to severe acute respiratory syndrome (SARS)-CoV-2 coronavirus was first described in December 2019 in Wuhan (China), rapidly evolving into a pandemic. In the first phase, when the viral replication plays a pivotal pathogenetic role, antiviral drugs could be crucial in limiting viral-induced organ damage. Unfortunately, there are no specific antivirals of proven efficacy for COVID-19, and several drugs have been repurposed to face this dramatic pandemic. In this paper we review the studies evaluating lopinavir/ritonavir association (LPV/r) use in COVID-19, and previously in SARS and Middle East respiratory syndrome (MERS). We searched PubMed to identify all relevant clinical and laboratory studies published up to 15 May 2020; the guidelines on the use of LPV/r in COVID-19 were further directly searched on the website of the main international scientific societies and agencies. Available evidence is currently scarce and of low quality. The recommendations issued for COVID-19 vary from positions clearly against the use of LPV/r to other positions that are more favorable. In our opinion, despite the controversial results of an important randomized clinical trial, and some recommendations, clinicians should not abandon the use of LPV/r for the treatment of COVID-19, possibly using this drug inside a prospective randomized trial, waiting for the results of the numerous ongoing trials evaluating its efficacy.
Highlights
Starting in December 2019 in Wuhan (Hubei province, China), a novel coronavirus (CoV), designated severe acute respiratory syndrome (SARS)-CoV-2, caused an international outbreak of a respiratory illness (COVID-19), and rapidly evolving into a pandemic
The aim of this paper is to review the available evidence on the efficacy of lopinavir/ritonavir association (LPV/r) in COVID-19, SARS, and Middle East respiratory syndrome (MERS), and to analyze the current guideline recommendations of the main international scientific societies and agencies on the use of this antiviral drug
Thirteen documents released by some authoritative scientific societies and international agencies involved in the management of COVID-19 were retrieved
Summary
Starting in December 2019 in Wuhan (Hubei province, China), a novel coronavirus (CoV), designated severe acute respiratory syndrome (SARS)-CoV-2, caused an international outbreak of a respiratory illness (COVID-19), and rapidly evolving into a pandemic. Most cases are asymptomatic or self-limiting, but the clinical spectrum of the disease extends to severe progressive pneumonia with acute respiratory distress syndrome (ARDS), which is a life-threatening condition requiring mechanical ventilation and intensive care support. Some antivirals initially developed as treatment for human immunodeficiency virus (HIV), including lopinavir/ritonavir association (LPV/r), have been investigated in the past two decades (drug repurposing) for other coronaviruses responsible for serious diseases such as the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) [1,2]. In the absence of proven effective treatments, LPV/r has, been widely used to face the COVID-19 pandemic from the beginning [4], and is currently investigated in several clinical trials [5], such as the Solidarity trial launched on 20 March by the World Health Organization [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
