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Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients: Results from a real-life patient cohort

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 disea...

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Autores principales: Karolyi, Mario, Pawelka, Erich, Mader, Theresa, Omid, Sara, Kelani, Hasan, Ely, Sarah, Jilma, Bernd, Baumgartner, Sebastian, Laferl, Hermann, Ott, Clemens, Traugott, Marianna, Turner, Michael, Seitz, Tamara, Wenisch, Christoph, Zoufaly, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416584/
https://www.ncbi.nlm.nih.gov/pubmed/32776298
http://dx.doi.org/10.1007/s00508-020-01720-y
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author Karolyi, Mario
Pawelka, Erich
Mader, Theresa
Omid, Sara
Kelani, Hasan
Ely, Sarah
Jilma, Bernd
Baumgartner, Sebastian
Laferl, Hermann
Ott, Clemens
Traugott, Marianna
Turner, Michael
Seitz, Tamara
Wenisch, Christoph
Zoufaly, Alexander
author_facet Karolyi, Mario
Pawelka, Erich
Mader, Theresa
Omid, Sara
Kelani, Hasan
Ely, Sarah
Jilma, Bernd
Baumgartner, Sebastian
Laferl, Hermann
Ott, Clemens
Traugott, Marianna
Turner, Michael
Seitz, Tamara
Wenisch, Christoph
Zoufaly, Alexander
author_sort Karolyi, Mario
collection PubMed
description 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(2) ≤ 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. 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.
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spelling pubmed-74165842020-08-10 Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients: Results from a real-life patient cohort Karolyi, Mario Pawelka, Erich Mader, Theresa Omid, Sara Kelani, Hasan Ely, Sarah Jilma, Bernd Baumgartner, Sebastian Laferl, Hermann Ott, Clemens Traugott, Marianna Turner, Michael Seitz, Tamara Wenisch, Christoph Zoufaly, Alexander Wien Klin Wochenschr Main Topic 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(2) ≤ 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. 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. Springer Vienna 2020-08-10 2021 /pmc/articles/PMC7416584/ /pubmed/32776298 http://dx.doi.org/10.1007/s00508-020-01720-y Text en © Springer-Verlag GmbH Austria, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Main Topic
Karolyi, Mario
Pawelka, Erich
Mader, Theresa
Omid, Sara
Kelani, Hasan
Ely, Sarah
Jilma, Bernd
Baumgartner, Sebastian
Laferl, Hermann
Ott, Clemens
Traugott, Marianna
Turner, Michael
Seitz, Tamara
Wenisch, Christoph
Zoufaly, Alexander
Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients: Results from a real-life patient cohort
title Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients: Results from a real-life patient cohort
title_full Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients: Results from a real-life patient cohort
title_fullStr Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients: Results from a real-life patient cohort
title_full_unstemmed Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients: Results from a real-life patient cohort
title_short Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients: Results from a real-life patient cohort
title_sort hydroxychloroquine versus lopinavir/ritonavir in severe covid-19 patients: results from a real-life patient cohort
topic Main Topic
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416584/
https://www.ncbi.nlm.nih.gov/pubmed/32776298
http://dx.doi.org/10.1007/s00508-020-01720-y
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