COVID-19 Patients Showed Faster Improvement After Treatment With Four Drugs

A security official stands guard as an ambulance arrives with a patient to the Infectious Disease Centre of Princess Margaret Hospital in Hong Kong on Jan. 22, 2020. Anthony Kwan/Getty Images

A four-drug regimen helped patients with COVID-19 recover more quickly from the new disease, doctors found.

Researchers in Hong Kong used ritonavir and lopanvir, a combination of drugs typically used to treat HIV, along with the antiviral ribavirin and interferon beta-1b, which helps boost the immune system by providing extra interferons.

The median recovery time for a group of 86 patients receiving the regimen was 7 days, compared to 8 to 15 days for the control group of 41 patients, according to the study results posted in The Lancet.

“Early triple antiviral therapy was safe and superior to lopinavir-ritonavir alone in alleviating symptoms and shortening the duration of viral shedding and hospital stay in patients with mild to moderate COVID-19,” they said.

The regimen was 400 milligrams of lopinavir, 100 milligrams of ritonavir, and 400 milligrams of ribavirin every 12 hours. Patients received the interferon injections on alternate days.

The control group received the same dosage of lopinavir and rironavir. They did not get the other two drugs.

Colorized scanning electron micrograph of cell (green) heavily infected with CCP virus particles (purple), commonly known as novel coronavirus, isolated from a patient sample on March 16, 2020. NIAID

Sarah Shalhoub, an assistant professor at the Schulich School of Medicine and Dentistry, said that most studies about possible CCP virus treatments have been retrospective or observational, making the new trial valuable.

“Despite the relatively small number of patients in the interferon beta-1b subgroup, significant differences in outcomes were demonstrated. Therefore, this study provides much needed data on a potential therapeutic regimen for SARS-CoV-2,” she wrote in an analysis published separately by The Lancet.

The patients in the study had only mild or moderate disease, she added. Future research should analyze the regimen in patients with severe COVID-19.

Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, said the trial was originally designed to assess mortality but no one in either group died within a month of entering the trial.

“They were able to measure the amount of virus at various sites in the patients and there was strong evidence that the time to reach the point of no virus being detected was about 5 days shorter in those who were allocated to receive interferon. A similar reduction in the time spent in hospital was also seen in this group,” added Evans, who was not involved with the study, in a statement.

The study was small and larger trials are needed, according to Evans. Researchers recommended a phase-three trial with interferon beta-1b as a backbone treatment with a placebo control group, noting the results suggest the drug was a key component of the combination treatment.

Researchers admitted the study had limitations. It was open label, meaning patients knew which treatment regimen they were receiving; had no group receiving a placebo; and lacked critically ill patients.

They said it was the first randomized, controlled trial on the drug combination. Patients taking the combination suffered only minor side effects.

Patients were recruited from six hospitals in Hong Kong. The requirements included being at least 18 years old and having symptoms for 14 days or less.

COVID-19 is a new disease caused by the CCP (Chinese Communist Party) virus, which emerged in China last year.