Comparing Outcomes of Two Antiviral Therapy Combinations among COVID‐19 Patients

Abstract

Several therapeutic regimens for COVID-19 have been studied, such as combination antiviral therapies. We aimed to compare outcome of two types of combination therapies atazanavir/ritonavir (ATV/r) or lopinavir/ritonavir (LPV/r) plus hydroxychloroquine among COVID-19 patients. 108 patients with moderate and severe forms of COVID-19 were divided into two groups (each group 54 patients). One group received ATV/r plus hydroxychloroquine, and the other group received hydroxychloroquine plus LPV/r. Then, both groups were evaluated and compared for clinical symptoms, recovery rates, and complications of treatment regimens. Our findings showed a significant increase in bilirubin in ATV/r-receiving group compared to LPV/r receivers. There was also a significant increase in arrhythmias in the LPV/r group compared to the ATV/r group during treatment. Other findings including length of hospital stay, outcome, and treatment complications were not statistically significant. There is no significant difference between protease inhibitor drugs including ATV/r and LPV/r in the treatment of COVID-19 regarding clinical outcomes. However, some side effects such as hyperbilirubinemia and arrhythmia were significantly different by application of atazanavir or lopinavir.

Impact of various buffers and weak bases on lysosomal and intracellular pH: Implications for infectivity of SARS‐CoV‐2

“…The current literature, however, in general does not show a significant impact of HCQ on clinical infection. 31 , 32 Whether the pH of lysosomes in these studies was increased sufficiently and the dose dependence of the change in lysosomal pH clinically remains to be determined. It is conceivable that the doses administered thus far to treat patients with SARS‐CoV‐2 have not been sufficient to increase lysosomal pH to the necessary values to deter viral infection.…”

“…30 The ability of CQ and HCQ to raise lysosomal pH suggests that these agents might be efficacious in treating SARS-CoV-2 and potentially other viral that require acidic lysosomes for viral The current literature, however, in general does not show a significant impact of HCQ on clinical infection. 31,32 Whether the pH of lysosomes in these studies was increased sufficiently and the dose dependence of the change in lysosomal pH clinically remains to be determined. It is conceivable that the doses administered thus far to treat patients with SARS-CoV-2 have not been sufficient to increase lysosomal pH to the necessary values to deter viral infection.…”

Comparative evaluation of authorized drugs for treating Covid‐19 patients

“…Therefore, we should take additional cautions for Covid‐19 patients who have a comorbidity of other diseases or immune/hepatic/renal impairment. 42 , 48 , 49 Paxlovid has proven itself effective, but, more importantly, the safety profile of this combination drug should provide long‐term reliability.…”

“…As ritonavir is a hepatic and renal enzyme cytochrome P450 and multidrug‐resistant protein P‐glycoprotein inhibitor, it might have several drug‐drug interactions. Therefore, we should take additional cautions for Covid‐19 patients who have a comorbidity of other diseases or immune/hepatic/renal impairment 42,48,49 . Paxlovid has proven itself effective, but, more importantly, the safety profile of this combination drug should provide long‐term reliability.…”

“…Therefore, we should take additional cautions for Covid-19 patients who have a comorbidity of other diseases or immune/hepatic/renal impairment. 42,48,49 Paxlovid has proven itself effective, but, more importantly, the safety profile of this combination drug should provide long-term reliability. 50 However, during the Omicron wave, the FDA paused the recommendation of casirivimab plus imdevimab and bamlanivimab plus etesevimab because of the significant reduction in susceptibility.…”