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COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment, Primary Prevention Ford N, Vitoria M, Rangaraj A, et al. Systematic review of the efficacy and safety of antiretroviral drugs against SARS, MERS or COVID-19: initial assessment. J Int AIDS Soc. 2020 Apr;23(4):e25489. doi: 10.1002/jia2.25489.
Abstract

INTRODUCTION: Several antiretroviral drugs are being considered for the treatment of COVID-19, the disease caused by a newly identified coronavirus, (SARS-CoV-2). We systematically reviewed the clinical outcomes of using antiretroviral drugs for the prevention and treatment of coronaviruses and planned clinical trials.

METHODS: Three databases were screened from inception to 30 March 2020 for studies reporting clinical outcomes of patients with SARS, MERS or COVID-19 treated with antiretrovirals.

RESULTS: From an initial screen of 433 titles, two randomized trials and 24 observational studies provided clinical outcome data on the use of antiretroviral drugs; most studies reported outcomes using LPV/r as treatment. Of the 21 observational studies reporting treatment outcomes, there were three studies among patients with SARS, six studies among patients with MERS and 12 studies among patients with COVID-19. In one randomized trial 99 patients with severe COVID-19 illness were randomized to receive LPV/r (400/100 mg twice a day) and 100 patients to standard of care for 14 days: LPV/r was not associated with a statistically significant difference in time to clinical improvement, although LPV/r given within 12 days of symptoms was associated with shorter time to clinical improvement; 28 day mortality was numerically lower in the LPV/r group (14/99) compared to the control group (25/100), but this difference was not statistically significant. The second trial found no benefit. The certainty of the evidence for the randomized trials was low. In the observational studies 3 out of 361 patients who received LPV/r died; the certainty of evidence was very low. Three studies reported a possible protective effect of LPV/r as post-exposure prophylaxis. Again, the certainty of the evidence was very low due to uncertainty due to limited sample size.

CONCLUSIONS: On the basis of the available evidence it is uncertain whether LPV/r and other antiretrovirals improve clinical outcomes or prevent infection among patients at high risk of acquiring COVID-19.

Ratings
Discipline / Specialty Area Score
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Occupational and Environmental Health
Public Health
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

This may be a useful quasi-negative study. It may throttle back panic buying and use of meds.

Hospital Doctor/Hospitalists rater

There has been a proliferation of studies, often preprints of what works & what doesn`t work for COVID-19. This is an important negative study.

Infectious Disease rater

This is a nice summary of the data that was available one month ago. Unfortunately, new data are emerging so rapidly that it likely will be out of date before a summary can be published.

Infectious Disease rater

There is far more enthusiasm than data behind the current antiviral regimens for COVID-19, and this article nicely summarizes how limited the data are and the need to consider these skeptically. Despite the desire to do something, existing antiviral therapies may not be beneficial treatments for most patients.

Internal Medicine rater

Need to keep everyone up-to-date with the latest data on treating COVID-19.

Internal Medicine rater

Uncertain how applicable therapeutics for other coronaviruses would apply to COVID-19. Too early in the COVID-19 story to have anything useful.

Occupational and Environmental Health rater

A preliminary analysis of multiple studies of several antiretroviral drugs with the conclusion that "it is uncertain" whether any of the drugs studied reliably improved clinical outcomes or decreased transmission of MERS, SARS, or coronavirus. Remdesivir was NOT one of the drugs studied in this report.

Occupational and Environmental Health rater

Although Occupational Medicine physicians may not be directly involved in prescribing these meds, the companies for whom they work might be interested in having this information available for their employees. This is thus relevant to enable dissemination of accurate information.

Public Health rater

Current evidence of lack of benefit of lopinavir/ritonavir (LPV/r) is based on small underpowered RCTs and thus inconclusive. Based on the current state of evidence, these drugs should not be used for prevention or treatment of COVID-19.