Lopinavir-ritonavir versus darunavir-ritonavir for hospitalized COVID-19 patients

Abstract Introduction Combinations of protease inhibitors such as lopinavir and darunavir with ritonavir have been repurposed as treatments for COVID-19. Lopinavir-ritonavir (LPV/r) and darunavir-ritonavir (DRV/r) showed in vitro efficacy against COVID-19, but the results are conflicting for human studies. Thus, our aim was to compare the efficacy of LPV/r and DRV/r in COVID-19 patients admitted to a tertiary center in Romania. Methods A clinical dataset from 417 hospitalised patients was analysed. Kaplan-Meier and Cox proportional hazards regression analysis were performed to compare in-hospital mortality and to assess factors associated with clinical improvement or fatal outcome. Results By day 10, more patients showed improvement with LPV/r and DRV/r (p = 0.03 and 0.01, respectively), only LPV/r was associated with improved survival compared to control arm (p = 0.05). The factors associated with mortality were: male gender (HR: 3.63, p = 0.02), diabetes (HR:2.49, p = 0.03), < 90% O2 saturation at admission (HR:5.23, p < 0.01), high blood glucose level (HR:3.68, p = 0.01), age (HR:1.04, p = 0.02) and > 25% lesion extension on chest CT scan (HR:2.28, p = 0.03). Conclusion LPV/r, but not DRV/r, showed a survival benefit in patients hospitalised with COVID-19, but these findings deserve further investigation in a randomized clinical trial.