Can lopinavir and ritonavir treat the COVID-19 coronavirus?
The lopinavir and ritonavir combination is under investigation for treatment of the COVID-19 coronavirus disease, a deadly respiratory infection pandemic caused by the SARS-nCoV-2 virus.
Most viruses have the ability to create proteins necessary for their life cycle. The lopinavir and ritonavir combination stops that process, in theory. For viruses to create their DNA or RNA (RNA in the case of SARS-nCov-2) the virus has to take control of some of the proteins in the host cell.
The virus relies on an enzyme called protease. Imagine the virus replication process as feeding dough into a pasta maker. The protease acts as a pair of scissors at the end, snipping off lengths of pasta as they come out of the machine to make the amino acids necessary for the virus to replicate itself.
What lopinavir and ritonavir aim to do as protease inhibitors is jam up that pair of scissors.
A lot of the experience with lopinavir and ritonavir, as with all the drugs the medical community is trying against the coronavirus pandemic, is drawn from the experience with the SARS outbreak in 2003. It was an option, but not clearly effective against the virus, according to trials done at the time.
Unfortunately, nothing tried in the SARS and later MERS epidemics was obviously effective, but there were signals that some of these drugs might be useful.
As of this article’s publication date of April 7, 2020, the most recent study on lopinavir and ritonavir was published March 2020 in the New England Journal of Medicine where they compared lopinavir and ritonavir with the current standard of care (supportive care to alleviate symptoms with no antiviral medication).
The conclusion was there was no increased benefit compared with the standard supportive care, but that study is not the last word on lopinavir and ritonavir’s effectiveness against the SARS-nCoV-2 virus. Further studies are underway, including the World Health Organization’s Solidarity study. This study allows healthcare providers around the world to provide observational data on a list of promising drugs now in use to help determine whether they really provide benefit or not.
The lopinavir and ritonavir combination is on that list, so doctors will know more as data comes in.
COVID-19 section data provided by Dominic Chan, a Pharm. D. and infectious disease specialist at Legacy Health System in Oregon.
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