Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

McCreary, Erin K; Pogue, Jason M

With the available data, it is difficult to assess whether LPV/r has a role for the treatment of COVID-19 either as monotherapy or in combination. The data from SARS-CoV-1 are encouraging, but this must be weighed against the inferior performance in mouse models against MERS-CoV, the less potent in vitro activity compared with remdesivir and chloroquine for SARS-CoV-1, and limited data suggesting no advantage over standard care for SARS-CoV-2. More important, it warrants comment that in the recent randomized controlled trial in COVID-19 pneumonia, the median time from symptom onset to initiation of therapy was 13 days, and in the SARS-CoV-1 experience, therapy appeared effective if started early, but not as rescue and/or salvage. If used, drug interactions must be screened, and gastrointestinal toxicities, including diarrhea, nausea, and vomiting, and hepatotoxicity, require close monitoring, particularly because elevated aspartate transaminase or ALT may exclude patients with COVID-19 from clinical trials. The LPV/r tablets can be taken without regard to food but should not be crushed because this decreases systemic exposure; solution should be used in patients who cannot receive intact tablets [38] .