Pharmacists form the front lines of this pandemic in many communities, facing worried patients (through masks) and helping dispel rumors. For many individuals, the trusted community pharmacist is their personal line to critical information about the novel coronavirus, severe acute respiratory syndrome (SARS)-CoV-2, and emerging treatments. Fortunately, there’s more good news to share with patients this week.

The Lancet study  published on May 8 demonstrated promising early results from a combination of three drugs previously approved for other purposes. The therapy—oral lopinavir/ritonavir, ribavirin, and interferon beta-1b—reduced the average length of time patients shed virus and remained contagious from 12 days to 7 days in patients with mild or moderate COVID-19. The combination was not tested in critically ill patients.

Lopinavir/ritonavir is used globally in the treatment of HIV/AIDS. Lopinavir/ritonavir plus ribavirin reduced mortality and the need for ventilator support in SARS, which is caused by a similar coronavirus. Ribavirin has also been used in hepatitis C treatment, whereas interferon beta-1b was initially developed to treat multiple sclerosis. All are available as generics.

“Our trial demonstrates that early treatment of mild to moderate COVID-19 with a triple combination of antiviral drugs may rapidly suppress the amount of virus in a patient's body, relieve symptoms, and reduce the risk to health-care workers by reducing the duration and quantity of viral shedding (when the virus is detectable and potentially transmissible). Furthermore, the treatment combination appeared safe and well tolerated by patients,” said lead author Kwok-Yung Yuen, MD, MBBS, chair of Infectious Diseases at the University of Hong Kong in a press release.

The study enrolled 127 adults treated in six hospitals in Hong Kong. All patients started the therapy within 7 days of their first symptoms. The 86 patients in the triple-therapy arm received a 14-day course of oral lopinavir/ritonavir and ribavirin every 12 hours and injections of interferon beta-1b every other day. The 47 patients in the other arm received lopinavir/ritonavir. 

The reduced time to viral negativity directly translated to fewer days of hospitalization, 9 days for those receiving triple therapy versus 14 days for those receiving lopinavir/ritonavir alone. 

Inflammatory cytokine levels also declined significantly in the triple therapy arm. That’s especially encouraging because many of the most serious complications from COVID-19 appear to be linked to an immune system overreaction or “cytokine storm,” in which immune system cells attack healthy organs.

No patients died during the study, and about half of the patients in both groups experienced adverse events, most commonly diarrhea, fever, nausea, and elevated alanine transaminase levels, which generally resolved within 3 days of the start of treatment.

The findings were particularly encouraging as a study published in the New England Journal of Medicine on May 7 found no benefit to lopinavir/ritonavir alone.

Unlike the primarily retrospective or observational studies of proposed treatments for COVID-19 to date, this one was a prospective, randomized trial, giving it some added weight. The researchers called for additional larger, blinded studies to verify their findings.

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