Lopinavir/ritonavir ve favipiravir ile tedavi edilen ağır olmayan COVID-19 pnömoni hastalarının karşılaştırılması

Year 2020, Volume: 4 Issue: 11, 970 - 973, 01.11.2020

Omer Ayten , Bengü Şaylan

https://doi.org/10.28982/josam.795283

Abstract

Amaç: Günümüzde COVID-19 için kanıtlanmış bir medikal tedavi yoktur. Çalışmamızda ağır seviyeli olmayan COVID-19 pnömoni hastalarında LPV/r ve FVR tedavilerinin etkinliğini değerlendirerek, LPV/r ile FVR ile tedavi edilen hastalar arasındaki klinik sonuçları karşılaştırmayı amaçladık.
Yöntemler: Bu çalışma retrospektif bir kohort çalışmasıdır. Lopinavir/ritonavir ve FVR ile tedavi edilen ağır seviyeli olmayan COVID-19 pnömoni hastalarının verileri incelendi.
Bulgular: 33'ü (%36,2) LPV/r ve 58'i (%63,8) FVR ile tedavi edilen, toplam 91 ağır seviyeli olmayan COVID-19 pnömoni hastası çalışmaya dahil edildi. LPV/r grubunun yaş ortalaması 53,1 (13), FVR grubunun yaş ortalaması 57,2 (17,4) idi (P=0,24). Her iki grup arasında komorbidite varlığı açısından istatiksel olarak anlamlı fark yoktu (P=0,06). FVR hastalarının LPV/r hastalarına göre radyolojik ağırlık skoru daha yüksekti ancak bu istatistiksel olarak anlamlı değildi (sırasıyla 8,67 (3,7) ve 7,66 (3,22), P=0,2). FVR hastalarının başvuru esnasındaki SpO2 seviyeleri LPV/r hastalarına göre daha düşük, CRP seviyeleri daha yüksekti (sırasıyla 92,22 (2,8) ve 97,87 (2,05), P<0,001, 75,42 (62) ve 45,42 (49,92), P=0,02). FVR hastalarında LPV /r hastalarına göre ateşin düşme süresi daha kısa idi (sırasıyla 2,7 (0,9) ve 4 (1), P<0,001). FVR kullanan hastalarda tedavi sonrasında LPV/r kullanan hastalara göre Nötrofil, Lenfosit, N/L oranı ve D-Dimer seviyelerinin daha fazla düştüğü saptandı (sırasıyla P=0,01, <0,001, 0,001, <0,001).
Sonuç: FVR kullanan hastaların, başvuru esnasında daha düşük oksijen saturasyonlarına, daha yaygın radyolojik tutulumlarına ve daha yüksek CRP seviyelerine sahip olmasına rağmen LPV/r kullanan hastalara göre laboratuvar parametrelerinin düzelmesinde ve ateşin kontrol altına alınmasında daha etkili olduğunu saptadık. COVID-19 hastalarında LPV/r ve FVR tedavilerinin etkinliği üzerine daha fazla çalışmaya ihtiyaç vardır.

Keywords

COVID-19, Ağır olmayan pnomoni, Favipiravir, Lopinavir/ritonavir

Comparison of non-severe COVID-19 pneumonia patients treated with lopinavir/ritonavir and favipiravir

Abstract

Aim: There is no proven medical treatment for COVID-19 to date. We aimed to evaluate the effectiveness of LPV/r and FVR treatments in non-severe COVID-19 pneumonia patients and compare the clinical outcomes.
Methods: In this retrospective cohort study, the data of non-severe COVID-19 pneumonia patients treated with lopinavir/ritonavir and FVR were analyzed.
Results: A total of 91 non-severe COVID-19 patients, 33 (36.2%) treated with LPV/r and 58 (63.8%) treated with FVR, were included in the study. The mean ages of the LPV/r group and FVR group were 53.1 (13) years and 57.2 (17.44) years, respectively (P=0.24). There was no statistically significant difference between the two groups in terms of comorbidities (P=0.06). FVR patients had higher radiological weight scores than LPV/r patients, but this was not statistically significant (8.67 (3.7) vs 7.66 (3.22) P=0.2, respectively). While SpO2 levels of FVR patients at the time of admission were lower than those of LPV/r patients, CRP levels were higher (92.22 (2.8) vs 97.87 (2.05), P<0.001, respectively and 75.42 (62) vs 45.42 (49.92), P=0.02, respectively). FVR patients had a shorter fever regression time than LPV/r patients (2.7 (0.9) vs 4 (1), P<0.001, respectively). Post-treatment neutrophil, lymphocyte, N/L ratio and D-Dimer levels decreased more in FVR group compared to the LPV/r group (P=0.01, <0.001, 0.001, <0.001, respectively).
Conclusion: Although non-severe COVID-19 patients using FVR had lower oxygen saturations, more widespread radiological involvement, and higher CRP levels at admission, we found that FVR was more effective in improving laboratory parameters and controlling fever than LPV/r treatment. The efficacy of lopinavir/ritonavir and FVR warrants further verification by future, larger studies.

Keywords

COVID 19, non severe pneumonia, lopinavir ritonavir, favipiravir

References

• 1. World Health Organization (WHO): Coronavirus Disease (COVID-2019) Situation Reports, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Accessed 30 June 2020.
• 2. Ayten O, Ozdemir C, Akturk UA, Sen N, Potential Treatment of COVID-19. Coronavirus Disease 2019 (COVİD 19) and Lung. Euroasian Journal of Pulmonology. 2020;22(4):35-44.
• 3. Morse JS, Lalonde T, Xu S, Liu WR. Learning from the past: possible urgent prevention and treatment options for severe acute respiratory infections caused by 2019-nCoV. Chembiochem. 2020;21(5):730-8.
• 4. Chan KS, Lai ST, Chu CM, Tsui E, Tam CY, Wong MM, et al. Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study. Hong Kong Med J. 2003;9(6):399–406.
• 5. Chu CM, Cheng VC, Hung IF, Wong MM, Chan KH, Chan KS, et al. Role of lopinavir/ritonavir in the treatment of SARS: Initial virological and clinical findings. Thorax. 2004;59(3):252‐6.
• 6. De Clercq E. New nucleoside analogues for the treatment of hemorrhagic fever virus infections. Chem. Asian J. 2019;14:3962–8.
• 7. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020;382:1787-99.
• 8. Cai Q, Yang M, Liu D, Chen J, Shu D, Xia J, et al. Experimental treatment with favipiravir for COVID-19: An open-label control study. Engineering 2020 March 18. [E-pub ahead of print] doi: 10.1016/j.eng.2020.03.007
• 9. Chen C, Zhang Y, Huang J, Yin P, Cheng Z, Wu J, et al. Favipiravir versus arbidol for COVID-19: A trial. BioRxiv 2020 April 15. [E-pub ahead of print] doi: 10.1101/2020.03.17. 20037432
• 10. Chang Y, Yu C, Chang S, Galvin JR, Liu H, Hsiao C, et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT. Radiology. 2005;236(3):1067–75.
• 11. Norman, G. Likert scales, levels of measurement and the laws of statistics. Advances in Health Sciences Education. 2010;15(5):625-32.
• 12. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506.
• 13. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
• 14. Giovanni PG, Maccaferrib M, Ruinia C, Tomasia A, Ozbend T. Biomarkers associated with COVID-19 disease progression. Critical Reviews in Clinical Laboratory Sciences. 2020;57(6):389-99.
• 15. Bao J, Li C, Zhang K, Kang H, Chen W, Gu B, Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19. Clinica Chimica Acta. 2020;509:180-94.
• 16. National Health Commission & State Administration of Traditional Chinese Medicine: Guidelines for the Prevention, Diagnosis, and Treatment of Novel Coronavirus-induced Pneumonia, The 7th edition, 2020 March 3. http://www.nhc.gov.cn/yzygj/s7653p/202002/ 8334a832 6d. Accessed 30 June 2020