ABSTRACT
Background: While several antivirals have been considered among the candidate repurposed drugs against SARS-CoV-2 infection, limited evidence exists on Atazanavir/Ritonavir. Objectives: This trial was designed to assess the efficacy of Atazanavir/Ritonavir compared to Lopinavir/Ritonavir, another antiretroviral drug investigated in the previous studies. Methods: This randomized, double-blind clinical trial was conducted on hospitalized patients with laboratory or confirmed SARS CoV-2 infection. Patients were randomly assigned (1:1) to receive either Lopinavir/Ritonavir (200mg Lopinavir+50mg Ritonavir, twice a day) or Atazanavir/Ritonavir (300mg Atazanavir+100 mg Ritonavir, once a day) for up to 14 days during their admission along with the standard care. The primary endpoint was total all-cause death in all patients during the hospitalization period. Secondary outcomes included length of hospitalization. Results: Out of 103 adults included in the analysis 54 and 49 were assigned to Atazanavir/Ritonavir and Lopinavir/Ritonavir groups, respectively. The occurrence of adverse effects, defined as symptoms attributed to the drugs which no longer appear upon the cessation of the drug, was higher for cardiac side effects in Atazanavir/Ritonavir group. No statistically significant difference was observed between the two groups in terms of the length of hospitalization. After adjustment for other covariates in the study, treatment with Atazanavir/ritonavir did not result in a significant reduction in mortality compared to treatment with Lopinavir/Ritonavir. Conclusion: The efficacy of Atazanavir/Ritonavir in this preliminary study was not superior to Lopinavir/Ritonavir in reducing mortality and length of hospitalization in COVID-19 patients. However, the limited efficacy of both compounds does not support their use in primary care for COVID-19 patients.
ABSTRACT
Introduction: Intensive care facilities may play an important role in reducing corona mortality. This study aimed to assess the epidemiological features, treatments, and prognosis of corona patients that admitted to the Intensive Care Unit (ICU) of Baqiyatallah Hospital. Methods: All patients with a corona that admitted to the ICU of Baqiyatallah Hospital from March 5 to May 20, 2020, were included. The epidemiological characteristics, pharmacological, non-pharmacological, and supportive therapies and prognosis were assessed. Underlying diseases, smoking, and severity of lung involvement based on CT scan findings (mild, moderate, severe) and length of hospital stay in the ICU were recorded in a questionnaire. Non-invasive ventilation (NIV) or tracheal intubation, ventilator ventilation, and duration of endotracheal intubation, if needed, were recorded in the questionnaire. Meanwhile, whether tracheostomy was performed, the time of the procedure, and its duration were also recorded. Results: Overall, 82 patients were included in the study that 68 (82.9%) of them were males. The mean age was 57.96 +/- 14.08 years. The mortality rate was 53 cases (64.6%). There were 57 subjects (73.1%) at a severe lung involvement and 21 subjects (26.9%) at a moderate lung involvement. There was a significant relationship between severity of lung involvement and mortality (Odds ratio= 14.3, P<0.001). There was a significant relationship between mortality and Armadile use (Odds ratio= 2.9, P=0.04). There was a significant relationship between mortality and tracheal intubation (Odds ratio= 27.2, P<0.001). There was no significant difference between mortality and discharge of patients regarding the intubation period (P=0.26). There was not a significant relationship between tracheostomy, NIV, and mortality status in the patients (P=0.14 and 0.33 respectively). Also, there was no significant difference between mortality and discharge of patients regarding tracheostomy and NIV period (P=0.51 and 0.17). There was no significant difference in age between severe and moderate lung involvement cases (P=0.63). There was a significant difference in the duration of ICU hospitalization between severe and moderate lung involvement cases (P=0.004). Conclusion: The results showed none of the factors of age, sex, underlying diseases other than hypertension, pharmacological methods other than Armadile, and non-pharmacological methods such as hemoperfusion, plasmapheresis, IVIG, hyperimmune plasma injection, and stem cell as well as Ozone therapy does not affect corona patient's mortality. Only the severity of lung involvement leading to endotracheal intubation and mechanical ventilation is related to patients' mortality