The effectiveness of hydroxychloroquine versus vydroxychloroquine plus Lopinavir/ritonavir therapy in SARSCoV- 2 Pneumonia

ABSTRACT

Introduction: There is no specific antiviral treatment with proven efficacy and safety in the management of Coronavirus disease-2019 (COVID-19). We aimed to compare the effectiveness of hydroxychloroquine (HQ) monotherapy and HQ-lopinavir/ritonavir (Lpv/r) combined therapy in patients with laboratory-confirmed COVID-19 and to determine the independent factors predicting mortality. Materials and Methods: Retrospective observational multi-centered cohort study. Results: In total, 151 patients (mean age 61±17 years, 66% male) with COVID-19 pneumonia were included 68 patients received combination therapy, i.e., Lpv/r in addition to HQ, and 83 patients received only HQ. The patients in both groups were similar regarding the majority of baseline variables except for white blood cell count, procalcitonin, lactate dehydrogenase levels, intensive care unit (ICU) admission rates, which were significantly higher, and decreased oxygen saturation in the combination group. The mean duration of symptoms and hospital stay were 5.6±2.3 days and 12.7±9.4 days, respectively. Nearly 43% (n=65) of patients were admitted to the ICU. Patients in the HQ monotherapy group had a shorter stay in hospital than those in the combination group (10 vs. 16 days, p<0.005). The primary end points were 14- and 28-day mortality. Neither treatment group revealed significant differences with respect to 14-day and 28-day survival before and after propensity score matching. Age, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, the Charlson Comorbidity Index (CCI), and ICU stay length were variable predictors of 14-day mortality, while CCI [Hazard ratio (HR) 95% confidence interval (CI) 0.85 (0.43-0.9)] and ICU stay length [HR (95% CI) 1.5 (1.39-1.76)] were the independent predictors of 28-day mortality. Conclusion: Combination therapy with Lpv/r and HQ did not provide any benefit compared with HQ monotherapy. Charlson Comorbidity Index and ICU stay were independent predictors of 28-day mortality.