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Open AccessReview

Role of Lopinavir/Ritonavir in the Treatment of Covid-19: A Review of Current Evidence, Guideline Recommendations, and Perspectives

1
Struttura Operativa Complessa di Medicina Interna, Azienda Unità Sanitaria Locale Toscana Centro, Ospedale Santa Maria Annunziata, 50012 Firenze, Italy
2
Clinica di Malattie Infettive, Azienda Sanitaria Universitaria Friuli centrale, 33100 Udine, Italy
3
Struttura Operativa Complessa di Medicina Interna, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Ospedale Felice Lotti, 56025 Pontedera, Italy
4
Dipartimento Cardiotoracico, Divisione di Cardiochirurgia, Azienda Sanitaria Universitaria Friuli centrale, 33100 Udine, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2050; https://doi.org/10.3390/jcm9072050
Received: 21 May 2020 / Revised: 17 June 2020 / Accepted: 22 June 2020 / Published: 30 June 2020
(This article belongs to the Special Issue COVID-19: From Pathophysiology to Clinical Practice)
A life-threatening respiratory illness (COVID-19) due to severe acute respiratory syndrome (SARS)-CoV-2 coronavirus was first described in December 2019 in Wuhan (China), rapidly evolving into a pandemic. In the first phase, when the viral replication plays a pivotal pathogenetic role, antiviral drugs could be crucial in limiting viral-induced organ damage. Unfortunately, there are no specific antivirals of proven efficacy for COVID-19, and several drugs have been repurposed to face this dramatic pandemic. In this paper we review the studies evaluating lopinavir/ritonavir association (LPV/r) use in COVID-19, and previously in SARS and Middle East respiratory syndrome (MERS). We searched PubMed to identify all relevant clinical and laboratory studies published up to 15 May 2020; the guidelines on the use of LPV/r in COVID-19 were further directly searched on the website of the main international scientific societies and agencies. Available evidence is currently scarce and of low quality. The recommendations issued for COVID-19 vary from positions clearly against the use of LPV/r to other positions that are more favorable. In our opinion, despite the controversial results of an important randomized clinical trial, and some recommendations, clinicians should not abandon the use of LPV/r for the treatment of COVID-19, possibly using this drug inside a prospective randomized trial, waiting for the results of the numerous ongoing trials evaluating its efficacy. View Full-Text
Keywords: lopinavir; ritonavir; COVID-19; SARS; MERS; guideline; recommendation lopinavir; ritonavir; COVID-19; SARS; MERS; guideline; recommendation
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MDPI and ACS Style

Meini, S.; Pagotto, A.; Longo, B.; Vendramin, I.; Pecori, D.; Tascini, C. Role of Lopinavir/Ritonavir in the Treatment of Covid-19: A Review of Current Evidence, Guideline Recommendations, and Perspectives. J. Clin. Med. 2020, 9, 2050.

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