RGD Reference Report - Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial.

General

Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial.
Authors:	Hung, Ivan Fan-Ngai Lung, Kwok-Cheung Tso, Eugene Yuk-Keung Liu, Raymond Chung, Tom Wai-Hin Chu, Man-Yee Ng, Yuk-Yung Lo, Jenny Chan, Jacky Tam, Anthony Raymond Shum, Hoi-Ping Chan, Veronica Wu, Alan Ka-Lun Sin, Kit-Man Leung, Wai-Shing Law, Wai-Lam Lung, David Christopher Sin, Simon Yeung, Pauline Yip, Cyril Chik-Yan Zhang, Ricky Ruiqi Fung, Agnes Yim-Fong Yan, Erica Yuen-Wing Leung, Kit-Hang Ip, Jonathan Daniel Chu, Allen Wing-Ho Chan, Wan-Mui Ng, Anthony Chin-Ki Lee, Rodney Fung, Kitty Yeung, Alwin Wu, Tak-Chiu Chan, Johnny Wai-Man Yan, Wing-Wah Chan, Wai-Ming Chan, Jasper Fuk-Woo Lie, Albert Kwok-Wai Tsang, Owen Tak-Yin Cheng, Vincent Chi-Chung Que, Tak-Lun Lau, Chak-Sing Chan, Kwok-Hung To, Kelvin Kai-Wang Yuen, Kwok-Yung
Citation:	Hung IF, etal., Lancet. 2020 May 30;395(10238):1695-1704. doi: 10.1016/S0140-6736(20)31042-4. Epub 2020 May 10.
RGD ID:	30296675
Pubmed:	PMID:32401715 (View Abstract at PubMed)
PMCID:	PMC7211500 (View Article at PubMed Central)
DOI:	DOI:10.1016/S0140-6736(20)31042-4 (Journal Full-text)
BACKGROUND: Effective antiviral therapy is important for tackling the coronavirus disease 2019 (COVID-19) pandemic. We assessed the efficacy and safety of combined interferon beta-1b, lopinavir-ritonavir, and ribavirin for treating patients with COVID-19. METHODS: This was a multicentre, prospective, open-label, randomised, phase 2 trial in adults with COVID-19 who were admitted to six hospitals in Hong Kong. Patients were randomly assigned (2:1) to a 14-day combination of lopinavir 400 mg and ritonavir 100 mg every 12 h, ribavirin 400 mg every 12 h, and three doses of 8 million international units of interferon beta-1b on alternate days (combination group) or to 14 days of lopinavir 400 mg and ritonavir 100 mg every 12 h (control group). The primary endpoint was the time to providing a nasopharyngeal swab negative for severe acute respiratory syndrome coronavirus 2 RT-PCR, and was done in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT04276688. FINDINGS: Between Feb 10 and March 20, 2020, 127 patients were recruited; 86 were randomly assigned to the combination group and 41 were assigned to the control group. The median number of days from symptom onset to start of study treatment was 5 days (IQR 3-7). The combination group had a significantly shorter median time from start of study treatment to negative nasopharyngeal swab (7 days [IQR 5-11]) than the control group (12 days [8-15]; hazard ratio 4·37 [95% CI 1·86-10·24], p=0·0010). Adverse events included self-limited nausea and diarrhoea with no difference between the two groups. One patient in the control group discontinued lopinavir-ritonavir because of biochemical hepatitis. No patients died during the study. INTERPRETATION: Early triple antiviral therapy was safe and superior to lopinavir-ritonavir alone in alleviating symptoms and shortening the duration of viral shedding and hospital stay in patients with mild to moderate COVID-19. Future clinical study of a double antiviral therapy with interferon beta-1b as a backbone is warranted. FUNDING: The Shaw-Foundation, Richard and Carol Yu, May Tam Mak Mei Yin, and Sanming Project of Medicine.

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Term	Qualifier	Evidence	With	Reference	Notes	Source	Original Reference(s)
COVID-19	treatment	IDA		30296675		RGD
COVID-19	treatment	ISO	IFNB1 (Homo sapiens)	30296675; 30296675		RGD

Objects Annotated

Genes (Rattus norvegicus)

Ifnb1 (interferon beta 1)

Genes (Mus musculus)

Ifnb1 (interferon beta 1, fibroblast)

Genes (Homo sapiens)

IFNB1 (interferon beta 1)

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Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial.