A 2-week antiviral therapy with interferon beta-1b plus lopinavir-ritonavir and ribavirin is safe and more effective at reducing the duration of viral shedding than lopinavir-ritonavir alone in patients with mild to moderate coronavirus disease 2019 (COVID-19), according to a clinical trial published by The Lancet.1

The first randomized trial involved 127 adults from 6 public hospitals in Hong Kong. The patients were randomly assigned 2:1 to a 14-day combination of lopinavir 400 mg and ritonavir 100 mg every 12 hours, ribavirin 400 mg every 12 hours, and 3 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 hours (control group).2

The median number of days from symptom onset to the start of study treatment was 5 days. The combination group had a significantly shorter median time from start of study treatment to negative nasopharyngeal swab than the control group, according to the researchers. Adverse events included self-limited nausea and diarrhea with no difference between the 2 groups.2

"Our trial demonstrates that early treatment of mild to moderate COVID-19 with a triple combination of antiviral drugs may rapidly suppress the amount of virus in a patient's body, relieve symptoms, and reduce the risk to health care workers by reducing the duration and quantity of viral shedding (when the virus is detectable and potentially transmissible),” said researcher Kwok-Yung Yuen in a press release. “Furthermore, the treatment combination appeared safe and well tolerated by patients.”1

The study authors found that 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. Further clinical study of a double antiviral therapy with interferon beta-1b as a backbone is suggested, according to the study authors.2

REFERENCES
  1. The Lancet: New triple antiviral drug combination shows early promise for treating COVID-19 in phase 2 randomized trial. EurekAlert! https://www.eurekalert.org/pub_releases/2020-05/tl-pss050820.php. Published May 8, 2020. Accessed May 15, 2020.
  2. Hung IF, Lung KC, Tso EY, et al. 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. The Lancet. doi: https://doi.org/10.1016/S0140-6736(20)31042-4.