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c19early.org COVID-19 treatment researchLopinavir/ritonavirLopinavir/r.. (more..)
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Slower Recovery with Early Lopinavir/Ritonavir use in Pediatric COVID-19 Patients: A Retrospective Observational Study

Wong et al., Pediatric Drugs, doi:10.1007/s40272-022-00500-7, Apr 2022
https://c19early.org/wong7.html
Discharge -96% Improvement Relative Risk Recovery -96% Lopinavir/r..  Wong et al.  EARLY TREATMENT Is early treatment with lopinavir/ritonavir beneficial for COVID-19? Retrospective 933 patients in China (January 2020 - January 2021) Lower discharge (p<0.0001) and worse recovery (p<0.0001) c19early.org Wong et al., Pediatric Drugs, April 2022 Favorslopinavir/ritonavir Favorscontrol 0 0.5 1 1.5 2+
Retrospective 933 pediatric COVID-19 patients in Hong Kong showing worse outcomes with early lopinavir/ritonavir (LPV/r) use.
Standard of Care (SOC) for COVID-19 in the study country, China, is poor with low average efficacy for approved treatments1.
risk of no hospital discharge, 96.1% higher, HR 1.96, p < 0.001, treatment 49, control 884, inverted to make HR<1 favor treatment, propensity score weighting.
risk of no recovery, 96.1% higher, HR 1.96, p < 0.001, treatment 49, control 884, inverted to make HR<1 favor treatment, propensity score weighting.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Wong et al., 16 Apr 2022, retrospective, China, peer-reviewed, 11 authors, study period 21 January, 2020 - 31 January, 2021. Contact: carlosho@hku.hk.
Slower Recovery with Early Lopinavir/Ritonavir use in Pediatric COVID-19 Patients: A Retrospective Observational Study
Carlos K H Wong, Marshall C H Low, Ashley C Y Kwok, Angel Y C Lui, Kristy T K Lau, Ivan C H Au, Xi Xiong, Matthew S H Chung, Mike Y W Kwan, Eric H Y Lau, Benjamin J Cowling
Pediatric Drugs, doi:10.1007/s40272-022-00500-7
Objectives There was initially insufficient understanding regarding suitable pharmacological treatment for pediatric Coronavirus Disease 2019 (COVID-19) patients. Lopinavir-ritonavir (LPV/r) was originally used for the treatment of Human Immunodeficiency Virus-1 (HIV-1) infection. It was also used in patients with severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) with positive results. Nonetheless, results from recent randomized controlled trials and observational studies on COVID-19 patients were unfavorable. We sought to evaluate the clinical outcomes associated with early treatment with LPV/r for pediatric COVID-19 patients. Study Design A total of 933 COVID-19 patients aged ≤ 18 years were admitted between 21 January 2020 and 31 January 2021 in Hong Kong. Exposure was receiving LPV/r within the first two days of admission. Time to clinical improvement, hospital discharge, seroconversion and hyperinflammatory syndrome, cumulative costs, and hospital length of stay were assessed. Multivariable Cox proportional hazard and linear models were performed to estimate hazard ratios (HR) and their 95% confidence intervals (CI) of time-to-event and continuous outcomes, respectively. Results LPV/r users were associated with longer time to clinical improvement (HR 0.51, 95% CI 0.38-0.70; p < 0.001), hospital discharge (HR 0.51, 95% CI 0.38-0.70; p < 0.001) and seroconversion (HR 0.59, 95% CI 0.43-0.80; p < 0.001) when compared with controls. LPV/r users were also associated with prolonged hospital length of stay (6.99 days, 95% CI 6.23-7.76; p < 0.001) and higher costs at 30 days (US$11,709 vs US$8270; p < 0.001) as opposed to controls. Conclusion Early treatment with LPV/r for pediatric COVID-19 patients was associated with longer time to clinical improvement. Our study advocates the recommendation against LPV/r use for pediatric patients across age groups.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s40272-022-00500-7 . Declarations Author Contributors' Statement Dr CKHW conceptualized, designed the study, reviewed and revised the manuscript. Mr MCHL, Miss ACYK and Miss AYCL searched literatures, drafted the initial manuscript, reviewed and revised the manuscript. Miss KTKL reviewed and revised the manuscript. Mr ICHA and Mr SHC conducted data analysis, reviewed and revised the manuscript. Miss XX, Mr EHYL and Prof. BJC reviewed and revised the manuscript. Dr MYWK provided clinical input. Conflict of interest Ethical approval and informed consent The study protocol was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (Reference No. UW . Given the extraordinary nature of the COVID-19 pandemic, individual patient informed consent was not required for this retrospective cohort study using anonymized data. Data sharing statement The data that support the findings of this study were provided by the Hong Kong Hospital Authority. Restrictions apply to the availability of these data, which were used under license for this study. Deidentified individual participant data will not be made available. Availability of Data and Material The data that supported the findings of this study were provided by the Hong Kong Hospital Authority but restrictions apply to the availability of these..
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DOI record: { "DOI": "10.1007/s40272-022-00500-7", "ISSN": [ "1174-5878", "1179-2019" ], "URL": "http://dx.doi.org/10.1007/s40272-022-00500-7", "alternative-id": [ "500" ], "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 1, "value": "13 March 2022" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 2, "value": "16 April 2022" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Author Contributors’ Statement", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "Dr CKHW conceptualized, designed the study, reviewed and revised the manuscript. Mr MCHL, Miss ACYK and Miss AYCL searched literatures, drafted the initial manuscript, reviewed and revised the manuscript. Miss KTKL reviewed and revised the manuscript. Mr ICHA and Mr SHC conducted data analysis, reviewed and revised the manuscript. Miss XX, Mr EHYL and Prof. BJC reviewed and revised the manuscript. Dr MYWK provided clinical input." }, { "group": { "label": "Funding/Support", "name": "EthicsHeading" }, "name": "Ethics", "order": 3, "value": "We received financial support from the Health and Medical Research Fund, Food and Health Bureau, Government of the Hong Kong Special Administrative Region, China (Grant no. COVID190210)." }, { "group": { "label": "Conflict of interest", "name": "EthicsHeading" }, "name": "Ethics", "order": 4, "value": "Dr Wong, Mr Low, Miss Kwok, Miss Lui, Miss Lau, Mr Au, Mr Chung, Miss Xiong, Mr Lau, Prof. Cowling and Dr Kwan have no conflicts of interest to disclose." }, { "group": { "label": "Ethical approval and informed consent", "name": "EthicsHeading" }, "name": "Ethics", "order": 5, "value": "The study protocol was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (Reference No. UW 20-493). Given the extraordinary nature of the COVID-19 pandemic, individual patient informed consent was not required for this retrospective cohort study using anonymized data." }, { "group": { "label": "Data sharing statement", "name": "EthicsHeading" }, "name": "Ethics", "order": 6, "value": "The data that support the findings of this study were provided by the Hong Kong Hospital Authority. Restrictions apply to the availability of these data, which were used under license for this study. Deidentified individual participant data will not be made available." }, { "group": { "label": "Availability of Data and Material", "name": "EthicsHeading" }, "name": "Ethics", "order": 7, "value": "The data that supported the findings of this study were provided by the Hong Kong Hospital Authority but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Hong Kong Hospital Authority." }, { "group": { "label": "Consent for publication", "name": "EthicsHeading" }, "name": "Ethics", "order": 8, "value": "All authors contributed to the interpretation of the analysis, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. 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Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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