Comparative outcomes of lopinavir/ritonavir and hydroxychloroquine for the treatment of coronavirus disease 2019 with mild to moderate severity.

Abstract Background: Lopinavir/ritonavir and hydroxychloroquine are both being used to treat COVID-19, but their relative effectiveness is unknown. The purpose of this study was to compare the clinical outcomes of patients treated for COVID-19 with lopinavir/ritonavir (LPV/r) or hydroxychloroquine (HCQ).Methods: A retrospective cohort study was conducted at 2 hospitals in Busan, South Korea, that treated approximately 90% of COVID-19 patients hospitalized in Busan during the study period. All patients aged ≥15 years that were hospitalized with mild-or-moderate COVID-19 received LPV/r or HCQ as their initial treatment and were included in the analysis.Results: Among the 72 patients with mild-to-moderate disease severity on admission, 45 received LPV/r and 27 received HCQ as their initial therapy. A higher proportion of the LPV group had pneumonia on admission (LPV 49% vs. HCQ 15%), but there were no other significant differences in the demographic or clinical characteristics between groups.Switching therapy due to clinical failure was significantly more common in the HCQ group than in the LPV/r group (41% [11/27] and 2% [1/45], respectively, P=0.001). Disease progression was also significantly more common in the HCQ group than in the LPV/r group (44% [12/27] and 18% [8/45], respectively, P=0.030).Conclusions: LPV/r appears to be more effective than HCQ at preventing progression to severe disease in patients with COVID-19.