羟氯喹与洛匹那韦/利托那韦治疗重症 COVID-19 患者：真实世界患者队列研究结果。
Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients : Results from a real-life patient cohort.
机构信息
Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
出版信息
Wien Klin Wochenschr. 2021 Apr;133(7-8):284-291. doi: 10.1007/s00508-020-01720-y. Epub 2020 Aug 10.
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a high mortality. To date no trial comparing hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/RTV) has been performed.
METHODS
Hospitalized patients ≥18 years old with severe coronavirus disease 2019 (COVID-19) were treated with either HCQ or LPV/RTV if they had either respiratory insufficiency (SpO ≤ 93% on room air or the need for oxygen insufflation) or bilateral consolidations on chest X‑ray and at least 2 comorbidities associated with poor COVID-19 prognosis. Outcomes investigated included in-hospital mortality, intensive care unit (ICU) admission, length of stay, PCR (polymerase chain reaction) negativity and side effects of treatment.
RESULTS
Of 156 patients (41% female) with a median age of 72 years (IQR 55.25-81) admitted to our department, 67 patients fulfilled the inclusion criteria (20 received HCQ, 47 LPV/RTV). Groups were comparable regarding most baseline characteristics. Median time from symptom onset to treatment initiation was 8 days and was similar between the groups (p = 0.727). There was no significant difference (HCQ vs. LPV/RTV) in hospital mortality (15% vs. 8.5%, p = 0.418), ICU admission rate (20% vs. 12.8%, p = 0.470) and length of stay (9 days vs. 11 days, p = 0.340). A PCR negativity from nasopharyngeal swabs was observed in approximately two thirds of patients in both groups. Side effects led to treatment discontinuation in 15% of patients in the LPV/RTV group.
CONCLUSION
No statistically significant differences were observed in outcome parameters in patients treated with HCQ or LPV/RTV but patients in the LPV/RTV group showed a numerically lower hospital mortality rate. Additionally, in comparison to other studies we demonstrated a lower mortality in patients treated with LPV/RTV despite having similar patient groups, perhaps due to early initiation of treatment.
背景
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染与高死亡率相关。迄今为止，尚无比较羟氯喹（HCQ）和洛匹那韦/利托那韦（LPV/RTV）的试验。
方法
对≥18 岁患有严重 2019 年冠状病毒病（COVID-19）的住院患者，如果存在呼吸功能不全（在室内空气中 SpO2≤93%或需要吸氧）或胸部 X 线片上存在双侧实变且至少有 2 种与 COVID-19 预后不良相关的合并症，则给予 HCQ 或 LPV/RTV 治疗。研究的结局包括院内死亡率、入住重症监护病房（ICU）、住院时间、PCR（聚合酶链反应）阴性和治疗副作用。
结果
在我院收治的 156 例患者中（41%为女性），中位年龄为 72 岁（IQR 55.25-81），其中 67 例符合纳入标准（20 例接受 HCQ，47 例 LPV/RTV）。两组患者在大多数基线特征方面相似。从症状发作到开始治疗的中位时间为 8 天，两组之间相似（p=0.727）。HCQ 组和 LPV/RTV 组的院内死亡率（15% vs. 8.5%，p=0.418）、入住 ICU 率（20% vs. 12.8%，p=0.470）和住院时间（9 天 vs. 11 天，p=0.340）无显著差异。两组中约有三分之二的患者鼻咽拭子 PCR 检测结果为阴性。LPV/RTV 组有 15%的患者因副作用而停止治疗。
结论
在接受 HCQ 或 LPV/RTV 治疗的患者中，未观察到结局参数存在统计学显著差异，但 LPV/RTV 组的住院死亡率呈数值下降。此外，与其他研究相比，我们在 LPV/RTV 治疗组中观察到较低的死亡率，尽管患者群体相似，这可能是由于治疗开始较早。
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