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With the vaccines still months, perhaps years, into the future, researchers are quick to determine if existing drugs can be used to treat the coronavirus. In the United States, only one, remdesivir, has been shown to be effective in accelerating recovery.
In the new study, published in The Lancet, researchers from six public hospitals in Hong Kong and the University of Hong Kong followed 127 adults with Covid-19, including 86 in the three-drug cocktail and 41 in a comparison group.
Their study was a preliminary Phase 2 trial, aimed at seeing if a treatment works. (It doesn’t determine if treatment is better than other options, but there are some other options for coronavirus.)
Patients who started the cocktail within seven days of the onset of their first symptoms stopped clearing the virus, meaning they were recovering and no longer infectious, before patients in the comparison group found the researchers.
In Hong Kong, even those with mild illness are hospitalized. According to the study, patients who took the three-drug combination also improved faster and had significantly shorter hospital stays than the comparison group.
Three antiviral drugs were included in the cocktail: lopinavir-ritonavir (sold under the brand name Kaletra), taken orally; Ribavirin, an antiviral medication used to treat hepatitis C, is also taken by mouth; and interferon beta-1b, an injectable medication used to treat multiple sclerosis that regulates inflammation and suppresses viral growth.
Patients who received the three-drug cocktail tested negative for coronavirus in seven days, on average, compared to an average of 12 days among those treated with the drug. The cocktail also cut the duration of Covid-19 symptoms in half, to four days from eight days.
“This is good news,” said Dr. Sarah Shalhoub, an infectious disease specialist at Western University in Ontario, Canada, who wrote a comment accompanying the article. “It tells us that patients get better faster and that the time they need to be hospitalized is shorter and that their viral clearance is shorter.”
“Whether these results will be reproducible in patients who require a lot of oxygen and end up in the intensive care unit is a different story,” said Dr. Shalhoub.
“We cannot extrapolate from these results and assume that they would apply to patients with ventilators or those expected to use a ventilator soon.”
The study was designed as a randomized trial: enrolling patients were randomly assigned to either the triple drug therapy group or the comparison group, and participants in the two groups were similar.
Triple drug treatment seemed to be safe. There were no differences between the two groups in side effects, which included fever, nausea, and diarrhea, although one patient in the comparison group had to discontinue treatment due to liver problems.
A limitation of the study was that it was an open trial, meaning that both researchers and patients knew what medications were being administered. This can subtly bias the evaluations of the data. Furthermore, some patients who were admitted seven or more days after their symptoms began were not offered interferon, but were tested as part of the combination group.
Previous research has found that a combination of lopinavir-ritonavir and ribavirin significantly reduced respiratory failure and death in patients with another coronavirus, the SARS virus. Interferon beta-1b has been shown to reduce viral load and improve lung problems in animal studies of the MERS virus, also a coronavirus.
The authors plan to conduct a larger trial to examine the effectiveness of the cocktail in critically ill patients with Covid-19, and may also evaluate the effectiveness of interferon alone.
