355 Lopinavir/ritonavir treatment in paediatric patients with covid-19

• Published in: BMJ paediatrics open 2021-04, Vol.5 (Suppl 1), p.A102-A103
• Main Authors: Ho, Po Ki, Wong, JSC, To, Kk, Ip, P, Yau, Ys, Kwan, Yw
• Format: Article
• Language: English
• Subjects: Antiretroviral drugs; Antiviral drugs; Coronaviruses; COVID-19; Hospitalization; Intensive care; Patients; Pediatrics; Severe acute respiratory syndrome coronavirus 2
• ISSN: 2399-9772
• DOI: 10.1136/bmjpo-2021-RCPCH.194

BackgroundProtease inhibitor lopinavir/ritonavir has been used alone or in combination with other therapeutics as treatment of COVID-19. Data on paediatric population are scarce.ObjectivesTo assess efficacy and safety of lopinavir/ritonavir for treating paediatric patients with COVID-19.MethodsFrom March to August 2020, patients aged 18 years or below with confirmed COVID-19 diagnosed by positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) in their respiratory specimens in Department of Paediatrics, Queen Elizabeth Hospital and Princess Margaret Hospital, Hong Kong, were included. Patients were treated with lopinavir/ritonavir at decision of primary physician for 14 days or shorter when patient was fit for discharge or PCR in nasopharyngeal swab (NPS) turned negative. NPS viral load, which was determined by RT-qPCR targeting the RdRp-Hel gene, was obtained at different study time points. Clinical features including demographics, duration of symptom and hospitalization, time to negative PCR in NPS, need of oxygen therapy or intensive care were retrieved from medical records.Results80 patients admitted from March 2020 to August 2020 for COVID-19 were recruited. 27(33.8%) received lopinavir/ritonavir and 53(66.2%) patients received standard of care. Median age of patients in both groups were 8 years. Most patients have no co-morbidity. 16(59.3%), 8(29.6%) and 3(11.1%) patients in treatment group while 33(62.3%), 20(37.7%) and none of patients in control group have upper respiratory infections, asymptomatic infection and pneumonia respectively. The median days from symptom onset to admission was 1 (IQR 0–2) in treatment and 3(IQR 1–5) in control group. The median days from symptom onset to start of lopinavir/ritonavir was 1(IQR 1–3). The NPS viral load reduction from baseline to day 7 was greater in treatment group. Viral load dropped from mean 6.5 log10 copies/ml (SD 2.1) on admission to mean 4.6 log10 copies/ml (SD 2.1) on day 7 in patients treated with lopinavir/ritonavir. Viral load dropped from mean 6.4 log10 copies/ml (SD 1.8) on admission to mean 5.3 log10 copies/ml (SD 1.5) on day 7 in patient who did not receive lopinavir/ritonavir. However, the difference was not statistically significant. There was no significant difference in viral load on day 10 and day 14 between the two groups. There was also no significant difference in time to symptom resolution, PCR negativity or duration of hospitalization. No patient in the cohort re