A group of Hong Kong Physicians report in Lancet that a cocktail of drugs approved for the treatment of other viral diseases significantly improved the clinical and laboratory outcomes of hospitalized COVID-19 patients. The symptoms of patients treated with the full four drug cocktail resolved more rapidly as compared to those treated by only two of the four drugs. All patients treated had mild to moderate disease.
The four drugs used include lopinavir and ritonavir (anti-HIV drugs), ribavarin (a broad spectrum inhibitor of RNA viruses), and interferon-1 beta (a drug that stimulates antiviral immune responses). The control arm was treatedwith lopinavir-ritonavir alone, a combination previously shown to be no better than a placebo.
The patients in the treatment group recovered much more rapidly. The average time to resolution of symptoms was reduced to 7 days from 12 days. Also encouraging is the measurable reduction in the virus load beginning day one post treatment and continuing throughout the treatment period.
This is exciting news and, as far as I know, the first published report of symptom improvement along with a reduction in viral load. A published study of remdesivir shows no effect on patient improvement or viral load. An NIH study (still unpublished) claims improvement in symptoms but makes no mention of viral load reduction.
The Hong Kong cocktail has another advantage. All the ingredients are available as generic formulations. This is especially important as the cost of medications will be an important factor in availability of the drugs, especially in resource limited settings.
Knowledge of how effective the cocktail will be for a broader population is limited by the relatively small number of patients treated and the selection of patients with mild to moderate symptoms only. Viral load declined more rapidly in the treated versus control group but did not drop dramatically as is the case for highly active antiviral drugs in other diseases. The authors correctly comment that this is at best an interim treatment until more effective antiviral drugs are developed.
Despite these limitations this report is a ray of hope in a dark landscape.