Tell Me About: Potential Covid-19 drugs ritonavir, lopinavir and interferon-beta


  • Wellness
  • Thursday, 23 Apr 2020

Two of the drugs being tested for Covid-19 treatment, ritonavir and lopinavir, are also used to treat HIV. — 123rf.com

You mentioned last fortnight while talking about chloroquine as a potential treatment for Covid-19 that Malaysia is part of a trial called Solidarity organised by the World Health Organization (WHO).

Yes, it is true. To recap, WHO has launched a large global clinical trial called Solidarity to see if some old and new drugs can be used to treat Covid-19.

We talked about two of these drugs, chloroquine and remdesivir, last fortnight.

We can discuss the other drugs that are being tested in the trial today.

They are:

  • Ritonavir/lopinavir
  • Ritonavir/lopinavir and interferon-beta
Wait, before we do that, could you tell me about the Solidarity trial? I am particularly hopeful since Malaysia is in it.

Only those above the age of 18 with Covid-19 will be able to participate in the Solidarity trial.

Patients will be asked to sign a consent form to show that they understand the possible risks of the treatments being given to them.

Then the patient will be randomly allocated to one of the treatments, which may or may not include a drug.

The patients signed up for this must also have no contraindications or allergies to any of the study drugs.

You mean the patient cannot choose to be on a certain drug? I know my uncle, who has Covid-19, would like to be given one of the newer antivirals.

Unfortunately, that is what a randomised, double-blind trial does.

Neither the patient nor the medical staff can choose which study treatment the patient will be on, nor will either party know which treatment the patient is getting.

The computer will randomly allocate treatment options for each patient.

Aside from the different drugs, a patient may be randomly allocated by the computer to receive the local standard of care option.

This means that the patient will receive the best supportive care the country can currently give a patient with Covid-19.

Before you cry “unfair”, this is the care that is currently being given to most Covid-19 patients around the world, as no drug has been scientifically proven to cure Covid-19 yet.

Now, everything in the trial is coded. The data for the many treatment options will be collected, including when the patient feels better, worse, is discharged or dies.

It will also include when ventilation is given or if intensive care is needed.

Interim analysis will be monitored by a Global Data and Safety Monitoring committee, which is made up of independent experts.

Are only patients who are very sick admitted into this trial?

No. All patients with Covid-19 who fit the eligible criteria can be admitted, whether they have mild symptoms. are very sick, or even on ventilation.

The objective of the trial is to find out which drug works best so that we have options to treat Covid-19 going into the future.

The results of this trial will be very important to shape the world, now that Covid-19 has taken over every aspect of our lives.

If we have a cure, or at least some sort of treatment to suppress the disease going forward, then we can go back to our normal lives again, knowing that there is a safety net should we get sick.

We cannot live the rest of our lives in self-isolation or quarantine, after all.

If you watch all those pandemic-type movies, they usually end on a positive note once a treatment or a vaccine has been found.

What is ritonavir then?

Ritonavir is an antiretroviral medication. It is classed under protease inhibitors.

It is used to inhibit the enzyme that metabolises other protease inhibitors, allowing them to work longer in the body.

That is why it is such a good combination drug.

It was discovered in 1989 for the treatment of HIV (human immunodeficiency virus), and was available in market by 1996.

It is one of the medicines used in the very effective HAART (highly active anti-retroviral therapy) regimen used to treat HIV/AIDS.

A low dose of ritonavir is used with other protease inhibitors in the regimen.

It can also be used in combination with other medicines to treat hepatitis C.

It is an oral medicine.

Its side effects include nausea, loss of appetite, diarrhoea and numbness.

It can also have serious side effects that affect the liver, pancreas and heart rhythm.

What about lopinavir?

Lopinavir is also a protease inhibitor. It is usually used with ritonavir because ritonavir strongly inhibits the metabolism of lopinavir, allowing lopinavir to work longer in the body.

It was patented in 1995 and came into use around 2000.

A Wuhan study this year (2020) found that the ritonavir/lopinavir combination was not effective in combating Covid-19.

However, the Solidarity trial will still study it to confirm or disprove the Wuhan results.

What is interferon-beta?

Interferon is a cytokine that is produced by our own bodies as part of the immune response against an invading virus or bacteria.

It is produced at the end of an attack, and helps the body reduce its own immune reaction and the severity of the inflammation caused. Call it a modulator if you will.

It is currently used to treat multiple sclerosis.

As some Covid-19 patients have a cytokine storm that causes their lungs to fill with fluid, requiring them to be ventilated, a drug like interferon-beta can help to “calm” this storm and prevent the need for ventilation.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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