New triple antiviral drug combination potential for treating COVID-19

A two-week course of antiviral therapy with interferon beta-1b plus lopinavir-ritonavir and ribavirin, started within seven days of showing COVID-19 symptoms has shown potential for treating COVID-19.

A two-week course of antiviral therapy with interferon beta-1b plus lopinavir-ritonavir and ribavirin, started within seven days of showing COVID-19 symptoms, is safe and more effective at reducing the duration of viral shedding than lopinavir-ritonavir alone in patients with mild to moderate illness, according to the first randomised trial of this triple combination therapy involving 127 adults (aged 18 and older) from six public hospitals in Hong Kong. 

These early but important findings, published in The Lancet, do not include severe cases of COVID-19, and the authors stress the need for larger phase 3 trials to examine the effectiveness of this triple combination in critically ill patients. 

Secondary outcomes (planned outcome measures that are not as important as the primary outcome measure, but are still of interest in evaluating the effect of an intervention) in the new study suggest that clinical improvement and length of hospital stay may be significantly shorter in people treated with triple combination less than seven days after showing symptoms, compared to lopinavir-ritonavir alone.

Experience with influenza, which  has a high viral load around the time  symptoms appear, suggests that treating hospitalised patients with a combination of multiple antiviral drugs may be more effective than single drug treatments, and minimise the risk of antiviral resistance.  The authors hypothesised that this could be a possible therapeutic approach for COVID-19, in which the viral load also peaks around the time of symptom onset. 

“Our trial demonstrates that early treatment of mild to moderate COVID-19 with a triple combination of antiviral drugs may rapidly suppress the amount of virus in a patient’s body, relieve symptoms, and reduce the risk to healthcare workers by reducing the duration and quantity of viral shedding (when the virus is detectable and potentially transmissible). Furthermore, the treatment combination appeared safe and well tolerated by patients,” commented Professor KwokYung Yuen from the University of Hong Kong who led the research. 

“These findings suggest that interferon beta 1-b may be a key component of the combination treatment and is worth further investigation for the treatment of COVID-19,” said co-author, Dr. Jenny Lo from Ruttonjee Hospital in Hong Kong. “Interferons are naturally occurring proteins, produced in response to viral infection, and the hope is that interferon beta-1b will boost the body’s ability to fight SARS-CoV-2. Future phase 3 trials will soon confirm or refute the usefulness of this candidate drug as a backbone treatment for COVID-19.”