N. Engl. J. Med. https://doi.org/10.1056/NEJMoa2001282 (2020)

A randomized, controlled, open-label trial of lopinavir–ritonavir in patients with severe COVID-19 shows no benefit for the primary endpoint beyond standard care but shows benefit for some secondary endpoints.

Currently, there are no effective antiviral treatments against the novel coronavirus SARS-CoV-2, the cause of the respiratory illness termed COVID-19. During the outbreak of severe acute respiratory syndrome (SARS) in 2003, in vitro testing identified lopinavir, an HIV aspartate protease inhibitor, to have activity against this virus.

Cao et al. carried out a randomized, controlled, open-label trial for lopinavir–ritonavir (ritonavir helps to stabilize lopinavir) in 199 hospitalized patients with severe COVID-19, of whom 99 were assigned to the treatment group, and 100 received the standard of care. The authors found no benefit of lopinavir–ritonavir time to clinical improvement beyond the standard of care, although lopinavir–ritonavir was found to have benefit for some secondary endpoints, the safety of the treatment was confirmed, and future trials will verify the results.