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Comparative Therapeutic Efficacy and Safety of Remdesivir monotherapy and its Combination of Lopinavir/Ritonavir in COVID-19 Patients

Objectives: The treatment of COVID-19 infection remains a challenge
because till now, there is no approved therapy for it. This study aimed
to estimate the difference in the therapeutic efficacy and safety
between remdesivir as monotherapy and its use in combination with
lopinavir/ritonavir provided with standard supportive care. Methods:
This is a prospective randomized cohort study included 1043 adult
patients with confirmed moderate and severe COVID-19 infection.
Treatment of all patients followed Egyptian Ministry of Health COVID-19
protocol as the first group received IV remdesivir 200 mg on day 1,
followed by 100 mg once daily, for 5 days while the second group
received lopinavir/ritonavir 400/100 mg twice daily, for 5 days with the
same remdesivir regimen in the first group. All laboratory and clinical
parameters were assessed before and after treatment duration. Results:
There was no significant difference related to improvement parameters
such as laboratory data and improvement time between the two groups. On
the other hand, hepatotoxicity of the second group (combination) was
significantly higher compared with that of the first one. The elevation
on liver enzymes was affected by the severity of the disease, the severe
cases showed a high enzyme elevation rate. Conclusion: Remdesivir as
monotherapy and its use in combination with lopinavir/ritonavir is
effective in the management of moderate COVID 19 subjects than severe
cases. The combination of remdesivir with lopinavir/ritonavir is not
recommended due to the increased hepatotoxicity effect.