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Infectious Diseases

17 June 2020

Antiviral trio shows mettle against Covid-19

A trial has demonstrated 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.

A triple whammy of three antiviral drugs shows promise in fighting mild to moderate Covid-19, a new, small study suggests.

Two weeks of interferon beta-1b, lopinavir-ritonavir and ribavirin – along with standard care – was tested in 127 adult patients in six Hong Kong hospitals.

The triple antiviral treatment was started within seven days of the patients showing Covid-19 symptoms and was found to be safe and to shorten the duration of viral shedding compared to lopinavir-ritonavir alone (average seven days vs. 12 days).

The phase two study in the 8 May issue of The Lancet journal didn't include patients with severe illness, and the researchers emphasised that larger phase three studies in critically ill patients are needed to determine if the triple therapy can provide clinically significant benefits.

Safe and well-tolerated

"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 health-care workers by reducing the duration and quantity of viral shedding [when the virus is detectable and potentially transmissible]," said study leader Dr Kwok-Yung Yuen, from the University of Hong Kong.

"Furthermore, the treatment combination appeared safe and well-tolerated by patients," he added in a journal news release.

"Despite these encouraging findings, we must confirm in larger phase three trials that interferon beta-1b alone or in combination with other drugs is effective in patients with more severe illness," Yuen said.

Another expert agreed that the antiviral combo needs further testing.

"Since some of these agents have proven antiviral properties it makes sense to test them," said Dr Matthew Heinz, a hospitalist at Tucson Medical Center who also assisted in the American response to the Ebola crisis during the Obama administration.

A step forward

"Lopinavir-ritonavir is an anti-retroviral medication used to treat HIV, and ribavirin is used to treat hepatitis C. Interferon beta-1b occurs naturally in humans when responding to viral infections such as influenza and is commonly used to treat multiple sclerosis," he said.

But "this study excluded severely and critically ill patients," Heinz added. "So we have no idea if the sickest Covid-19 patients would benefit from the combination therapy."

Still, the author of an accompanying commentary said the trial is a step forward in the search for a Covid-19 treatment.

"Most published studies so far have been retrospective or observational. Therefore, this prospective, randomised controlled design adds notable value to the growing evidence on treatments, eliminating a number of limitations inherent to retrospective studies," said Dr Sarah Shalhoub, from Western University in Canada.

"This study presents a step towards finding a much-needed therapy for SARS-CoV-2. However, as the authors acknowledge, future studies to examine the efficacy of interferon beta-1b alone or in combination with other drugs to treat severe or critically ill patients with confirmed Covid-19 compared with placebo are warranted," she wrote.

Image credit: Getty