ritonavir and Pulmonary-Fibrosis

In spite of many ongoing attempts to repurpose existing antivirals, no drugs have emerged yet with the desirable activity against SARS-CoV-2. Hydroxychloroquine, lopinavir/ritonavir, remdesivir, umifenovir, favipiravir, ribavirin and beta-interferon-1 gave rise to variable but still inconsistent proof of clinical efficacy in the treatment of COVID-19. Pathogenetic studies have shown significant differences between commonly defined viral pneumonia and COVID-19 pulmonary disease. In severe forms, immune/inflammatory alterations reminiscent of disease forms like Macrophage Activation Syndrome (MAS) have been described, and therapeutic options other than anti-infective have been proposed and implemented, such as anti-inflammatory and anticoagulative agents. The thrombotic phenomena described in the pulmonary vascular bed of patients with severe COVID-19 suggest the administration of low-molecular weight heparin (LMWH) as standard measure in hospitalized patients with COVID-19.

Topics: Adenosine Monophosphate; Alanine; Anticoagulants; Antiviral Agents; Biomarkers; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Critical Care; Disease Management; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Embolism; Endothelium, Vascular; Heparin, Low-Molecular-Weight; Humans; Hydroxychloroquine; Interferon beta-1b; Lopinavir; Macrophage Activation; Pandemics; Pneumonia, Viral; Pulmonary Fibrosis; Randomized Controlled Trials as Topic; Ritonavir; Thromboembolism; Thrombophilia; Thrombosis

At the end of February, the Lombardy region (Northern Italy) was involved in the pandemic spread of the new COVID-19. We here summarize the clinical and radiological characteristics of 90 confirmed cases and analyze their role in predicting the evolution of fibrosis.. We retrospectively analyzed the clinical and radiological data of 90 patients with COVID-19 pneumonitis. All subjects underwent an HRCT study on the day of admission and eight weeks later, and were treated with lopinavir + ritonavir (Kaletra) 400/100 mg two times a day or darunavir + ritonavir two times a day, and Hydroxychloroquine 200 mg two times a day. Pulmonary fibrosis was defined according to the Fleischner Society glossary of terms for thoracic imaging.. Twenty-three patients developed pulmonary fibrosis (25.5%): 15 were males, whose mean age was 75 ± 15. The majority were active smokers (60.8%) and had comorbidities (78.2%), above all, hypertension (47.8%), and diabetes (34.7%). Interestingly, in our series of cases, the "reversed halo sign" is frequent (63%) and seems to be a typical COVID-19 pneumonitis pattern. The patients showing fibrosis had a higher grade of systemic inflammation (ESR and PCR) and appeared to have bone marrow inhibition with a significant reduction in platelets, leukocytes, and hemoglobin.. To conclude, our data showed that the reversed halo sign associated with a ground-glass pattern may be a typical HRCT pattern of COVID-19 pneumonitis. The evolution to pulmonary fibrosis is frequent in older males and patients with comorbidities and bone marrow involvement.

Topics: Aged; Aged, 80 and over; Antiviral Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Drug Combinations; Female; Humans; Hydroxychloroquine; Lopinavir; Male; Middle Aged; Pandemics; Pneumonia, Viral; Pulmonary Fibrosis; Radiography; Retrospective Studies; Ritonavir; SARS-CoV-2; Tomography, X-Ray Computed