Podcast 266: Interferon and early treatment in COVID-19 bring good outcomes

A combination of three antivirals — Kaletra (which is lopinavir plus ritonavir) and ribavirin — when given early and with interferon significantly reduces viral shedding, disease symptoms, and hospital stay in  patients with COVID-19 when compared with a control regimen of Kaletra alone. The drugs are active against other coronaviruses, but the key factors seem to be interferon and promptness of treatment.



When the triple-drug combo was administered without interferon 7 days or more after the onset of symptoms, the results were no better than with Kaletra alone. Prof. Ivan Hung, the lead author on the report, explains that the researchers were afraid of prompting a cytokine “storm” if interferon was given after 6 days of symptoms — they’re not sure that that reluctance was well founded now. In any case, no patients died in either group.



The study was conducted in Hong Kong and has just been published in The Lancet. (An earlier study by another group published in the New England Journal of Medicine found no special benefit from Kaletra alone — a result seemingly confirmed by this study in The Lancet.)



We were able to interview Prof. Hung over ZOOM from Hong Kong, where he was about to enjoy a Mother’s Day lunch with his mom. It was very generous of him.



Prof. Hung’s article in The Lancet (https://www.thelancet.com/journals/la...)



NEJM study on Kaletra’s ineffectiveness against COVID-19 (https://www.nejm.org/doi/full/10.1056...)



Running time: 14 minutes



Links to other interviews in this series:




1. Dr. Anthony Fauci (https://podcasts.jwatch.org/index.php...)


2. Dr. Susan Sadoughi (https://podcasts.jwatch.org/index.php...)


3. Dr. Matthew Young (https://podcasts.jwatch.org/index.php...)


4. Dr. Julian Flores (https://podcasts.jwatch.org/index.php...)


5. Dr. Kristi Koenig (https://podcasts.jwatch.org/index.php...)


6. Dr. Renee Salas (https://podcasts.jwatch.org/index.php...)


7. Drs. Andre Sofair and William Chavey (https://podcasts.jwatch.org/index.php...)


8. Dr. Comilla Sasson (https://podcasts.jwatch.org/index.php...)


9. Dr. John Jernigan (https://podcasts.jwatch.org/index.php...)




Transcript __________________



Joe Elia: ________You are listening to Clinical Conversations. I’m your host, Joe Elia.



A study out of Hong Kong, just published in The Lancet, shows that a combination of three antiviral drugs has the effect of shortening the time from the start of COVID-19 treatment to when nasopharyngeal swabs are free of virus. The researchers used a combination of three drugs, all of which have shown activity against coronaviruses related to SARS-CoV-2. Some patients also received interferon.



The regime was compared against a regime using only two of the antivirals and no interferon.



The study’s first author, Professor Ivan Hung, has kindly agreed to talk with us. Professor Hung is with the State Key Laboratory of Emerging Infectious Diseases, Carol Yu Center for Infection, at the University of Hong Kong.



Welcome, Professor Hung, and thank you for agreeing to talk with us.



Professor Ivan Hung: ________Thank you, Joe. Very kind of you.



Joe Elia: ________Previous work on 2003 SARS and 2012 MERS was key here, wasn’t it?



Professor Ivan Hung: ________Absolutely. Yes.



Joe Elia: ________And can you briefly explain the rationale for using the three drugs that you did?



Professor Ivan Hung: ________Yes, the choices of the three drugs are based on our previous research, published in 2003 and also in, subsequently in 2015. The two studies were based on…in 2003, we were using the Kaletra, which is the lopinavir/ritonavir, together with the ribavirin, in patients with SARS in 2003. And we were able to demonstrate that with that combination that patients clinically, they actually performed better with fewer complication of ARDS and also fewer mortalities. Nevertheless, it was a pilot study.



Subsequently, we did another study on marmoset, which is the, you know, the South American monkey, and we did, in that animal model, we were able to demonstrate by using either interferon or with the Kaletra, we were ...