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?:abstract
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BACKGROUND: Limited data are available regarding antiviral therapy efficacy in most severe patients under mechanical ventilation for Covid-19-related acute respiratory distress syndrome (ARDS) METHODS: Comparison of antiviral strategies (none, hydroxychloroquine (OHQ), lopinavir/ritonavir (L/R), others (combination or remdesivir) in an observational multicentre cohort of patients with moderate-to-severe Covid-19 ARDS The primary endpoint was the number of day 28 ventilator-free days (VFD) Patients who died before d28 were considered as having 0 VFD The variable was dichotomized into \'patients still ventilated or dead at day 28\' versus \'patients weaned and alive at day 28\' RESULTS: We analyzed 415 patients (85 treated with standard of care (SOC), 57 with L/R, 220 with OHQ, and 53 others) The median number of d28-VFD was 0 (IQR 0-13) and differed between groups (P = 0 03), SOC patients having the highest d28-VFD After adjustment for age, sex, Charlson Comorbidity Index, PaO(2)/FiO(2) ratio and plateau pressure and accounting for center effect with a generalized linear mixed model, none of the antiviral strategies increased the chance of being alive and weaned from MV at day 28 compared to the SOC strategy (OR 0 48 CI95% (0 18-1 25);OR 0 96 (0 47-2 02) and OR 1 43 (0 53-4 04) for L/R, OHQ and other treatments, respectively) Acute kidney injury during ICU stay was frequent (55%);its incidence was higher in patients receiving lopinavir (66 vs 53%, P = 0 03) After adjustment for age, sex, BMI, chronic hypertension and chronic renal disease, the use of L/R was associated with an increased risk of renal replacement therapy (RRT) (OR 2 52 CI95% 1 16-5 59) CONCLUSION: In this multicentre observational study of moderate-to-severe Covid-19 ARDS patients, we did not observe any benefit among patients treated with OHQ or L/R compared with SOC The use of L/R treatment was associated with an increased need for RRT Take home message Neither hydroxychloroquine nor lopinavir/ritonavir as COVID-19 antiviral treatment is associated with higher ventilator-free days at day 28 when compared with standard of care (no antiviral treatment) in ICU patients under invasive mechanical ventilation Lopinavir/ritonavir is associated with an increased risk of renal replacement therapy requirement Tweet COVID-19: Insights from ARDS cohort: no signal of efficacy of any antiviral drugs Lopinavir/ritonavir may be associated with need for RRT
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