French researchers have found that older, severely ill COVID-19 patients who were given a combination of two antiretroviral drugs developed a slow heart rate condition called bradycardia.
A team of researchers from Amiens University Hospital, France, looked at 41 patients who received lopinavir and ritonavir twice a day for 10 days, of which, 22 percent developed bradycardia. And when the drugs were stopped or doses were reduced, their heart rates returned to normal.
The researchers published their findings online last week in the journal Circulation: Arrhythmia and Electrophysiology.
Cardiologist Dr. Gregg Fonarow of the University of California, Los Angeles, who was not part of the study, said, “There are extensive investigations underway to find therapies that are effective at treating patients infected with COVID-19.”
The combination of lopinavir and ritonavir has been considered a potential treatment for COVID-19 patients based on small studies, off-label use, and randomized trials, Dr. Fonarow explained.
However, previous studies have found that this antiretroviral combination could lead to heart block – a problem associated with electrical signals in the heart.
Dr. Fonarow said, “Determining how these drugs lead to the bradycardia will require further study,” adding that clinicians should be aware of the potential risk of bradycardia due to these drugs and should carefully monitor patients.
“Moreover, preliminary clinical trial results suggest this therapy is not effective in COVID-19, so use in this setting will likely be very limited going forward,” Dr. Fonarow added.
The combination of lopinavir and ritonavir is sold under the brand name Kaletra for the treatment and prevention of HIV/AIDS. The drugs have also been used to treat other coronaviruses that cause severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS).
The researchers noted that these drugs caused bradycardia in HIV patients.
Bradycardia is a condition in which the heart rate falls below 60 beats per minute, reducing overall blood flow that can lead to syncope, fainting, chest pain, low blood pressure, and heart failure.
Dr. Marc Siegel of NYU Langone Medical Center, New York City, reviewed the findings and noted that the combination of lopinavir and ritonavir had not helped hospitalized COVID-19 patients in other recent studies.
Dr. Siegel explained that the drugs should not be used in COVID-19 patients because they are not effective.
He said, “The remaining hope for this combination of drugs was early in the disease, but the significant amount of bradycardia in these critically ill patients raises the question that this combo is not well tolerated in many patients.” Moving forward, Dr. Siegel said Gilead’s experimental antiviral drug remdesivir has been found effective in treating COVID-19.
