A combination of lopinavir/ ritonavir, ribavirin and interferon beta-1b will expedite the recovery, suppress the viral load, shorten hospitalisation and reduce mortality in patients with 2019-n-CoV infection compared with to lopinavir/ ritonavir
Hypothesis A combination of lopinavir/ ritonavir, ribavirin and interferon beta-1b will
expedite the recovery, suppress the viral load, shorten hospitalisation and reduce mortality
in patients with 2019-n-CoV infection compared with to lopinavir/ ritonavir alone
Primary objective: To evaluate the safety and efficacy in mortality reduction with a
combination of lopinavir/ ritonavir, ribavirin and interferon beta-1b in the treatment of
patient hospitalised for 2019-n-CoV infection and compare this to lopinavir/ ritonavir alone
Subject/patient definition: Recruited subjects include adult patients ≥18 years of age,
admitted to the HA Hospitals from February 2020 onwards, with laboratory confirmed 2019-n-CoV
infection. All subjects give written informed consent. Subjects must be available to complete
the study and comply with study procedures.
Study design: This is a prospective open-label randomised controlled trial among adult
patients hospitalised after February 2020 for virologically confirmed 2019-n-CoV infection.
Patients will be randomly assigned to either a 14-day course of lopinavir/ ritonavir
400mg/100mg twice daily, ribavirin 400mg bd and zero to three doses of subcutaneous injection
of interferon beta-1b 1mL (0.25mg; 8 million IU) on day 1, 3 and 5 (depending on day of
admission from symptoms onset) plus standard care, or a 14-day course of lopinavir/ ritonavir
400mg/100mg twice daily plus standard care alone (2:1).
Intervention/study article: lopinavir/ ritonavir, ribavirin and interferon beta-1b
Primary outcome: Time to negative nasopharyngeal swab (NPS) 2019-n-CoV coronavirus viral
RT-PCR
Secondary outcome:
1. Time to negative saliva 2019-n-CoV coronavirus viral RT-PCR
2. Time to clinical improvement of NEWS2 (National Early Warning Score 2) of 0 maintained
for 24 hours
3. Length of hospitalisation
4. Adverse events during treatment
5. 30-day mortality
6. Cytokine/ chemokine changes
Drug: Lopinavir/ritonavir
400mg/100mg twice daily for 14 days
Drug: Ribavirin
400mg twice daily for 14 days
Drug: Interferon Beta-1B
0.25mg subcutaneous injection alternate day for 3 days
Inclusion Criteria:
1. Recruited subjects include all adult patients ≥18 years hospitalised for virologically
confirmed 2019-n-CoV infection.
2. NEWS of ≥1 upon recruitment
3. Auditory temperature ≥38°C with at least one of the following symptoms (cough, sputum
production, sore-throat, nasal discharge, myalgia, headache or fatigue) upon admission
4. Symptom duration ≤10 days
5. All subjects give written informed consent.
6. Subjects must be available to complete the study and comply with study procedures.
Willingness to allow for serum samples to be stored beyond the study period, for
potential additional future testing to better characterize immune response.
Exclusion Criteria:
1. Inability to comprehend and to follow all required study procedures.
2. Allergy or severe reactions to the study drugs
3. Patients with known prolonged QT or PR interval, second- or third-degree heart block,
or ventricular cardiac arrhythmias, including torsade de pointes
4. Patients taking medication that will potentially interact with lopinavir/ ritonavir,
ribavirin or interferon-beta1b
5. Patients with known history of severe depression
6. Pregnant or lactation women
7. Inability to comprehend and to follow all required study procedures
8. Received an experimental agent (vaccine, drug, biologic, device, blood product, or
medication) within 1 month prior to recruitment in this study or expect to receive an
experimental agent during this study. Unwilling to refuse participation in another
clinical study through the end of this study.
9. Have a history of alcohol or drug abuse in the last 5 years.
10. Have any condition that the investigator believes may interfere with successful
completion of the study.
University of Hong Kong, Queen Mary Hospital
Hong Kong, Hong Kong
Ivan FN Hung, MD FRCP, Principal Investigator
The University of Hong Kong