Exploring Potential Synergism Between Darunavir/Cobicistat and Ribavirin for the Treatment of Covid-19 Patients: A Retrospective Comparison Study

Objective: Exploring potential synergistic effect of darunavir/cobicistat (DRV/COBI) plus ribavirin (RBV) in COVID-19 treatment. Methods: Retrospective, observational comparison study conducted in Qatar. Adult patients with confirmed positive SARSCoV-2 who received either DRV/COBI or DRV/COBI+RBV were included. Primary outcome was time to viral clearance, while secondary outcomes. include clinical improvement (resolution of fever/tachypnea), development of acute respiratory distress syndromes (ARDS) and 28-days all-cause mortality, and incidence of adverse reactions. Results: Sixty-four patients were included (41 received DRV/COBI and 23 received DRV/COBI+ RBV). Mean age of patients was 48.4±14.6 years with predominant male gender (58/64; 90.6%). Median time from starting therapy till viral clearance was 11 days in DRV/COBI+RBV vs. 16 days in DRV/COBI groups (P=0.295). At day-28, viral clearance was observed in 82.6% (19/23) and 73.2% (30/41) in DRV/COBI+RBV and DRV/COBI groups, respectively (P=0.392). Patients receiving DRV/COBI+RBV did not achieve faster resolution of fever or tachypnea compared to those receiving DRV/COBI. Three patients in DRV/COBI+RBV group developed ARDS, while none in DRV/COBI group. Frequency of hemoglobin drop of ≥2g/dl was significantly higher in DRV/COBI+RBV group than in DRV/COBI group (34.8% vs. 7.9%, P=0.008, respectively). Conclusion: Use of darunavir/cobicistat plus ribavirin was not associated with faster viral clearance or better clinical outcomes.