Role of Kaletra (combination of lopinavir and ritonavir) in the treatment of COVID-19 virus infection; an issue related to kidney transplant patients – A review study on current knowledge

A number of therapies are prescribed for the treatment of COVID-19, but none of them have proven efficacy. In this review article, we summarized the pharmacodynamic and pharmacokinetic properties, effect and potential toxicity of Kaletra (combination of lopinavir and ritonavir) among kidney transplant (KTP) patients who have COVID-19. We used a variety of sources by searching through PubMed, Scopus, Embase and Current Content to collect current data about our issue. Articles published in the English language, as full-text manuscripts, and or as abstract form were included in the study. Lopinavir and ritonavir are two structurally related novel protease inhibitors which have antiretroviral properties. They have primarily been used as part of combination therapy for the treatment of HIV, SARS-CoV and MERS-CoV viruses. However, it seems that use of Kaletra is not associated with clinical improvement, or reduces mortality among patients including KTP recipients who have laboratory-confirmed COVID-19. On the other hand, co-administration of Kaletra with medications that are commonly used among KTP recipients including calcineurin inhibitors and mTOR inhibitors has profound drug-drug interactions. Co-administration of Kaletra with these medications could lead to significant and unexpected increase of blood concentrations of both calcineurin and mTOR inhibitors and therefore frequent monitoring of the immunosuppressive drugs concentrations are necessary to optimize immunosuppressive therapy and prevention of toxicity. It is important to note that frequent monitoring of the immunosuppressive drugs concentration is expensive and also not easily available in many countries including our country. According to the above important points, we recommend that use of Kaletra among KTP patients who have laboratory-confirmed COVID-19 should be avoided especially among patients who are still on calcineurin and mTOR inhibitors.