Ineffective of lopinavir/ritonavir and chloroquine for a COVID-19
treatment: A perspective of physiologically-based pharmacokinetic and
pharmacodynamic modelling
Abstract
Ineffective selection of therapeutic drugs during an urgent situation
leads to failure for COVID-19 treatment in large clinical trials,
resulting in wasting time and cost. We aimed to demonstrate the utility
of physiologically-based pharmacokinetic (PBPK)/pharmacodynamic (PD)
modeling to support the withdrawal of chloroquine and ritonavir-boosted
lopinavir (LPV/r) for COVID-19 treatment. The developed whole-body PBPK
models were validated against clinical data. Model validation was
performed using acceptable methods. The inhibitory effect was calculated
to demonstrate drug efficacy. Various regimens of chloroquine and LPV/r
for COVID-19 treatment in different clinical trials were used for a
simulation. The risk of cardiotoxicity following high dose chloroquine
administration was assessed. The effect of lung pH on drug
concentrations in epithelial lining fluid (ELF) following a high dose of
chloroquine and LPV/r was evaluated. The whole-body PBPK models were
successfully developed (AAFEs of 1.2-fold). The inhibitory effect (%E)
of chloroquine following high dose regimens in both ELF and bronchial
epithelial cells (BEC) were lower than 2 and 1%, respectively. The
corresponding values for the high dose of LPV/r were 40 and 2%,
respectively. The risk of prolonged QTc in the population was higher
than 20%. In addition, the %E of chloroquine was increased to 76% at
pH 5.6 and decreased to 0.13% at pH 7.5. The change in pH in ELF had no
influence on LPV/r concentrations. PBPK/PD modelling supports the
withdrawal of chloroquine and LPV/r for COVID-19 treatment as an
effective tool for the selection of therapeutic drug regimens in urgent
situation.