Discussion
This is the first study assessing severe DDI pairs of LPV/RTV used in the treatment of COVID-19 patients and were predicted to cause clinically significant life-threatening ADRs.
The findings of this study have great novelty in terms of reducing clinician burdens especially when DDI alert fatigues may expected to occur in this emergency pandemic health situations. This study has tabulated the composite lists of severe DDI pairs of LPV/RTV that were recognized by both the international well-recognized evidenced-based resources and is highly recommended to check at least 10 severe DDI pairs of LPV/RTV to reduce the risk of life-threatening ADRs.
Meanwhile, it is also noteworthy that in many developing countries, computer based DDI alert systems may not available and clinicians in these countries may be advantaged greatly from the severe DDI pairs identified in this study in general, and in particular the composite list recognized by both the international drug interactions resources.
Important findings of this study revealed that clinicians should not depend on any particular DDI checking systems of LPV/RTV and may be other COVID-19 drugs as well since high level of discrepancies were identified in this study. For example, if clinicians solely rely on the Liverpool COVID-19 DDI checking system which has recently emerged specifically for COVID-19 therapeutics, it is found that around seven very clinically important drugs may be missed for checking DDIs that may cause life-threatening ADRs. On the other hand, if clinicians solely rely on the FDA prescribing information of LPV/RTV, it is found that around 45 very clinically important drugs may be missed for checking DDIs that may also cause life-threatening ADRs. Therefore, it is suggested to undertake systematic cross-comparison in future by the professional DDI bodies to reduce disagreement in between the drug interaction resources. Also, suggested to identify any discrepancies by the clinicians in order to avoid missing any interacting drugs predicted to cause clinically significant DDIs.
It is important to recognize that although different other ways e.g. computerized DDI alerts12,13, web-based DDI checkers etc. can be used to identify potential clinically significant DDIs of LPV/RTV, however there are lots of limitations of these checking systems including alert fatigues 11, lack of robust evidence of the interactions etc. The findings of the present study may therefore serve as considerably best severe DDI pairs of LPV/RTV predicted to cause life-threatening ADRs since the DDI pairs were identified from the internationally well-recognized evidenced based DDI resources.