COVID-19 triggers inflammatory cytokine release, which reduces the effectiveness of drug metabolizing enzymes and alters drug levels in the bloodstream.
A study of 92 hospitalized patients showed a significant correlation between plasma concentrations of lopinavir (LPV) and C-reactive protein (CRP), indicating that inflammation impacts LPV metabolism, while hydroxychloroquine (HCQ) concentrations did not correlate with CRP.
Despite high LPV levels in COVID-19 patients, the concentrations were found to be insufficient in the lungs for effective treatment, suggesting that inflammation can inhibit important drug metabolism pathways.