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Coelho PS, Sousa AJO, Rodrigues ISR, Nascimento HS, Pantoja LC, Miranda MS. Preimplantation development of in vitro-produced bovine embryos treated with hydroxychloroquine. Toxicol In Vitro 2024; 98:105847. [PMID: 38759936 DOI: 10.1016/j.tiv.2024.105847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024]
Abstract
Hydroxychloroquine (HCQ) is a safe antimalarial drug but its overdosage or inappropriate use, such as during the pandemic, may cause adverse effects once this drug is considered a potent inhibitor of autophagy. Information about HCQ's effects on the reproductive field, including gametes and initial embryos, is limited. In this study, we evaluated the effect of HCQ (1, 6, 12, and 24 μM) on pre-implantation embryo development, autophagy, and apoptosis of bovine embryos produced in vitro. A dose-response experiment showed a reduction (p < 0.05) in cleavage only at the highest concentration. Blastocyst rate was gradually reduced (p < 0.05) with the increase of HCQ dosage starting at 6 μM, with no embryo formation occurring at 24 μM. Further analysis showed that embryos treated with 12 μM of HCQ had a higher (p < 0.05) accumulation of acidic autophagic vesicles on Days 5 and 7 of development and a higher (p < 0.01) apoptotic index on Day 7. To our knowledge, this is the first study to evaluate the effects of HCQ on embryo pre-implantation development in mammals. The results contribute with more information related to the study of autophagy in embryology as well as add some discussion on HCQ toxicology and its effects on reproductive cells.
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Affiliation(s)
- P S Coelho
- Laboratory of Amazon Animal Biotechnology and Medicine (BIOMEDAM), Veterinary Medicine Institute, Federal University of Pará, City of Castanhal 68741-740, Pará State, Brazil
| | - A J O Sousa
- Laboratory of Amazon Animal Biotechnology and Medicine (BIOMEDAM), Veterinary Medicine Institute, Federal University of Pará, City of Castanhal 68741-740, Pará State, Brazil
| | - I S R Rodrigues
- Laboratory of Amazon Animal Biotechnology and Medicine (BIOMEDAM), Veterinary Medicine Institute, Federal University of Pará, City of Castanhal 68741-740, Pará State, Brazil
| | - H S Nascimento
- Laboratory of Amazon Animal Biotechnology and Medicine (BIOMEDAM), Veterinary Medicine Institute, Federal University of Pará, City of Castanhal 68741-740, Pará State, Brazil
| | - L C Pantoja
- Laboratory of Amazon Animal Biotechnology and Medicine (BIOMEDAM), Veterinary Medicine Institute, Federal University of Pará, City of Castanhal 68741-740, Pará State, Brazil
| | - M S Miranda
- Laboratory of Amazon Animal Biotechnology and Medicine (BIOMEDAM), Veterinary Medicine Institute, Federal University of Pará, City of Castanhal 68741-740, Pará State, Brazil.
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2
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Zhao X, Wu H, Li S, Gao C, Wang J, Ge L, Song Z, Ni B, You Y. The impact of the COVID-19 pandemic on SLE. Mod Rheumatol 2024; 34:247-264. [PMID: 36961736 DOI: 10.1093/mr/road030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/21/2023] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
Little is known about the association between coronavirus disease 2019 (COVID-19) and autoimmune diseases, especially in the case of systemic lupus erythematosus (SLE). SLE patients met with many questions during the pandemic in COVID-19, such as how to minimize risk of infection, the complex pathological features and cytokine profiles, diagnosis and treatment, rational choice of drugs and vaccine, good nursing, psychological supervision, and so on. In this study, we review and discuss the multifaceted effects of the COVID-19 pandemic on patients living with SLE using the available literature. Cross-talk in implicated inflammatory pathways/mechanisms exists between SLE and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and SARS-CoV-2 displays similar clinical characteristics and immuno-inflammatory responses to SLE. Current epidemiological data inadequately assess the risk and severity of COVID-19 infection in patients with SLE. More evidence has shown that hydroxychloroquine and chloroquine cannot prevent COVID-19. During the pandemic, patients with SLE had a higher rate of hospitalization. Vaccination helps to reduce the risk of infection. Several therapies for patients with SLE infected with COVID-19 are discussed. The cases in the study can provide meaningful information for clinical diagnosis and management. Our main aim is to help preventing infection and highlight treatment options for patients with SLE infected with COVID-19.
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Affiliation(s)
- Xingwang Zhao
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Haohao Wu
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shifei Li
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Cuie Gao
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Juan Wang
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lan Ge
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhiqiang Song
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Bing Ni
- Department of Pathophysiology, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yi You
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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3
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Wang Z, Huang AS, Tang L, Wang J, Wang G. Microfluidic-assisted single-cell RNA sequencing facilitates the development of neutralizing monoclonal antibodies against SARS-CoV-2. LAB ON A CHIP 2024; 24:642-657. [PMID: 38165771 DOI: 10.1039/d3lc00749a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
As a class of antibodies that specifically bind to a virus and block its entry, neutralizing monoclonal antibodies (neutralizing mAbs) have been recognized as a top choice for combating COVID-19 due to their high specificity and efficacy in treating serious infections. Although conventional approaches for neutralizing mAb development have been optimized for decades, there is an urgent need for workflows with higher efficiency due to time-sensitive concerns, including the high mutation rate of SARS-CoV-2. One promising approach is the identification of neutralizing mAb candidates via single-cell RNA sequencing (RNA-seq), as each B cell has a unique transcript sequence corresponding to its secreted antibody. The state-of-the-art high-throughput single-cell sequencing technologies, which have been greatly facilitated by advances in microfluidics, have greatly accelerated the process of neutralizing mAb development. Here, we provide an overview of the general procedures for high-throughput single-cell RNA-seq enabled by breakthroughs in droplet microfluidics, introduce revolutionary approaches that combine single-cell RNA-seq to facilitate the development of neutralizing mAbs against SARS-CoV-2, and outline future steps that need to be taken to further improve development strategies for effective treatments against infectious diseases.
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Affiliation(s)
- Ziwei Wang
- School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Amelia Siqi Huang
- Dalton Academy, The Affiliated High School of Peking University, Beijing, 100190, China
| | - Lingfang Tang
- Dalton Academy, The Affiliated High School of Peking University, Beijing, 100190, China
| | - Jianbin Wang
- School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Guanbo Wang
- Institute for Cell Analysis, Shenzhen Bay Laboratory, Shenzhen, 518132, China.
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4
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Arman BY, Brun J, Hill ML, Zitzmann N, von Delft A. An Update on SARS-CoV-2 Clinical Trial Results-What We Can Learn for the Next Pandemic. Int J Mol Sci 2023; 25:354. [PMID: 38203525 PMCID: PMC10779148 DOI: 10.3390/ijms25010354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has claimed over 7 million lives worldwide, providing a stark reminder of the importance of pandemic preparedness. Due to the lack of approved antiviral drugs effective against coronaviruses at the start of the pandemic, the world largely relied on repurposed efforts. Here, we summarise results from randomised controlled trials to date, as well as selected in vitro data of directly acting antivirals, host-targeting antivirals, and immunomodulatory drugs. Overall, repurposing efforts evaluating directly acting antivirals targeting other viral families were largely unsuccessful, whereas several immunomodulatory drugs led to clinical improvement in hospitalised patients with severe disease. In addition, accelerated drug discovery efforts during the pandemic progressed to multiple novel directly acting antivirals with clinical efficacy, including small molecule inhibitors and monoclonal antibodies. We argue that large-scale investment is required to prepare for future pandemics; both to develop an arsenal of broad-spectrum antivirals beyond coronaviruses and build worldwide clinical trial networks that can be rapidly utilised.
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Affiliation(s)
- Benediktus Yohan Arman
- Antiviral Drug Discovery Unit, Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford OX1 3QU, UK; (J.B.); (N.Z.)
- Kavli Institute for Nanoscience Discovery, University of Oxford, Oxford OX1 3QU, UK
| | - Juliane Brun
- Antiviral Drug Discovery Unit, Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford OX1 3QU, UK; (J.B.); (N.Z.)
- Kavli Institute for Nanoscience Discovery, University of Oxford, Oxford OX1 3QU, UK
| | - Michelle L. Hill
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, UK;
| | - Nicole Zitzmann
- Antiviral Drug Discovery Unit, Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford OX1 3QU, UK; (J.B.); (N.Z.)
- Kavli Institute for Nanoscience Discovery, University of Oxford, Oxford OX1 3QU, UK
| | - Annette von Delft
- Kavli Institute for Nanoscience Discovery, University of Oxford, Oxford OX1 3QU, UK
- Centre for Medicine Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
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Smith DRM, Chervet S, Pinettes T, Shirreff G, Jijón S, Oodally A, Jean K, Opatowski L, Kernéis S, Temime L. How have mathematical models contributed to understanding the transmission and control of SARS-CoV-2 in healthcare settings? A systematic search and review. J Hosp Infect 2023; 141:132-141. [PMID: 37734676 DOI: 10.1016/j.jhin.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/04/2023] [Indexed: 09/23/2023]
Abstract
Since the onset of the COVID-19 pandemic, mathematical models have been widely used to inform public health recommendations regarding COVID-19 control in healthcare settings. The objective of this study was to systematically review SARS-CoV-2 transmission models in healthcare settings, and to summarize their contributions to understanding nosocomial COVID-19. A systematic search and review of published articles indexed in PubMed was carried out. Modelling studies describing dynamic inter-individual transmission of SARS-CoV-2 in healthcare settings, published by mid-February 2022 were included. Models have mostly focused on acute-care and long-term-care facilities in high-income countries. Models have quantified outbreak risk, showing great variation across settings and pandemic periods. Regarding surveillance, routine testing rather than symptom-based was highlighted as essential for COVID-19 prevention due to high rates of silent transmission. Surveillance impacts depended critically on testing frequency, diagnostic sensitivity, and turn-around time. Healthcare re-organization also proved to have large epidemiological impacts: beyond obvious benefits of isolating cases and limiting inter-individual contact, more complex strategies (staggered staff scheduling, immune-based cohorting) reduced infection risk. Finally, vaccination impact, while highly effective for limiting COVID-19 burden, varied substantially depending on assumed mechanistic impacts on infection acquisition, symptom onset and transmission. Modelling results form an extensive evidence base that may inform control strategies for future waves of SARS-CoV-2 and other viral respiratory pathogens. We propose new avenues for future models of healthcare-associated outbreaks, with the aim of enhancing their efficiency and contributions to decision-making.
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Affiliation(s)
- D R M Smith
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France; Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France
| | - S Chervet
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France; Université Paris-Cité, INSERM, IAME, F-75018, Paris, France
| | - T Pinettes
- Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - G Shirreff
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France; Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France
| | - S Jijón
- Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - A Oodally
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France; Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France
| | - K Jean
- Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - L Opatowski
- Anti-infective Evasion and Pharmacoepidemiology Team, CESP, Université Paris-Saclay, UVSQ, INSERM U1018, Montigny-le-Bretonneux, France; Institut Pasteur, Université Paris-Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France
| | - S Kernéis
- Université Paris-Cité, INSERM, IAME, F-75018, Paris, France; Equipe de Prévention du Risque Infectieux (EPRI), AP-HP, Hôpital Bichat, F-75018 Paris, France.
| | - L Temime
- Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers, F-75003 Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
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6
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Zhou G, Verweij S, Bijlsma MJ, de Vos S, Oude Rengerink K, Pasmooij AMG, van Baarle D, Niesters HGM, Mol P, Vonk JM, Hak E. Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis. BMJ Open Respir Res 2023; 10:e001674. [PMID: 37640510 PMCID: PMC10462970 DOI: 10.1136/bmjresp-2023-001674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the prevention of laboratory-confirmed SARS-CoV-2 infection and/or COVID-19 among healthy adults. DESIGN Systematic review. ELIGIBILITY Quantitative experimental and observational intervention studies that evaluated the effectiveness of repurposed drugs for the primary prevention of SARS-CoV-2 infection and/or COVID-19 disease. DATA SOURCE PubMed and Embase (1 January 2020-28 September 2022). RISK OF BIAS Cochrane Risk of Bias 2.0 and Risk of Bias in Non-Randomised Studies of Interventions tools were applied to assess the quality of studies. DATA ANALYSIS Meta-analyses for each eligible drug were performed if ≥2 similar study designs were available. RESULTS In all, 65 (25 trials, 40 observational) and 29 publications were eligible for review and meta-analyses, respectively. Most studies pertained to hydroxychloroquine (32), ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) (11), statin (8), and ivermectin (8). In trials, hydroxychloroquine prophylaxis reduced laboratory-confirmed SARS-CoV-2 infection (risk ratio: 0.82 (95% CI 0.74 to 0.90), I2=48%), a result largely driven by one clinical trial (weight: 60.5%). Such beneficial effects were not observed in observational studies, nor for prognostic clinical outcomes. Ivermectin did not significantly reduce the risk of SARS-CoV-2 infection (RR: 0.35 (95% CI 0.10 to 1.26), I2=96%) and findings for clinical outcomes were inconsistent. Neither ACEi or ARB were beneficial in reducing SARS-CoV-2 infection. Most of the evidence from clinical trials was of moderate quality and of lower quality in observational studies. CONCLUSIONS Results from our analysis are insufficient to support an evidence-based repurposed drug policy for SARS-CoV-2 prophylaxis because of inconsistency. In the view of scarce supportive evidence on repurposing drugs for COVID-19, alternative strategies such as immunisation of vulnerable people are warranted to prevent the future waves of infection. PROSPERO REGISTRATION NUMBER CRD42021292797.
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Affiliation(s)
- Guiling Zhou
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Stefan Verweij
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Maarten J Bijlsma
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Stijn de Vos
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | | | - Debbie van Baarle
- Virology and Immunology Research Group, Department of Medical Microbiology and Infection Prevention, University Medical Centre, Groningen, The Netherlands
| | - Hubert G M Niesters
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
| | - Peter Mol
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre, Groningen, The Netherlands
| | - Judith M Vonk
- Groningen Research Institute for Asthma and COPD, University Medical Centre, Groningen, The Netherlands
- Department of Epidemiology, University Medical Centre, Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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7
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Shan T, Li LY, Yang JM, Cheng Y. Role and clinical implication of autophagy in COVID-19. Virol J 2023; 20:125. [PMID: 37328875 PMCID: PMC10276507 DOI: 10.1186/s12985-023-02069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic constitutes a serious public health concern worldwide. Currently, more than 6 million deaths have occurred despite drastic containment measures, and this number is still increasing. Currently, no standard therapies for COVID-19 are available, which necessitates identifying effective preventive and therapeutic agents against COVID-19. However, developing new drugs and vaccines is a time-consuming process, and therefore, repurposing the existing drugs or redeveloping related targets seems to be the best strategy to develop effective therapeutics against COVID-19. Autophagy, a multistep lysosomal degradation pathway contributing to nutrient recycling and metabolic adaptation, is involved in the initiation and progression of numerous diseases as a part of an immune response. The key role of autophagy in antiviral immunity has been extensively studied. Moreover, autophagy can directly eliminate intracellular microorganisms by selective autophagy, that is, "xenophagy." However, viruses have acquired diverse strategies to exploit autophagy for their infection and replication. This review aims to trigger the interest in the field of autophagy as an antiviral target for viral pathogens (with an emphasis on COVID-19). We base this hypothesis on summarizing the classification and structure of coronaviruses as well as the process of SARS-CoV-2 infection and replication; providing the common understanding of autophagy; reviewing interactions between the mechanisms of viral entry/replication and the autophagy pathways; and discussing the current state of clinical trials of autophagy-modifying drugs in the treatment of SARS-CoV-2 infection. We anticipate that this review will contribute to the rapid development of therapeutics and vaccines against COVID-19.
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Affiliation(s)
- Tianjiao Shan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Hunan Provincial Engineering Research Centre of Translational Medicine and Innovative Drug, Changsha, 410011, China
| | - Lan-Ya Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Hunan Provincial Engineering Research Centre of Translational Medicine and Innovative Drug, Changsha, 410011, China
| | - Jin-Ming Yang
- Department of Toxicology and Cancer Biology, Department of Pharmacology, and Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA.
| | - Yan Cheng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
- Hunan Provincial Engineering Research Centre of Translational Medicine and Innovative Drug, Changsha, 410011, China.
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8
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Hong H, Friedland A, Hu M, Anstrom KJ, Halabi S, McKinnon JE, Amaravadi R, Rojas-Serrano J, Abella BS, Portillo-Vázquez AM, Woods CW, Hernandez AF, Boulware DR, Naggie S, Rajasingham R. Safety and efficacy of hydroxychloroquine as prophylactic against COVID-19 in healthcare workers: a meta-analysis of randomised clinical trials. BMJ Open 2023; 13:e065305. [PMID: 37328184 PMCID: PMC10276967 DOI: 10.1136/bmjopen-2022-065305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE We studied the safety and efficacy of hydroxychloroquine (HCQ) as pre-exposure prophylaxis for COVID-19 in healthcare workers (HCWs), using a meta-analysis of randomised controlled trials (RCTs). DATA SOURCES PubMed and EMBASE databases were searched to identify randomised trials studying HCQ. STUDY SELECTION Ten RCTs were identified (n=5079 participants). DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this systematic review and meta-analysis between HCQ and placebo using a Bayesian random-effects model. A pre-hoc statistical analysis plan was written. MAIN OUTCOMES The primary efficacy outcome was PCR-confirmed SARS-CoV-2 infection and the primary safety outcome was incidence of adverse events. The secondary outcome included clinically suspected SARS-CoV-2 infection. RESULTS Compared with placebo, HCWs randomised to HCQ had no significant difference in PCR-confirmed SARS-CoV-2 infection (OR 0.92, 95% credible interval (CI): 0.58, 1.37) or clinically suspected SARS-CoV-2 infection (OR 0.78, 95% CI: 0.57, 1.10), but significant difference in adverse events (OR 1.35, 95% CI: 1.03, 1.73). CONCLUSIONS AND RELEVANCE Our meta-analysis of 10 RCTs investigating the safety and efficacy of HCQ as pre-exposure prophylaxis in HCWs found that compared with placebo, HCQ does not significantly reduce the risk of confirmed or clinically suspected SARS-CoV-2 infection, while HCQ significantly increases adverse events. PROSPERO REGISTRATION NUMBER CRD42021285093.
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Affiliation(s)
- Hwanhee Hong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Anne Friedland
- Department of Infectious Disease, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Mengyi Hu
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Kevin J Anstrom
- Collaborative Studies Coordinating Center, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Susan Halabi
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - John E McKinnon
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ravi Amaravadi
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Benjamin S Abella
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - David R Boulware
- Division of Infectious Diseases & International Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Susanna Naggie
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Radha Rajasingham
- Division of Infectious Diseases & International Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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9
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Naggie S, Milstone A, Castro M, Collins SP, Lakshmi S, Anderson DJ, Cahuayme-Zuniga L, Turner KB, Cohen LW, Currier J, Fraulo E, Friedland A, Garg J, George A, Mulder H, Olson RE, O'Brien EC, Rothman RL, Shenkman E, Shostak J, Woods CW, Anstrom KJ, Hernandez AF. Hydroxychloroquine for pre-exposure prophylaxis of COVID-19 in health care workers: a randomized, multicenter, placebo-controlled trial Healthcare Worker Exposure Response and Outcomes of Hydroxychloroquine (HERO-HCQ). Int J Infect Dis 2023; 129:40-48. [PMID: 36682681 PMCID: PMC9851717 DOI: 10.1016/j.ijid.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To determine whether hydroxychloroquine (HCQ) is safe and effective at preventing COVID-19 infections among health care workers (HCWs). METHODS In a 1: 1 randomized, placebo-controlled, double-blind, parallel-group, superiority trial at 34 US clinical centers, 1360 HCWs at risk for COVID-19 infection were enrolled between April and November 2020. Participants were randomized to HCQ or matched placebo. The HCQ dosing included a loading dose of HCQ 600 mg twice on day 1, followed by 400 mg daily for 29 days. The primary outcome was a composite of confirmed or suspected COVID-19 clinical infection by day 30, defined as new-onset fever, cough, or dyspnea and either a positive SARS-CoV-2 polymerase chain reaction test (confirmed) or a lack of confirmatory testing due to local restrictions (suspected). RESULTS Study enrollment closed before full accrual due to recruitment challenges. The primary end point occurred in 41 (6.0%) participants receiving HCQ and 53 (7.8%) participants receiving placebo. No difference in the proportion of participants experiencing clinical infection (estimated difference of -1.8%, 95% confidence interval -4.6-0.9%, P = 0.20) was identified nor any significant safety issues. CONCLUSION Oral HCQ taken as prescribed appeared safe among HCWs. No significant clinical benefits were observed. The study was not powered to detect a small but potentially important reduction in infection. TRIAL REGISTRATION NCT04334148.
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Affiliation(s)
- Susanna Naggie
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | | | - Mario Castro
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sean P Collins
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | - Lauren W Cohen
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Judith Currier
- University of California Los Angeles, Los Angeles, California, USA
| | - Elizabeth Fraulo
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Anne Friedland
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jyotsna Garg
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Anoop George
- Temple University, Philadelphia, Pennsylvania, USA
| | - Hillary Mulder
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Rachel E Olson
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | | | | | - Jack Shostak
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Christopher W Woods
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Kevin J Anstrom
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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10
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Spivak AM, Barney BJ, Greene T, Holubkov R, Olsen CS, Bridges J, Srivastava R, Webb B, Sebahar F, Huffman A, Pacchia CF, Dean JM, Hess R. A Randomized Clinical Trial Testing Hydroxychloroquine for Reduction of SARS-CoV-2 Viral Shedding and Hospitalization in Early Outpatient COVID-19 Infection. Microbiol Spectr 2023; 11:e0467422. [PMID: 36861976 PMCID: PMC10101001 DOI: 10.1128/spectrum.04674-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
Early in the COVID-19 pandemic, no effective treatment existed to prevent clinical worsening of COVID-19 among recently diagnosed outpatients. At the University of Utah, Salt Lake City, Utah, we conducted a phase 2 prospective parallel group randomized placebo-controlled trial (NCT04342169) to determine whether hydroxychloroquine given early in disease reduces the duration of SARS-CoV-2 shedding. We enrolled nonhospitalized adults (≥18 years of age) with a recent positive diagnostic test for SARS-CoV-2 (within 72 h of enrollment) and adult household contacts. Participants received either 400 mg hydroxychloroquine by mouth twice daily on day 1 followed by 200 mg by mouth twice daily on days 2 to 5 or oral placebo with the same schedule. We performed SARS-CoV-2 nucleic acid amplification testing (NAAT) on oropharyngeal swabs on days 1 to 14 and 28 and monitored clinical symptomatology, rates of hospitalization, and viral acquisition by adult household contacts. We identified no overall differences in the duration of oropharyngeal carriage of SARS-CoV-2 (hazard ratio of viral shedding time comparing hydroxychloroquine to placebo, 1.21; 95% confidence interval [CI], 0.91, 1.62). Overall, 28-day hospitalization incidence was similar between treatments (4.6% hydroxychloroquine versus 2.7% placebo). No differences were seen in symptom duration, severity, or viral acquisition in household contacts between treatment groups. The study did not reach the prespecified enrollment target, which was likely influenced by a steep decline in COVID-19 incidence corresponding to the initial vaccine rollout in the spring of 2021. Oropharyngeal swabs were self-collected, which may introduce variability in these results. Placebo treatments were not identical to hydroxychloroquine treatments (capsules versus tablets) which may have led to inadvertent participant unblinding. In this group of community adults early in the COVID-19 pandemic, hydroxychloroquine did not significantly alter the natural history of early COVID-19 disease. (This study has been registered at ClinicalTrials.gov under registration no. NCT04342169). IMPORTANCE Early in the COVID-19 pandemic, no effective treatment existed to prevent clinical worsening of COVID-19 among recently diagnosed outpatients. Hydroxychloroquine received attention as a possible early treatment; however, quality prospective studies were lacking. We conducted a clinical trial to test the ability of hydroxychloroquine to prevent clinical worsening of COVID-19.
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Affiliation(s)
- Adam M. Spivak
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Bradley J. Barney
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Tom Greene
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Cody S. Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jordan Bridges
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Raj Srivastava
- Senior Medical Executive Director, Intermountain Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Brandon Webb
- Division of Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Frances Sebahar
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Ainsley Huffman
- Utah Clinical and Translational Science Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - J. Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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11
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Dhibar DP, Arora N, Chaudhary D, Prakash A, Medhi B, Singla N, Mohindra R, Suri V, Bhalla A, Sharma N, Singh MP, Lakshmi PVM, Goyal K, Ghosh A. The 'myth of Hydroxychloroquine (HCQ) as post-exposure prophylaxis (PEP) for the prevention of COVID-19' is far from reality. Sci Rep 2023; 13:378. [PMID: 36611040 PMCID: PMC9825075 DOI: 10.1038/s41598-022-26053-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023] Open
Abstract
The efficacy of Hydroxychloroquine (HCQ) as post-exposure prophylaxis (PEP) for the prevention of COVID-19 was contentious. In this randomized control double-blind clinical trial, asymptomatic individuals with direct contact with laboratory-confirmed COVID-19 cases were randomized into PEP/HCQ (N = 574) and control/placebo (N = 594) group. The PEP/HCQ group received tablet HCQ 400 mg q 12 hourly on day one followed by 400 mg once weekly for 3 weeks, and the control/Placebo group received matching Placebo. The incidence of COVID-19 was similar (p = 0.761) in PEP [N = 24 out of 574, (4.2%)] and control [N = 27 out of 594, (4.5%)] groups. Total absolute risk reduction for the incidence of new-onset COVID-19 was -0.3% points with an overall relative risk of 0.91 (95% confidence interval, 0.52 to 1.60) and the number needed to treat (NNT) was 333 to prevent the incident of one case of COVID-19. The study found that, PEP with HCQ was not advantageous for the prevention of COVID-19 in asymptomatic individuals with high risk for SARS-CoV-2 infection. Though HCQ is a safer drug, the practice of irrational and indiscriminate use of HCQ for COVID-19 should be restrained with better pharmacovigilance.
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Affiliation(s)
- Deba Prasad Dhibar
- Department of Internal Medicine, PGIMER, Chandigarh, India. .,Department of Internal Medicine, F-Block, Neheru Hospital PGIMER, Chandigarh, 160012, India.
| | - Navneet Arora
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Deepak Chaudhary
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ajay Prakash
- grid.415131.30000 0004 1767 2903Department of Pharmacology, PGIMER, Chandigarh, India
| | - Bikash Medhi
- grid.415131.30000 0004 1767 2903Department of Pharmacology, PGIMER, Chandigarh, India
| | - Neeraj Singla
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ritin Mohindra
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Vikas Suri
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ashish Bhalla
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Navneet Sharma
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Mini P. Singh
- grid.415131.30000 0004 1767 2903Department of Virology, PGIMER, Chandigarh, India
| | - P. V. M. Lakshmi
- grid.415131.30000 0004 1767 2903Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Kapil Goyal
- grid.415131.30000 0004 1767 2903Department of Virology, PGIMER, Chandigarh, India
| | - Arnab Ghosh
- grid.415131.30000 0004 1767 2903Department of Virology, PGIMER, Chandigarh, India
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12
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Zielińska A, Eder P, Karczewski J, Szalata M, Hryhorowicz S, Wielgus K, Szalata M, Dobrowolska A, Atanasov AG, Słomski R, Souto EB. Tocilizumab-coated solid lipid nanoparticles loaded with cannabidiol as a novel drug delivery strategy for treating COVID-19: A review. Front Immunol 2023; 14:1147991. [PMID: 37033914 PMCID: PMC10073701 DOI: 10.3389/fimmu.2023.1147991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Commonly used clinical strategies against coronavirus disease 19 (COVID-19), including the potential role of monoclonal antibodies for site-specific targeted drug delivery, are discussed here. Solid lipid nanoparticles (SLN) tailored with tocilizumab (TCZ) and loading cannabidiol (CBD) are proposed for the treatment of COVID-19 by oral route. TCZ, as a humanized IgG1 monoclonal antibody and an interleukin-6 (IL-6) receptor agonist, can attenuate cytokine storm in patients infected with SARS-CoV-2. CBD (an anti-inflammatory cannabinoid and TCZ agonist) alleviates anxiety, schizophrenia, and depression. CBD, obtained from Cannabis sativa L., is known to modulate gene expression and inflammation and also shows anti-cancer and anti-inflammatory properties. It has also been recognized to modulate angiotensin-converting enzyme II (ACE2) expression in SARS-CoV-2 target tissues. It has already been proven that immunosuppressive drugs targeting the IL-6 receptor may ameliorate lethal inflammatory responses in COVID-19 patients. TCZ, as an immunosuppressive drug, is mainly used to treat rheumatoid arthritis, although several attempts have been made to use it in the active hyperinflammatory phase of COVID-19, with promising outcomes. TCZ is currently administered intravenously. It this review, we discuss the potential advances on the use of SLN for oral administration of TCZ-tailored CBD-loaded SLN, as an innovative platform for managing SARS-CoV-2 and related infections.
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Affiliation(s)
- Aleksandra Zielińska
- Institute of Human Genetics, Polish Academy of Sciences Poznan, Poznan, Poland
- *Correspondence: Aleksandra Zielińska, ; Piotr Eder, ; Eliana B. Souto,
| | - Piotr Eder
- Department of Gastroenterology, Dietetics, and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
- *Correspondence: Aleksandra Zielińska, ; Piotr Eder, ; Eliana B. Souto,
| | - Jacek Karczewski
- Department of Environmental Medicine/Department of Gastroenterology, Human Nutrition and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Marlena Szalata
- Department of Biochemistry and Biotechnology, Poznań University of Life Sciences, Poznań, Poland
| | - Szymon Hryhorowicz
- Institute of Human Genetics, Polish Academy of Sciences Poznan, Poznan, Poland
| | - Karolina Wielgus
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Milena Szalata
- Department of Biotechnology, Institute of Natural Fibres and Medicinal Plants National Research Institute, Poznan, Poland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics, and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Atanas G. Atanasov
- Institute of Genetics and Animal Biotechnology, Magdalenka, Poland
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
- Department of Pharmacognosy, University of Vienna, Vienna, Austria
| | - Ryszard Słomski
- Institute of Human Genetics, Polish Academy of Sciences Poznan, Poznan, Poland
| | - Eliana B. Souto
- UCIBIO – Applied Molecular Biosciences Unit, MEDTECH, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
- *Correspondence: Aleksandra Zielińska, ; Piotr Eder, ; Eliana B. Souto,
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13
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Huang X, Li S, Shi W, Wang Y, Wan X, He J, Xu Y, Zhang W, Shi X, Chen R, Xu L, Zha X, Wang J. A prospective, randomized clinical trial of emergency treatment of chemotherapy-induced neutropenia and febrile neutropenia by pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF). Br J Clin Pharmacol 2023; 89:372-379. [PMID: 36001055 DOI: 10.1111/bcp.15507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS As one of the mainstays of breast cancer therapy, chemotherapy inevitably induces neutropenia. In this study, we explored the role of PEG-rhG-CSF (pegylated recombinant human granulocyte colony-stimulating factor) in the emergency treatment of chemotherapy-induced grades 3-4 neutropenia. METHODS A total of 100 patients with breast cancer were randomized (1:1) into the study. Fifty patients randomized to the experimental group were treated with PEG-rhG-CSF after grades 3-4 neutropenia following the first cycle of chemotherapy, while 50 patients randomized to the control group received a daily injection of rhG-CSF (recombinant human granulocyte colony-stimulating factor). The primary endpoint was the recovery time of grades 3-4 neutropenia. RESULTS Compared with patients in the control group, the mean ± SD recovery time of grades 3-4 neutropenia and febrile neutropenia (FN) was significantly shorter for patients in the experimental group (grades 3-4, P = .000; grade 4, P = .000; FN, P = .038). There is no significant difference in the incidence of FN for the two groups. In the experimental group, the duration of grades 3-4 neutropenia in patients aged <60 years and ≥60 years was 2.15 and 3.20 days, respectively (P = .037). Adverse events (AEs) of any grade were reported in 37 (75.5%) and 28 (59.6%) patients from the two groups, respectively. No grade ≥3 AEs were reported. CONCLUSION This study supported that the PEG-rhG-CSF was more effective and convenient than rhG-CSF for treating grades 3-4 neutropenia and FN in patients with breast cancer and had manageable toxicity.
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Affiliation(s)
- Xiaofeng Huang
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shuo Li
- Department of Burn and Plastic Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Wenjie Shi
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ye Wang
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyu Wan
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinzhi He
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yinggang Xu
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Weiwei Zhang
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoqing Shi
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rui Chen
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lu Xu
- Department of Clinical Nutrition, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoming Zha
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jue Wang
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
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14
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Nasri E, Fakhim H, Salahi M, Ghafel S, Pourajam S, Darakhshandeh A, Kassaian N, Sadeghi S, Ataei B, Javanmard SH, Vaezi A. Efficacy of Hydroxychloroquine in Pre-exposure Severe Acute Respiratory Syndrome Coronavirus 2 Prophylaxis among High-Risk HealthCare Workers: A Multicenter Study. Adv Biomed Res 2023; 12:3. [PMID: 36926426 PMCID: PMC10012028 DOI: 10.4103/abr.abr_104_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 09/10/2021] [Accepted: 10/04/2021] [Indexed: 02/05/2023] Open
Abstract
Background Prophylaxis could be an established strategy to potentially prevent and control infectious diseases and should be considered in the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to assess the effectiveness of hydroxychloroquine as a prophylaxis treatment strategy in the reduction of the risk of COVID-19 among health professionals. Materials and Methods The health professionals were randomly assigned (1:1) to the control group without receiving any hydroxychloroquine as prophylaxis and the hydroxychloroquine group receiving a weekly hydroxychloroquine dose of 400 mg up to 12 weeks. Results A total of 146 health professionals were randomly enrolled in this study between August 11 and November 11 in 2020. Among the screened health professionals, 21 (14.6%) were infected with COVID-19 during the 12 weeks, and 14 (66.6%) out of the 21 health professionals were in the control group. Most participants with COVID-19 had mild symptoms (62%). In addition, 9.5% (n = 2) of the participants suffered from moderate disease and 28.5% were diagnosed with severe symptoms. In the hydroxychloroquine group, 5 (7.1%) and 2 (2.8%) participants were reported with mild and moderate symptoms of COVID-19, respectively, and 2 participants had moderate, 8 (10.9%) participants had mild symptoms, and 6 (8.2%) participants had severe symptoms in the control group, within 3 months. Severe symptoms of COVID-19 were not observed in the hydroxychloroquine group. Conclusion This study addressed the effect and benefit of hydroxychloroquine administration for the prevention of COVID-19 among health professionals. The improved perception of prophylaxis might highlight its important role in future COVID-19 outbreaks to prevent hospital transmission, which is a major route of spread.
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Affiliation(s)
- Elahe Nasri
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Fakhim
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Salahi
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safiyeh Ghafel
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samane Pourajam
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Darakhshandeh
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazila Kassaian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Sadeghi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Afsane Vaezi
- Department of Medical Laboratory Science, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
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15
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Polo R, García-Albéniz X, Terán C, Morales M, Rial-Crestelo D, Garcinuño MA, García Del Toro M, Hita C, Gómez-Sirvent JL, Buzón L, Díaz de Santiago A, Arellano JP, Sanz J, Bachiller P, Alfaro EM, Díaz-Brito V, Masiá M, Hernández-Torres A, Guerra JM, Santos J, Arazo P, Muñoz L, Arribas JR, Martínez de Salazar P, Moreno S, Hernán MA, Del Amo J. Daily tenofovir disoproxil fumarate/emtricitabine and hydroxychloroquine for pre-exposure prophylaxis of COVID-19: a double-blind placebo-controlled randomized trial in healthcare workers. Clin Microbiol Infect 2023; 29:85-93. [PMID: 35940567 PMCID: PMC9352647 DOI: 10.1016/j.cmi.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the effect of hydroxychloroquine (HCQ) and Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as pre-exposure prophylaxis on COVID-19 risk. METHODS EPICOS is a double-blind, placebo-controlled randomized trial conducted in Spain, Bolivia, and Venezuela. Healthcare workers with negative SARS-CoV-2 IgM/IgG test were randomly assigned to the following: daily TDF/FTC plus HCQ for 12 weeks, TDF/FTC plus HCQ placebo, HCQ plus TDF/FTC placebo, and TDF/FTC placebo plus HCQ placebo. Randomization was performed in groups of four. Primary outcome was laboratory-confirmed, symptomatic COVID-19. We also studied any (symptomatic or asymptomatic) COVID-19. We compared group-specific 14-week risks via differences and ratios with 95% CIs. RESULTS Of 1002 individuals screened, 926 (92.4%) were eligible and there were 14 cases of symptomatic COVID-19: 220 were assigned to the TDF/FTC plus HCQ group (3 cases), 231 to the TDF/FTC placebo plus HCQ group (3 cases), 233 to the TDF/FTC plus HCQ placebo group (3 cases), and 223 to the double placebo group (5 cases). Compared with the double placebo group, 14-week risk ratios (95% CI) of symptomatic COVID-19 were 0.39 (0.00-1.98) for TDF + HCQ, 0.34 (0.00-2.06) for TDF, and 0.49 (0.00-2.29) for HCQ. Corresponding risk ratios of any COVID-19 were 0.51 (0.21-1.00) for TDF + HCQ, 0.81 (0.44-1.49) for TDF, and 0.73 (0.41-1.38) for HCQ. Adverse events were generally mild. DISCUSSION The target sample size was not met. Our findings are compatible with both benefit and harm of pre-exposure prophylaxis with TDF/FTC and HCQ, alone or in combination, compared with placebo.
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Affiliation(s)
- Rosa Polo
- Division for HIV, STI, Viral Hepatitis and TB Control, Ministry of Health, Madrid, Spain
| | - Xabier García-Albéniz
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA; RTI Health Solutions, Barcelona, Spain
| | - Carolina Terán
- Facultad de Medicina Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Hospital Santa Bárbara, Sucre, Bolivia
| | | | - David Rial-Crestelo
- Hospital Doce de Octubre, Madrid, Spain; CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain
| | | | | | | | | | - Luis Buzón
- Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Jesus Sanz
- CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain; Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | - Mar Masiá
- CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain; Hospital General Universitario de Elche, Alicante, Spain
| | | | | | - Jesús Santos
- Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain
| | - Piedad Arazo
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Leopoldo Muñoz
- Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Jose Ramon Arribas
- CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain; Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Pablo Martínez de Salazar
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Santiago Moreno
- CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Miguel A Hernán
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julia Del Amo
- Division for HIV, STI, Viral Hepatitis and TB Control, Ministry of Health, Madrid, Spain; CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain.
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16
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Gentry CA, Thind SK, Williams RJ, Hendrickson SC, Kurdgelashvili G, Humphrey MB. Development of SARS-CoV-2 infection in patients with rheumatic conditions on hydroxychloroquine monotherapy vs. patients without rheumatic conditions: A retrospective, propensity-matched cohort study. Am J Med Sci 2023; 365:19-25. [PMID: 36103912 PMCID: PMC9464360 DOI: 10.1016/j.amjms.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/25/2022] [Accepted: 08/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The primary purpose of the current study was to examine whether patients with rheumatologic conditions receiving only chronic hydroxychloroquine therapy for their disease are at less risk of developing SARS-CoV-2 infection than a comparative group of patients without rheumatologic conditions. METHODS A retrospective, observational, nationwide stratified propensity analysis was conducted comparing patients only on chronic treatment with hydroxychloroquine for their rheumatologic condition to a random sample of patients without rheumatologic conditions and not receiving hydroxychloroquine, utilizing a Veterans Health Administration nationwide clinical administrative database. RESULTS The 1-to-1 stratified propensity analysis was undertaken using a random sample of patients without rheumatoid conditions and not receiving hydroxychloroquine (n 33,081) and patients with rheumatoid conditions receiving hydroxychloroquine as the lone medication for their condition (n 6047). A total of 5,474 patients in each group were successfully matched. The incidence of documented SARS-CoV-2 infections during the study period did not differ between patients receiving hydroxychloroquine and patients not receiving hydroxychloroquine (41/5,474 [0.749%] vs. 36/5,474 [0.658%], respectively, p = 0.57; Odds ratio [OR] 1.14, 95% confidence interval [CI] 0.73-1.79). There were no statistically-significant differences in secondary outcomes between the two groups in patients who developed active SARS-CoV-2 infection. Multivariate logistic regression to determine independent variables associated with the development of active SARS-CoV-2 infection failed to include receipt of hydroxychloroquine (OR 0.99, 95% CI 0.62-1.56). CONCLUSIONS Hydroxychloroquine failed to demonstrate a preventative effect against SARS-CoV-2 infection in a large group of patients with rheumatologic conditions compared to patients without rheumatologic conditions.
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Affiliation(s)
- Chris A. Gentry
- Pharmacy Service, Oklahoma City Veterans Affairs Healthcare System, Oklahoma City, OK, United States,Corresponding author. Chris A. Gentry, Pharm.D., BCPS, Chief, Pharmacy Service, Oklahoma City Veterans Affairs Healthcare System, 921 Northeast 13th Street (119), Oklahoma City, Oklahoma 73104
| | - Sharanjeet K. Thind
- Section of Infectious Diseases, Department of Medicine, University of Oklahoma Health Sciences Center and Section of Infectious Diseases, Medical Service, Oklahoma City Veterans Affairs Healthcare System, Oklahoma City, OK, United States
| | - Riley J. Williams
- Pharmacy Service, Oklahoma City Veterans Affairs Healthcare System, Oklahoma City, OK, United States
| | - Sage C. Hendrickson
- Pharmacy Service, Oklahoma City Veterans Affairs Healthcare System, Oklahoma City, OK, United States
| | - George Kurdgelashvili
- Section of Infectious Diseases, Department of Medicine, University of Oklahoma Health Sciences Center and Section of Infectious Diseases, Medical Service, Oklahoma City Veterans Affairs Healthcare System, Oklahoma City, OK, United States
| | - Mary Beth Humphrey
- Section of Rheumatology/Immunology, Department of Medicine, University of Oklahoma Health Sciences Center and Section of Rheumatology/Immunology, Medical Service, Oklahoma City Veterans Affairs Healthcare System, Oklahoma City, OK, United States
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Gönenli MG, Kayı İ, Alpay-Kanıtez N, Baydaş T, Köse M, Nalbantoğlu EA, Keskinler MV, Akpınar TS, Ergönül Ö. Analysis of the Prophylactic use of Hydroxychloroquine at the Beginning of the COVID-19 Pandemic Among Physicians. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:236-243. [PMID: 38633712 PMCID: PMC10986685 DOI: 10.36519/idcm.2022.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 11/22/2022] [Indexed: 04/19/2024]
Abstract
Objective Throughout the pandemic, physicians working at the frontlines have embarked on various quests to protect themselves, and many physicians preferred using hydroxychloroquine (HQN) as a prophylactic agent. This study aimed to investigate the reasons leading physicians to use HQN and its effects on them. Materials and Methods This study is cross-sectional with a target population of physicians working in pandemic hospitals in İstanbul, Turkey. We invited participants from seven hospitals via email between May 14 and June 13, 2020. An online questionnaire, including 57 questions, was sent to physicians. Results A total of 148 (26%) physicians out of 564 participants had used hydroxychloroquine for prevention. Older physicians and those with a history of exposure to COVID-19 patients without protection used prophylactic HQN more frequently. The use of HQN did not differ statistically in terms of being infected among the exposed physicians (p=0.52). Nineteen (13%) physicians using HQN developed side effects related to the drug. Diarrhea and nausea were the most common. Conclusion Prophylactic HQN use was more common among physicians older than 40 years and with higher exposure rates to a COVID-19 patient without protection. The physicians working on the front line had the highest rate of infection. HQN was not effective in the prophylaxis of COVID-19 among the exposed physicians.
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Affiliation(s)
| | - İlker Kayı
- Department of Public Health, Koç University Hospital, İstanbul, Turkey
| | | | - Tuba Baydaş
- Department of Internal Medicine, Bezmialem University Hospital, İstanbul, Turkey
| | - Murat Köse
- Department of Internal Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | | | - Miraç Vural Keskinler
- Department of Internal Medicine, Istanbul Medeniyet University, Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Timur Selçuk Akpınar
- Department of Internal Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Önder Ergönül
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
- Koç University İşbank Center for Infectious Diseases, Istanbul, Turkey
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Sturmberg J, Paul E, Van Damme W, Ridde V, Brown GW, Kalk A. The danger of the single storyline obfuscating the complexities of managing SARS-CoV-2/COVID-19. J Eval Clin Pract 2022; 28:1173-1186. [PMID: 34825442 DOI: 10.1111/jep.13640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Abstract
Chimamanda Ngozi Adichie showed how a single story is limited and thereby distorts the true nature of an issue. During this COVID-19 pandemic there have been, at least, three consecutive single stories-the 'lethal threat' story, followed by the 'economic threat' story, and finally the 'vaccine miracle' story. None of these single stories can convincingly and permanently capture the dynamics of the pandemic. This is because countries experienced different morbidity and mortality patterns, different socioeconomic disadvantage, age and vulnerability of population, timing and level of lockdown with economic variability, and, despite heavy promotion, vaccines were beset with a significant and variable degree of hesitancy. Lack of transparency, coherence and consistency of pandemic management-arising from holding on to single storylines-showed the global deficiency of public health policy and planning, an underfunding of (public) health and social services, and a growing distrust in governments' ability to manage crises effectively. Indeed, the global management has increased already large inequities, and little has been learnt to address the growing crises of more infectious and potentially more lethal virus mutations. Holding onto single stories prevents the necessary learnings to understand and manage the complexities of 'wicked' problems, whereas listening to the many stories provides insights and pathways to do so effectively as well as efficiently.
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Affiliation(s)
- Joachim Sturmberg
- Discipline of General Practice, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Foundation President-International Society for Systems and Complexity Sciences for Health
| | - Elisabeth Paul
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Valery Ridde
- CEPED, Institute for Research on Sustainable Development (IRD), ERL INSERM SAGESUD, IRD-Université de Paris, Paris, France
| | - Garrett W Brown
- Colead-Global Health, School of Politics and International Studies (POLIS), University of Leeds, Leeds, UK
| | - Andreas Kalk
- Kinshasa Country Office, Deutsche Gesellschaft für Internationale Zusammenarbeit, Kinshasa, Democratic Republic of the Congo
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19
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Niemann B, Puleo A, Stout C, Markel J, Boone BA. Biologic Functions of Hydroxychloroquine in Disease: From COVID-19 to Cancer. Pharmaceutics 2022; 14:pharmaceutics14122551. [PMID: 36559044 PMCID: PMC9787624 DOI: 10.3390/pharmaceutics14122551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022] Open
Abstract
Chloroquine (CQ) and Hydroxychloroquine (HCQ), initially utilized in the treatment of malaria, have now developed a long list of applications. Despite their clinical relevance, their mechanisms of action are not clearly defined. Major pathways by which these agents are proposed to function include alkalinization of lysosomes and endosomes, downregulation of C-X-C chemokine receptor type 4 (CXCR4) expression, high-mobility group box 1 protein (HMGB1) inhibition, alteration of intracellular calcium, and prevention of thrombus formation. However, there is conflicting data present in the literature. This is likely the result of the complex overlapping pathways between these mechanisms of action that have not previously been highlighted. In fact, prior research has focused on very specific portions of particular pathways without describing these in the context of the extensive CQ/HCQ literature. This review summarizes the detailed data regarding CQ/HCQ's mechanisms of action while also providing insight into the overarching themes. Furthermore, this review provides clinical context to the application of these diverse drugs including their role in malaria, autoimmune disorders, cardiovascular disease, thrombus formation, malignancies, and viral infections.
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Affiliation(s)
- Britney Niemann
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA
- Correspondence: ; Tel.: +1-304-293-1254
| | - Amanda Puleo
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA
| | - Conley Stout
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA
| | - Justin Markel
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA
| | - Brian A. Boone
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA
- Department of Microbiology, Immunology and Cell Biology, West Virginia University, Morgantown, WV 26506, USA
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20
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Bepouka B, Bandubuila Kaja P, Situakibanza H. Treatment and case fatality rate of COVID-19 in Africa. J Public Health Afr 2022; 13:1931. [DOI: 10.4081/jphia.2022.1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
In Africa, the treatment of COVID-19 depends on each country. Several protocols are observed with real results that we described in this study. The objective of this review was to describe the treatment of COVID-19 and the case fatality rate in African countries, by reviewing the literature on treatment and case fatality in African countries whose data was available through the internet during the writing period until February 7, 2021. The majority of African countries had a treatment based on hydroxychloroquine or chloroquine + azithromycin, used in varying doses depending on the country. The lethality in Africa remains low compared to European and American countries. The same treatment being used in some northern countries does not fully explain the low case fatality.
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21
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White H, McDonald SJ, Barber B, Davis J, Burr L, Nair P, Mukherjee S, Tendal B, Elliott J, McGloughlin S, Turner T. Care for adults with
COVID
‐19: living guidelines from the National
COVID
‐19 Clinical Evidence Taskforce. Med J Aust 2022; 217:368-378. [PMID: 36150213 PMCID: PMC9538623 DOI: 10.5694/mja2.51718] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022]
Abstract
Introduction The Australian National COVID‐19 Clinical Evidence Taskforce was established in March 2020 to maintain up‐to‐date recommendations for the treatment of people with coronavirus disease 2019 (COVID‐19). The original guideline (April 2020) has been continuously updated and expanded from nine to 176 recommendations, facilitated by the rapid identification, appraisal, and analysis of clinical trial findings and subsequent review by expert panels. Main recommendations In this article, we describe the recommendations for treating non‐pregnant adults with COVID‐19, as current on 1 August 2022 (version 61.0). The Taskforce has made specific recommendations for adults with severe/critical or mild disease, including definitions of disease severity, recommendations for therapy, COVID‐19 prophylaxis, respiratory support, and supportive care. Changes in management as a result of the guideline The Taskforce currently recommends eight drug treatments for people with COVID‐19 who do not require supplemental oxygen (inhaled corticosteroids, casirivimab/imdevimab, molnupiravir, nirmatrelvir/ritonavir, regdanvimab, remdesivir, sotrovimab, tixagevimab/cilgavimab) and six for those who require supplemental oxygen (systemic corticosteroids, remdesivir, tocilizumab, sarilumab, baricitinib, casirivimab/imdevimab). Based on evidence of their achieving no or only limited benefit, ten drug treatments or treatment combinations are not recommended; an additional 42 drug treatments should only be used in the context of randomised trials. Additional recommendations include support for the use of continuous positive airway pressure, prone positioning, and endotracheal intubation in patients whose condition is deteriorating, and prophylactic anticoagulation for preventing venous thromboembolism. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- Heath White
- Cochrane Australia Monash University Melbourne VIC
| | | | | | - Joshua Davis
- John Hunter Hospital Newcastle NSW
- The University of Newcastle Newcastle NSW
| | - Lucy Burr
- Mater Hospital Brisbane Brisbane QLD
- Mater Research Institute University of Queensland Brisbane QLD
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22
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Di Stefano L, Ogburn EL, Ram M, Scharfstein DO, Li T, Khanal P, Baksh SN, McBee N, Gruber J, Gildea MR, Clark MR, Goldenberg NA, Bennani Y, Brown SM, Buckel WR, Clement ME, Mulligan MJ, O’Halloran JA, Rauseo AM, Self WH, Semler MW, Seto T, Stout JE, Ulrich RJ, Victory J, Bierer BE, Hanley DF, Freilich D. Hydroxychloroquine/chloroquine for the treatment of hospitalized patients with COVID-19: An individual participant data meta-analysis. PLoS One 2022; 17:e0273526. [PMID: 36173983 PMCID: PMC9521809 DOI: 10.1371/journal.pone.0273526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Results from observational studies and randomized clinical trials (RCTs) have led to the consensus that hydroxychloroquine (HCQ) and chloroquine (CQ) are not effective for COVID-19 prevention or treatment. Pooling individual participant data, including unanalyzed data from trials terminated early, enables more detailed investigation of the efficacy and safety of HCQ/CQ among subgroups of hospitalized patients. METHODS We searched ClinicalTrials.gov in May and June 2020 for US-based RCTs evaluating HCQ/CQ in hospitalized COVID-19 patients in which the outcomes defined in this study were recorded or could be extrapolated. The primary outcome was a 7-point ordinal scale measured between day 28 and 35 post enrollment; comparisons used proportional odds ratios. Harmonized de-identified data were collected via a common template spreadsheet sent to each principal investigator. The data were analyzed by fitting a prespecified Bayesian ordinal regression model and standardizing the resulting predictions. RESULTS Eight of 19 trials met eligibility criteria and agreed to participate. Patient-level data were available from 770 participants (412 HCQ/CQ vs 358 control). Baseline characteristics were similar between groups. We did not find evidence of a difference in COVID-19 ordinal scores between days 28 and 35 post-enrollment in the pooled patient population (odds ratio, 0.97; 95% credible interval, 0.76-1.24; higher favors HCQ/CQ), and found no convincing evidence of meaningful treatment effect heterogeneity among prespecified subgroups. Adverse event and serious adverse event rates were numerically higher with HCQ/CQ vs control (0.39 vs 0.29 and 0.13 vs 0.09 per patient, respectively). CONCLUSIONS The findings of this individual participant data meta-analysis reinforce those of individual RCTs that HCQ/CQ is not efficacious for treatment of COVID-19 in hospitalized patients.
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Affiliation(s)
- Leon Di Stefano
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth L. Ogburn
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Daniel O. Scharfstein
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Tianjing Li
- University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado, United States of America
| | - Preeti Khanal
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Sheriza N. Baksh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nichol McBee
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Joshua Gruber
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Marianne R. Gildea
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Megan R. Clark
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Neil A. Goldenberg
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins All Children’s Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, United States of America
| | - Yussef Bennani
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- University Medical Center, New Orleans, New Orleans, Louisiana, United States of America
| | - Samuel M. Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States of America
- University of Utah, Salt Lake City, Utah, United States of America
| | - Whitney R. Buckel
- Pharmacy Services, Intermountain Healthcare, Murray, Utah, United States of America
| | - Meredith E. Clement
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- University Medical Center, New Orleans, New Orleans, Louisiana, United States of America
| | - Mark J. Mulligan
- Department of Medicine, Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York, United States of America
- Vaccine Center, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jane A. O’Halloran
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, United States of America
| | - Adriana M. Rauseo
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, United States of America
| | - Wesley H. Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Matthew W. Semler
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Todd Seto
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Jason E. Stout
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Robert J. Ulrich
- Department of Medicine, Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jennifer Victory
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, United States of America
| | - Barbara E. Bierer
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Daniel Freilich
- Department of Internal Medicine, Division of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, United States of America
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Characteristics of SARS-CoV-2 Infection in an Actively Monitored Cohort of Patients with Lupus Nephritis. Biomedicines 2022; 10:biomedicines10102423. [PMID: 36289685 PMCID: PMC9599215 DOI: 10.3390/biomedicines10102423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: We sought to investigate the impact of the COVID-19 pandemic in patients with lupus nephritis (LN); (2) Methods: A total of 95 patients with LN actively monitored in our department between 26 February 2020, when the first case of COVID-19 was diagnosed in Romania, and 1 May 2021, were included in the study. Multivariate logistic regression analysis was performed to identify the independent risk factors for SARS-CoV-2 infection; (3) Results: A total of 15 patients (15.8%) had a confirmed SARS-CoV-2 infection during a total follow-up time of 105.9 patient-years (unadjusted incidence rate: 14.28 SARS-CoV-2 infections per 100 patient-years). Median time to SARS-CoV-2 infection was 9.3 months (IQR: 7.2–11.3). The majority of patients had a mild form of SARS-CoV-2 infection (73.3%), while the remaining had moderate forms. None of the patients had a severe infection or a SARS-CoV-2-related death. The most frequent symptom was fatigue (73.3%), followed by loss of taste/smell (53.3%) and fever (46.7%). Forty percent of those with SARS-CoV-2 infection were hospitalized for a median 11.5 days (IQR:3.75–14). In the multivariate logistic regression analysis, a current oral corticosteroid dose ≥ 15 mg/day was associated with a 7.69-fold higher risk (OR, 7.69; 95%, 1.3–45.46), while the use of hydroxychloroquine was associated with a 91% lower risk for a SARS-CoV-2 infection (OR, 0.09; 95%CI, 0.01–0.59). (4) Conclusions: Our study confirms that the SARS-CoV-2 infection-associated morbidity might only be moderately increased in patients with LN. The current oral corticosteroid dose was the only independent predictor of infection occurrence, while use of hydroxychloroquine was associated with a protective effect.
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Identification of Suitable Drug Combinations for Treating COVID-19 Using a Novel Machine Learning Approach: The RAIN Method. Life (Basel) 2022; 12:life12091456. [PMID: 36143492 PMCID: PMC9505329 DOI: 10.3390/life12091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary This study follows an improved approach to systematic reviews, called the Systematic Review and Artificial Intelligence Network Meta-Analysis (RAIN), registered within PROSPERO (CRD42021256797), in which, the PRISMA criterion is still considered. Drugs used in the treatment of COVID-19 were searched in the databases of ScienceDirect, Web of Science (WoS), ProQuest, Embase, Medline (PubMed), and Scopus. In addition, using artificial intelligence and the measurement of the p-value between human genes affected by COVID-19 and drugs that have been suggested by clinical experts, and reported within the identified research papers, suitable drug combinations are proposed for the treatment of COVID-19. During the systematic review process, 39 studies were selected. Our analysis shows that most of the reported drugs, such as azithromycin and hydroxyl-chloroquine on their own, do not have much of an effect on the recovery of COVID-19 patients. Based on the result of the new artificial intelligence, on the other hand, at a significance level of less than 0.05, the combination of the two drugs therapeutic corticosteroid + camostat with a significance level of 0.02, remdesivir + azithromycin with a significance level of 0.03, and interleukin 1 receptor antagonist protein + camostat with a significance level 0.02 are considered far more effective for the treatment of COVID-19 and are therefore recommended. Abstract COVID-19 affects several human genes, each with its own p-value. The combination of drugs associated with these genes with small p-values may lead to an estimation of the combined p-value between COVID-19 and some drug combinations, thereby increasing the effectiveness of these combinations in defeating the disease. Based on human genes, we introduced a new machine learning method that offers an effective drug combination with low combined p-values between them and COVID-19. This study follows an improved approach to systematic reviews, called the Systematic Review and Artificial Intelligence Network Meta-Analysis (RAIN), registered within PROSPERO (CRD42021256797), in which, the PRISMA criterion is still considered. Drugs used in the treatment of COVID-19 were searched in the databases of ScienceDirect, Web of Science (WoS), ProQuest, Embase, Medline (PubMed), and Scopus. In addition, using artificial intelligence and the measurement of the p-value between human genes affected by COVID-19 and drugs that have been suggested by clinical experts, and reported within the identified research papers, suitable drug combinations are proposed for the treatment of COVID-19. During the systematic review process, 39 studies were selected. Our analysis shows that most of the reported drugs, such as azithromycin and hydroxyl-chloroquine on their own, do not have much of an effect on the recovery of COVID-19 patients. Based on the result of the new artificial intelligence, on the other hand, at a significance level of less than 0.05, the combination of the two drugs therapeutic corticosteroid + camostat with a significance level of 0.02, remdesivir + azithromycin with a significance level of 0.03, and interleukin 1 receptor antagonist protein + camostat with a significance level 0.02 are considered far more effective for the treatment of COVID-19 and are therefore recommended. Additionally, at a significance level of less than 0.01, the combination of interleukin 1 receptor antagonist protein + camostat + azithromycin + tocilizumab + oseltamivir with a significance level of 0.006, and the combination of interleukin 1 receptor antagonist protein + camostat + chloroquine + favipiravir + tocilizumab7 with corticosteroid + camostat + oseltamivir + remdesivir + tocilizumab at a significant level of 0.009 are effective in the treatment of patients with COVID-19 and are also recommended. The results of this study provide sets of effective drug combinations for the treatment of patients with COVID-19. In addition, the new artificial intelligence used in the RAIN method could provide a forward-looking approach to clinical trial studies, which could also be used effectively in the treatment of diseases such as cancer.
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Drapkina OM, Yavelov IS. Evolution of Approaches to Therapeutic Prevention and Treatment of the New Coronavirus Infection. HERALD OF THE RUSSIAN ACADEMY OF SCIENCES 2022; 92:430-436. [PMID: 36091845 PMCID: PMC9447967 DOI: 10.1134/s1019331622040049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 06/15/2023]
Abstract
The means of drug intervention for the prevention and treatment of new coronavirus infection (COVID-19) are discussed. Changes in approaches aimed at the main links of pathogenesis and capable of positively influencing the course and outcome of the disease that have been implemented after the appearance of the results of numerous randomized trials are presented. Some aspects of the ongoing study of the problem are characterized.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Health of Russia, Moscow, Russia
| | - I. S. Yavelov
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Health of Russia, Moscow, Russia
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Di Stefano L, Ogburn EL, Ram M, Scharfstein DO, Li T, Khanal P, Baksh SN, McBee N, Gruber J, Gildea MR, Clark MR, Goldenberg NA, Bennani Y, Brown SM, Buckel WR, Clement ME, Mulligan MJ, O’Halloran JA, Rauseo AM, Self WH, Semler MW, Seto T, Stout JE, Ulrich RJ, Victory J, Bierer BE, Hanley DF, Freilich D. Hydroxychloroquine/chloroquine for the treatment of hospitalized patients with COVID-19: An individual participant data meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.01.10.22269008. [PMID: 35043124 PMCID: PMC8764733 DOI: 10.1101/2022.01.10.22269008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Results from observational studies and randomized clinical trials (RCTs) have led to the consensus that hydroxychloroquine (HCQ) and chloroquine (CQ) are not effective for COVID-19 prevention or treatment. Pooling individual participant data, including unanalyzed data from trials terminated early, enables more detailed investigation of the efficacy and safety of HCQ/CQ among subgroups of hospitalized patients. Methods We searched ClinicalTrials.gov in May and June 2020 for US-based RCTs evaluating HCQ/CQ in hospitalized COVID-19 patients in which the outcomes defined in this study were recorded or could be extrapolated. The primary outcome was a 7-point ordinal scale measured between day 28 and 35 post enrollment; comparisons used proportional odds ratios. Harmonized de-identified data were collected via a common template spreadsheet sent to each principal investigator. The data were analyzed by fitting a prespecified Bayesian ordinal regression model and standardizing the resulting predictions. Results Eight of 19 trials met eligibility criteria and agreed to participate. Patient-level data were available from 770 participants (412 HCQ/CQ vs 358 control). Baseline characteristics were similar between groups. We did not find evidence of a difference in COVID-19 ordinal scores between days 28 and 35 post-enrollment in the pooled patient population (odds ratio, 0.97; 95% credible interval, 0.76-1.24; higher favors HCQ/CQ), and found no convincing evidence of meaningful treatment effect heterogeneity among prespecified subgroups. Adverse event and serious adverse event rates were numerically higher with HCQ/CQ vs control (0.39 vs 0.29 and 0.13 vs 0.09 per patient, respectively). Conclusions The findings of this individual participant data meta-analysis reinforce those of individual RCTs that HCQ/CQ is not efficacious for treatment of COVID-19 in hospitalized patients.
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Affiliation(s)
- Leon Di Stefano
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth L. Ogburn
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel O. Scharfstein
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Tianjing Li
- University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Preeti Khanal
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sheriza N. Baksh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nichol McBee
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joshua Gruber
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Marianne R. Gildea
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland
- Current address: FHI 360, Durham, North Carolina
| | - Megan R. Clark
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Neil A. Goldenberg
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins All Children’s Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Yussef Bennani
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
- University Medical Center, New Orleans, New Orleans, Louisiana
| | - Samuel M. Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
- University of Utah, Salt Lake City, Utah
| | | | - Meredith E. Clement
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
- University Medical Center, New Orleans, New Orleans, Louisiana
| | - Mark J. Mulligan
- Department of Medicine, Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York
- Vaccine Center, New York University Grossman School of Medicine, New York, New York
| | - Jane A. O’Halloran
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Adriana M. Rauseo
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Wesley H. Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew W. Semler
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Seto
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Jason E. Stout
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | - Robert J. Ulrich
- Department of Medicine, Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York
| | - Jennifer Victory
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
| | - Barbara E. Bierer
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Daniel Freilich
- Department of Internal Medicine, Division of Infectious Diseases, Bassett Medical Center, Cooperstown, New York
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Solid Organ Rejection following SARS-CoV-2 Vaccination or COVID-19 Infection: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10081289. [PMID: 36016180 PMCID: PMC9412452 DOI: 10.3390/vaccines10081289] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection is extremely rare but can occur. T-cell recognition of antigen is the primary and central event that leads to the cascade of events that result in rejection of a transplanted organ. Objectives: To describe the results of a systematic review for solid organ rejections following SARS-CoV-2 vaccination or COVID-19 infection. Methods: For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines for studies on the incidence of solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection, published from 1 December 2019 to 31 May 2022, with English language restriction. Results: One hundred thirty-six cases from fifty-two articles were included in the qualitative synthesis of this systematic review (56 solid organs rejected post-SARS-CoV-2 vaccination and 40 solid organs rejected following COVID-19 infection). Cornea rejection (44 cases) was the most frequent organ observed post-SARS-CoV-2 vaccination and following COVID-19 infection, followed by kidney rejection (36 cases), liver rejection (12 cases), lung rejection (2 cases), heart rejection (1 case) and pancreas rejection (1 case). The median or mean patient age ranged from 23 to 94 years across the studies. The majority of the patients were male (n = 51, 53.1%) and were of White (Caucasian) (n = 51, 53.7%) and Hispanic (n = 15, 15.8%) ethnicity. A total of fifty-six solid organ rejections were reported post-SARS-CoV-2 vaccination [Pfizer-BioNTech (n = 31), Moderna (n = 14), Oxford Uni-AstraZeneca (n = 10) and Sinovac-CoronaVac (n = 1)]. The median time from SARS-CoV-2 vaccination to organ rejection was 13.5 h (IQR, 3.2–17.2), while the median time from COVID-19 infection to organ rejection was 14 h (IQR, 5–21). Most patients were easily treated without any serious complications, recovered and did not require long-term allograft rejection therapy [graft success (n = 70, 85.4%), graft failure (n = 12, 14.6%), survived (n = 90, 95.7%) and died (n = 4, 4.3%)]. Conclusion: The reported evidence of solid organ rejections post-SARS-CoV-2 vaccination or COIVD-19 infection should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively small in relation to the hundreds of millions of vaccinations that have occurred, and the protective benefits offered by SARS-CoV-2 vaccination far outweigh the risks.
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Systematic review and meta-analysis of randomized trials of hydroxychloroquine for the prevention of COVID-19. Eur J Epidemiol 2022; 37:789-796. [PMID: 35943669 PMCID: PMC9360718 DOI: 10.1007/s10654-022-00891-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
Background Recruitment into randomized trials of hydroxychloroquine (HCQ) for prevention of COVID-19 has been adversely affected by a widespread conviction that HCQ is not effective for prevention. In the absence of an updated systematic review, we conducted a meta-analysis of randomized trials that study the effectiveness of HCQ to prevent COVID-19. Methods A search of PubMed, medRxiv, and clinicaltrials.gov combined with expert consultation found 11 completed randomized trials: 7 pre-exposure prophylaxis trials and 4 post-exposure prophylaxis trials. We obtained or calculated the risk ratio of COVID-19 diagnosis for assignment to HCQ versus no HCQ (either placebo or usual care) for each trial, and then pooled the risk ratio estimates. Results The pooled risk ratio estimate of the pre-exposure prophylaxis trials was 0.72 (95% CI: 0.58–0.90) when using either a fixed effect or a standard random effects approach, and 0.72 (95% CI: 0.55–0.95) when using a conservative modification of the Hartung-Knapp random effects approach. The corresponding estimates for the post-exposure prophylaxis trials were 0.91 (95% CI: 0.72–1.16) and 0.91 (95% CI: 0.62–1.35). All trials found a similar rate of serious adverse effects in the HCQ and no HCQ groups. Discussion A benefit of HCQ as prophylaxis for COVID-19 cannot be ruled out based on the available evidence from randomized trials. However, the “not statistically significant” findings from early prophylaxis trials were widely interpreted as definite evidence of lack of effectiveness of HCQ. This interpretation disrupted the timely completion of the remaining trials and thus the generation of precise estimates for pandemic management before the development of vaccines.
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He W, Gao Y, Zhou J, Shi Y, Xia D, Shen HM. Friend or Foe? Implication of the autophagy-lysosome pathway in SARS-CoV-2 infection and COVID-19. Int J Biol Sci 2022; 18:4690-4703. [PMID: 35874956 PMCID: PMC9305279 DOI: 10.7150/ijbs.72544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/24/2022] [Indexed: 12/14/2022] Open
Abstract
There is increasing amount of evidence indicating the close interplays between the replication cycle of SARS-CoV-2 and the autophagy-lysosome pathway in the host cells. While autophagy machinery is known to either assist or inhibit the viral replication process, the reciprocal effects of the SARS-CoV-2 on the autophagy-lysosome pathway have also been increasingly appreciated. More importantly, despite the disappointing results from the clinical trials of chloroquine and hydroxychloroquine in treatment of COVID-19, there is still ongoing effort in discovering new therapeutics targeting the autophagy-lysosome pathway. In this review, we provide an update-to-date summary of the interplays between the autophagy-lysosome pathway in the host cells and the pathogen SARS-CoV-2 at the molecular level, to highlight the prognostic value of autophagy markers in COVID-19 patients and to discuss the potential of developing novel therapeutic strategies for COVID-19 by targeting the autophagy-lysosome pathway. Thus, understanding the nature of such interactions between SARS-CoV-2 and the autophagy-lysosome pathway in the host cells is expected to provide novel strategies in battling against this global pandemic.
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Affiliation(s)
- Weifeng He
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yuan Gao
- Faculty of Health Sciences, University of Macau, Macau, China.,Chinese Academy of Sciences Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, 100101 Beijing, China
| | - Jing Zhou
- Department of Physiology, School of Preclinical Medicine, Guangxi Medical University, Nanning, Guangxi Province, China
| | - Yi Shi
- Chinese Academy of Sciences Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, 100101 Beijing, China
| | - Dajing Xia
- Department of Toxicology of School of Public Health, Department of Gynecologic Oncology of Women's Hospital; Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Han-Ming Shen
- Faculty of Health Sciences, University of Macau, Macau, China
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30
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Khan N, Afghah Z, Baral A, Geiger JD, Chen X. Dimethoxycurcumin Acidifies Endolysosomes and Inhibits SARS-CoV-2 Entry. FRONTIERS IN VIROLOGY 2022. [DOI: 10.3389/fviro.2022.923018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) caused by infection by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) continues to take a huge toll on global health. Although improving, currently there are only limited therapies against SARS-CoV-2. Curcumin, a natural polyphenol, exerts antiviral effects against a wide variety of viruses and can inhibit SARS-CoV-2 entry. However, undesirable physicochemical and pharmacokinetic properties of curcumin limit its clinical application. Here, we determined the effects of dimethoxycurcumin (DiMC), a methylated analog of curcumin with improved bioavailability, on the entry of SARS-CoV-2. DiMC blocked entry of pseudo-SARS-CoV-2 into Calu-3 human non-small cell lung adenocarcinoma cells and Vero E6 green monkey kidney epithelial cells. Mechanistically, DiMC acidified lysosomes, enhanced lysosome degradation capabilities, and promoted lysosome degradation of angiotensin converting enzyme 2 (ACE2), a major receptor for SARS-CoV-2 entry, as well as pseudo-SARS-CoV-2 and the SARS-CoV-2 S1 protein. Furthermore, other lysosome acidifying agents, including the TRPML1 agonist ML-SA1 and the BK channel activator NS1619, also blocked the entry of pseudo-SARS-CoV-2. Thus, the anti-SARS-CoV-2 potential of DiMC and lysosome acidifying agents might be explored further as possible effective therapeutic strategies against COVID-19.
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31
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Schaffer AL, Henry D, Zoega H, Elliott JH, Pearson SA. Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia. PLoS One 2022; 17:e0269482. [PMID: 35704621 PMCID: PMC9200317 DOI: 10.1371/journal.pone.0269482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Since COVID-19 was first recognised, there has been ever-changing evidence and misinformation around effective use of medicines. Understanding how pandemics impact on medicine use can help policymakers act quickly to prevent harm. We quantified changes in dispensing of common medicines proposed for “re-purposing” due to their perceived benefits as therapeutic or preventive for COVID-19 in Australia. Methods We performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidized medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analog). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models and compared characteristics of initiators in 2020 and 2019. Results In March 2020, we observed a 99% (95%CI: 96%-103%) increase in hydroxychloroquine dispensing (approximately 22% attributable to new users), and a 199% increase (95%CI: 184%-213%) in initiation, with an increase in prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsided following regulatory restrictions on prescribing. There was a small but sustained increase in ivermectin dispensing over multiple months, with an 80% (95%CI 42%-118%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April. Other than increases in March related to stockpiling, we observed no change in the initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin was lower than expected from April through November 2020. Conclusions While most increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users, we observed increases in the initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns which may be related to the media hype around these medicines. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harm.
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Affiliation(s)
- Andrea L. Schaffer
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
- * E-mail:
| | - David Henry
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
- Centre of Public Health Services, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Julian H. Elliott
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Monash, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
- Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia
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Tirupakuzhi Vijayaraghavan BK, Jha V, Rajbhandari D, Myatra SN, Ghosh A, Bhattacharya A, Arfin S, Bassi A, Donaldson LH, Hammond NE, John O, Joshi R, Kunigari M, Amrutha C, Husaini SHM, Ghosh S, Nag SK, Selvaraj HK, Kantroo V, Shah KD, Venkatesh B. Hydroxychloroquine plus personal protective equipment versus personal protective equipment alone for the prevention of laboratory-confirmed COVID-19 infections among healthcare workers: a multicentre, parallel-group randomised controlled trial from India. BMJ Open 2022; 12:e059540. [PMID: 35649613 PMCID: PMC9160584 DOI: 10.1136/bmjopen-2021-059540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To determine whether hydroxychloroquine when used with personal protective equipment reduces the proportion of laboratory-confirmed COVID-19 among healthcare workers in comparison to the use of personal protective equipment alone. DESIGN Multicentre, parallel-group, open-label randomised trial. Enrolment started on 29 June 2020 and stopped on 4 February 2021. Participants randomised in HydrOxychloroquine Prophylaxis Evaluation were followed for 6 months. SETTING 9 hospitals across India. PARTICIPANTS Healthcare workers in an environment with exposure to COVID-19 were randomised in a 1:1 ratio to hydroxychloroquine plus use of personal protective equipment or personal protective equipment alone. 886 participants were screened and 416 randomised (213 hydroxychloroquine arm and 203 personal protective equipment). INTERVENTION Participants in intervention arm received 800 mg of hydroxychloroquine on day of randomisation and then 400 mg once a week for 12 weeks in addition to the use of personal protective equipment. In the control arm, participants continued to use personal protective equipment alone. MAIN OUTCOME Proportion of laboratory-confirmed COVID-19 in the 6 months after randomisation. RESULTS Participants were young (mean age 32.1 years, SD 9.1 years) with low-comorbid burden. 47.4% were female. In the 6 months after randomisation (primary analysis population=413), 11 participants assigned to the hydroxychloroquine group and 12 participants assigned to the standard practice group met the primary endpoint (5.2% vs 5.9%; OR 0.85, 95% CI 0.35 to 2.07, p=0.72). There was no heterogeneity of treatment effect in any prespecified subgroup. There were no significant differences in the secondary outcomes. The adverse event rates were 9.9% and 6.9% in the hydroxychloroquine and standard practice arms, respectively. There were no serious adverse events in either group. CONCLUSIONS AND RELEVANCE Hydroxychloroquine along with personal protective equipment was not superior to personal protective equipment alone on the proportion of laboratory-confirmed COVID-19. Definitive conclusions are precluded as the trial stopped early for futility, and hence was underpowered. TRIAL REGISTRATION NUMBER CTRI/2020/05/025067.
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Affiliation(s)
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Sheila Nainan Myatra
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Anaesthesiology and Critical Care Medicine, Tata Memorial Hospital, Mumbai, India
| | - Arpita Ghosh
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Sumaiya Arfin
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Abhinav Bassi
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Naomi E Hammond
- Critical Care, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Oommen John
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Rohina Joshi
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Subir Ghosh
- Apollo Hospitals Ahmedabad, Ahmedabad, Gujarat, India
| | | | | | - Viny Kantroo
- Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Kamal D Shah
- NephroPlus Health Services, Hyderabad, Telangana, India
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, Newtown, New South Wales, Australia
- Wesley Hospital, Brisbane, Queensland, Australia
- Wesley Medical Research, Brisbane, Queensland, Australia
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Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review. Pharmaceuticals (Basel) 2022; 15:ph15050634. [PMID: 35631460 PMCID: PMC9144263 DOI: 10.3390/ph15050634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 01/09/2023] Open
Abstract
Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.
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Fadlallah R, Daher N, El-Harakeh A, Hammam R, Brax H, Bou Karroum L, Lopes LC, Arnous G, Kassamany I, Baltayan S, Harb A, Lotfi T, El-Jardali F, Akl EA. Approaches to prioritising primary health research: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2021-007465. [PMID: 35501067 PMCID: PMC9062777 DOI: 10.1136/bmjgh-2021-007465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To systematically identify and describe approaches to prioritise primary research topics in any health-related area. Methods We searched Medline and CINAHL databases and Google Scholar. Teams of two reviewers screened studies and extracted data in duplicate and independently. We synthesised the information across the included approaches by developing common categorisation of relevant concepts. Results Of 44 392 citations, 30 articles reporting on 25 approaches were included, addressing the following fields: health in general (n=9), clinical (n=10), health policy and systems (n=10), public health (n=6) and health service research (n=5) (10 addressed more than 1 field). The approaches proposed the following aspects to be addressed in the prioritisation process: situation analysis/ environmental scan, methods for generation of initial list of topics, use of prioritisation criteria, stakeholder engagement, ranking process/technique, dissemination and implementation, revision and appeal mechanism, and monitoring and evaluation. Twenty-two approaches proposed involving stakeholders in the priority setting process. The most commonly proposed stakeholder category was ‘researchers/academia’ (n=17, 77%) followed by ‘healthcare providers’ (n=16, 73%). Fifteen of the approaches proposed a list of criteria for determining research priorities. We developed a common framework of 28 prioritisation criteria clustered into nine domains. The criterion most frequently mentioned by the identified approaches was ‘health burden’ (n=12, 80%), followed by ‘availability of resources’ (n=11, 73%). Conclusion We identified and described 25 prioritisation approaches for primary research topics in any health-related area. Findings highlight the need for greater participation of potential users (eg, policy-makers and the general public) and incorporation of equity as part of the prioritisation process. Findings can guide the work of researchers, policy-makers and funders seeking to conduct or fund primary health research. More importantly, the findings should be used to enhance a more coordinated approach to prioritising health research to inform decision making at all levels.
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Affiliation(s)
- Racha Fadlallah
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Najla Daher
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Rima Hammam
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Faculty of Medicine, Université Saint-Joseph, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | | | - Ghida Arnous
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Inas Kassamany
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Stephanie Baltayan
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Aya Harb
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Tamara Lotfi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon .,Clinical Research Institute, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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The relationship between hydroxychloroquine plasma concentration and COVID-19 outcomes in rheumatoid arthritis patients in Saudi Arabia. Saudi Pharm J 2022; 30:964-970. [PMID: 35645589 PMCID: PMC9124633 DOI: 10.1016/j.jsps.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background The drug hydroxychloroquine (HCQ) is widely used to treat rheumatoid arthritis (RA) and has been repurposed for the treatment of COVID-19. This study aims to determine whether HCQ concentration levels in individuals with RA alter the incidence of COVID-19 or its complications. Methods We collected plasma samples from 13 individuals with confirmed rheumatoid arthritis (RA) to measure HCQ concentration levels. The study included individuals at least 18 years old who had been taking HCQ for at least six months at daily doses ranging from 200 to 400 mg. Results The study enrolled a total of 13 RA patients. All patients were chronic HCQ users. Among the 13 patients, 7 patients were receiving HCQ at a dose of 200 mg per day, and 6 patients were receiving HCQ at a dose of 400 mg per day. COVID-19 confirmed cases accounted for approximately 46% of all patients. Half of the infected patients (n = 3) were taking a daily dose of 200 mg daily, while the other half were taking 400 mg daily. COVID-19 symptoms ranged from mild to moderate, and the intensity of the symptoms was not severe enough to necessitate hospitalization. COVID-19 symptoms in RA patients included headache, fever, fatigue, dry cough, and loss of taste or smell. Conclusions Our findings indicated that there was no correlation between HCQ concentrations in rheumatoid arthritis patients and the occurrence of COVID-19 or its complications.
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Mohapatra S, Ayash Kumar P, Farooq U, Jain P, khan R, Hasan N, Shamim A, Javed Ansari M, Alalaiwe AS, Aldawsari MF, Aamir Mirza M, Iqbal Z. COVID 19 pandemic challenges and their management: A review of medicines, vaccines, patents and clinical trials with emphasis on psychological health issues. Saudi Pharm J 2022; 30:879-905. [PMID: 35645588 PMCID: PMC9128298 DOI: 10.1016/j.jsps.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022] Open
Abstract
The SARS‐CoV‐2 (COVID 19) paroxysm is a dominant health exigency that caused significant distress, affecting physical and mental health. Increased mortality, a stressed healthcare system, financial crisis, isolation, and new living and working styles enhanced societal commiseration leading to poor health outcomes. Though people try to maintain good physical health but unfortunately the mental affliction is still ignored. Poor psychological health has emerged as a burgeoning social issue and demands attention. Henceforth, the fundamental objective of this review article is to collate information about COVID-linked physical and psychological agony in diverse population groups with related symptoms and accessible diagnosis techniques. Recent studies have unraveled the fragile mental states of people who have either contracted COVID 19 or had near and dear ones falling prey to it. The impact of the epidemic on the human mind both in short and long-term, with possible risk and preventive factors together with suggested solutions for maintaining good health have also been discussed here. It also enlists the available medications, vaccines and investigational research in the form of patents and clinical trials. This article can be taken as an updated information sheet for COVID 19, accompanied by its management techniques with special emphasis on coping strategies for mental health. Further, it may also assist the policymakers to devise approaches that could enable the public to overcome the pandemic-driven adversity not only in the given situation but also futuristically.
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Rao A, Veluswamy SK, Shankarappa BG, Reddy RM, Umesh N, John L, Mathew L, Shetty N. Hydroxychloroquine as pre-exposure prophylaxis against COVID-19 infection among healthcare workers: a prospective cohort study. Expert Rev Anti Infect Ther 2022; 20:781-787. [PMID: 34865592 PMCID: PMC8726004 DOI: 10.1080/14787210.2022.2015326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hydroxychloroquine had attracted significant attention in the initial phases of the COVID-19 pandemic but current recommendations do not support its use. However, the evidence against its use as pre-exposure prophylaxis have been of low to moderate quality and have been limited by high risk of bias. METHODS Following institutional ethics committee approval, healthcare workers (n = 1294) completing their first week-long COVID in-patient duty, subsequent institutional quarantine and RT-PCR testing for COVID-19 infection were included for this prospective cohort study. Demographic data, hydroxychloroquine usage and related adverse effects were captured through a 'Caring for the Caregivers' surveillance system. A chi-Square test of independence was used to determine the effect of hydroxychloroquine prophylaxis. RESULTS Among the 1294 participants (age: 31 ± 7 years, 61% women), 273 (21.1%) healthcare workers used hydroxychloroquine prophylaxis as per Indian Council of Medical Research recommendations and 83/1294 (6.4%) tested positive after their duty. There was no significant difference in COVID-19 incidence between those on hydroxychloroquine prophylaxis and those not on it (5.9% vs 6.6%, χ2 = 0.177, p = 0.675; RR = 0.89, 95% CI - 0.53 to 1.52). There were no significant adverse effects to hydroxychloroquine usage. CONCLUSION This study demonstrated no benefit of hydroxychloroquine prophylaxis and provides quality evidence against its use in COVID-19 prevention.
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Affiliation(s)
- Akshay Rao
- Department of Internal Medicine, MS Ramaiah Medical College, Bengaluru, India
| | - Sundar Kumar Veluswamy
- Department of Physiotherapy, MS Ramaiah Medical College
- Healthy Living for Pandemic Event Protection (Hl- Pivot) Network, Chicago, Illinois, USA
| | | | | | - Nethravathi Umesh
- Office of Nursing Superintendent, MS Ramaiah Medical College HospitalBengaluru, India
| | - Lissy John
- Office of Nursing Superintendent, MS Ramaiah Medical College HospitalBengaluru, India
| | - Lysamma Mathew
- Office of Nursing Superintendent, MS Ramaiah Memorial Hospital, Bengaluru, India
| | - Naresh Shetty
- Caring for the Caregivers Surveillance System, MS Ramaiah Medical College Hospitals
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Bandaru R, Rout SR, Kamble O, Samal SK, Gorain B, Sahebkar A, Ahmed FJ, Kesharwani P, Dandela R. Clinical progress of therapeutics and vaccines: Rising hope against COVID-19 treatment. Process Biochem 2022; 118:154-170. [PMID: 35437418 PMCID: PMC9008982 DOI: 10.1016/j.procbio.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/11/2022] [Accepted: 04/08/2022] [Indexed: 02/07/2023]
Abstract
Cases of deaths due to COVID-19 (COrona VIrus Disease-19) infection are increasing gradually worldwide. Immense research is ongoing to control this pandemic condition. Continual research outcomes are indicating that therapeutic and prophylactic agents are the possible hope to prevent the pandemic from spreading and to combat this increasing death count. Experience gained from previous coronavirus infections (eg., SARS (Severe Acute Respiratory Syndrome), MERS (Middle Ease Respiratory Syndrome), accumulated clinical knowledge during this pandemic, and research helped to identify a few therapeutic agents for emergency treatment of COVID-19. Thereby, monoclonal antibodies, antivirals, broad-spectrum antimicrobials, immunomodulators, and supplements are being suggested for treatment depending on the stage of the disease. These recommended treatments are authorized under medical supervision in emergency conditions only. Urgent need to control the pandemic condition had resulted in various approaches of repurposing the existing drugs, However, poorly designed clinical trials and associated outcomes do not provide enough evidence to fully approve treatments against COVID-19. So far, World Health Organization (WHO) authorized three vaccines as prophylactic against SARS-CoV-2. Here, we discussed about various therapeutic agents, their clinical trials, and limitations of trials for the management of COVID-19. Further, we have also spotlighted different vaccines in research in combating COVID-19.
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Emergence of Two Distinct SARS-CoV-2 Gamma Variants and the Rapid Spread of P.1-like-II SARS-CoV-2 during the Second Wave of COVID-19 in Santa Catarina, Southern Brazil. Viruses 2022; 14:v14040695. [PMID: 35458424 PMCID: PMC9029728 DOI: 10.3390/v14040695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
The western mesoregion of the state of Santa Catarina (SC), Southern Brazil, was heavily affected as a whole by the COVID-19 pandemic in early 2021. This study aimed to evaluate the dynamics of the SARS-CoV-2 virus spreading patterns in the SC state from March 2020 to April 2021 using genomic surveillance. During this period, there were 23 distinct variants, including Beta and Gamma, among which the Gamma and related lineages were predominant in the second pandemic wave within SC. A regionalization of P.1-like-II in the Western SC region was observed, concomitant to the increase in cases, mortality, and the case fatality rate (CFR) index. This is the first evidence of the regionalization of the SARS-CoV-2 transmission in SC and it highlights the importance of tracking the variants, dispersion, and impact of SARS-CoV-2 on the public health systems.
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40
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Long B, Chavez S, Carius BM, Brady WJ, Liang SY, Koyfman A, Gottlieb M. Clinical update on COVID-19 for the emergency and critical care clinician: Medical management. Am J Emerg Med 2022; 56:158-170. [PMID: 35397357 PMCID: PMC8956349 DOI: 10.1016/j.ajem.2022.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/28/2022] [Accepted: 03/19/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. OBJECTIVE This is the second part in a series on COVID-19 updates providing a focused overview of the medical management of COVID-19 for emergency and critical care clinicians. DISCUSSION COVID-19, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality worldwide. A variety of medical therapies have been introduced for use, including steroids, antivirals, interleukin-6 antagonists, monoclonal antibodies, and kinase inhibitors. These agents have each demonstrated utility in certain patient subsets. Prophylactic anticoagulation in admitted patients demonstrates improved outcomes. Further randomized data concerning aspirin in outpatients with COVID-19 are needed. Any beneficial impact of other therapies, such as colchicine, convalescent plasma, famotidine, ivermectin, and vitamins and minerals is not present in reliable medical literature. In addition, chloroquine and hydroxychloroquine are not recommended. CONCLUSION This review provides a focused update of the medical management of COVID-19 for emergency and critical care clinicians to help improve care for these patients.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, USA.
| | - Summer Chavez
- Department of Emergency Medicine, UT Health Houston McGovern School of Medicine, 6431 Fannin Street, Houston, TX, 77030, USA.
| | | | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
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Liang H, Luo D, Liao H, Li S. Coronavirus Usurps the Autophagy-Lysosome Pathway and Induces Membranes Rearrangement for Infection and Pathogenesis. Front Microbiol 2022; 13:846543. [PMID: 35308399 PMCID: PMC8924481 DOI: 10.3389/fmicb.2022.846543] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/19/2022] [Indexed: 12/24/2022] Open
Abstract
Autophagy is a crucial and conserved homeostatic mechanism for early defense against viral infections. Recent studies indicate that coronaviruses (CoVs) have evolved various strategies to evade the autophagy–lysosome pathway. In this minireview, we describe the source of double-membrane vesicles during CoV infection, which creates a microenvironment that promotes viral RNA replication and virion synthesis and protects the viral genome from detection by the host. Firstly, CoVs hijack autophagy initiation through non-structural proteins and open-reading frames, leading to the use of non-nucleated phagophores and omegasomes for autophagy-derived double-membrane vesicles. Contrastingly, membrane rearrangement by hijacking ER-associated degradation machinery to form ER-derived double-membrane vesicles independent from the typical autophagy process is another important routine for the production of double-membrane vesicles. Furthermore, we summarize the molecular mechanisms by which CoV non-structural proteins and open-reading frames are used to intercept autophagic flux and thereby evade host clearance and innate immunity. A comprehensive understanding of the above mechanisms may contribute to developing novel therapies and clinical drugs against coronavirus disease 2019 (COVID-19) in the future.
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Affiliation(s)
- Haowei Liang
- Department of Immunology, School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China.,School of Life Sciences and Engineering, Southwest Jiaotong University, Chengdu, China
| | - Dan Luo
- Department of Immunology, School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
| | - Hai Liao
- School of Life Sciences and Engineering, Southwest Jiaotong University, Chengdu, China
| | - Shun Li
- Department of Immunology, School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China.,Non-coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, China
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Jafari Y, Yin M, Lim C, Pople D, Evans S, Stimson J, Pham TM, Read JM, Robotham JV, Cooper BS, Knight GM. Effectiveness of infection prevention and control interventions, excluding personal protective equipment, to prevent nosocomial transmission of SARS-CoV-2: a systematic review and call for action. Infect Prev Pract 2022; 4:100192. [PMID: 34870142 PMCID: PMC8628369 DOI: 10.1016/j.infpip.2021.100192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022] Open
Abstract
Many infection prevention and control (IPC) interventions have been adopted by hospitals to limit nosocomial transmission of SARS-CoV-2. The aim of this systematic review is to identify evidence on the effectiveness of these interventions. We conducted a literature search of five databases (OVID MEDLINE, Embase, CENTRAL, COVID-19 Portfolio (pre-print), Web of Science). SWIFT ActiveScreener software was used to screen English titles and abstracts published between 1st January 2020 and 6th April 2021. Intervention studies, defined by Cochrane Effective Practice and Organisation of Care, that evaluated IPC interventions with an outcome of SARS-CoV-2 infection in either patients or healthcare workers were included. Personal protective equipment (PPE) was excluded as this intervention had been previously reviewed. Risks of bias were assessed using the Cochrane tool for randomised trials (RoB2) and non-randomized studies of interventions (ROBINS-I). From 23,156 screened articles, we identified seven articles that met the inclusion criteria, all of which evaluated interventions to prevent infections in healthcare workers and the majority of which were focused on effectiveness of prophylaxes. Due to heterogeneity in interventions, we did not conduct a meta-analysis. All agents used for prophylaxes have little to no evidence of effectiveness against SARS-CoV-2 infections. We did not find any studies evaluating the effectiveness of interventions including but not limited to screening, isolation and improved ventilation. There is limited evidence from interventional studies, excluding PPE, evaluating IPC measures for SARS-CoV-2. This review calls for urgent action to implement such studies to inform policies to protect our most vulnerable populations and healthcare workers.
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Affiliation(s)
- Yalda Jafari
- Centre for Mathematical Modelling of Infectious Diseases, IDE, EPH, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mo Yin
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- University Medicine Cluster, National University Hospital, Singapore
- Department of Medicine, National University of Singapore, Singapore
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Cherry Lim
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Diane Pople
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, PHE, Colindale, London, UK
| | - Stephanie Evans
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, PHE, Colindale, London, UK
| | - James Stimson
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, PHE, Colindale, London, UK
| | - Thi Mui Pham
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | - Julie V. Robotham
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, PHE, Colindale, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in Partnership with Public Health England, Oxford, UK
| | - Ben S. Cooper
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gwenan M. Knight
- Centre for Mathematical Modelling of Infectious Diseases, IDE, EPH, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Rojas-Serrano J, Portillo-Vásquez AM, Thirion-Romero I, Vázquez-Pérez J, Mejía-Nepomuceno F, Ramírez-Venegas A, Pérez-Kawabe KM, Pérez-Padilla R. Hydroxychloroquine for prophylaxis of COVID-19 in health workers: A randomized clinical trial. PLoS One 2022; 17:e0261980. [PMID: 35139097 PMCID: PMC8827445 DOI: 10.1371/journal.pone.0261980] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/24/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Health care workers are at high risk of being infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our aim is to evaluate the efficacy and safety of hydroxychloroquine (HCQ) for prophylaxis of coronavirus disease 19 (COVID-19) in health personnel exposed to patients infected by SARS-CoV-2. METHODS Double-blind randomized, placebo-controlled single center clinical trial. Included subjects were health care workers caring for severe COVID-19 patients. Main outcome was time to symptomatic SARS-CoV-2 infection. RESULTS 127 subjects with a confirmed baseline negative RT-PCR SARS-CoV2 test were included in the trial. 62 assigned to HCQ and 65 to placebo. One subject (1.6%) in the HCQ group and 6 (9.2%) subjects in the placebo group developed COVID-19 (Log-Rank test p = 0.07). No severe COVID-19 cases were observed. The study was suspended because of a refusal to participate and losses to follow up after several trials reported lack of effectiveness of hydroxychloroquine in hospitalized patients with COVID-19. CONCLUSION The effect size of hydroxychloroquine was higher than placebo for COVID-19 symptomatic infection in health personnel, although this was not statistically significant. The trial is underpowered due to the failure to complete the estimated sample size.
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Affiliation(s)
- Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
- * E-mail:
| | | | - Ireri Thirion-Romero
- Department of Investigation on Tobacco and Chronic Obstructive Pulmonary Disease, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Joel Vázquez-Pérez
- Department of Investigation on Tobacco and Chronic Obstructive Pulmonary Disease, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Fidencio Mejía-Nepomuceno
- Department of Investigation on Tobacco and Chronic Obstructive Pulmonary Disease, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Alejandra Ramírez-Venegas
- Department of Investigation on Tobacco and Chronic Obstructive Pulmonary Disease, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Karla Midori Pérez-Kawabe
- Department of Investigation on Tobacco and Chronic Obstructive Pulmonary Disease, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Rogelio Pérez-Padilla
- Department of Investigation on Tobacco and Chronic Obstructive Pulmonary Disease, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
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García-García I, Seco-Meseguer E, Ruiz-Seco P, Navarro-Jimenez G, Martínez-Porqueras R, Espinosa-Díaz M, Ortega-Albás JJ, Sagastagoitia I, García-Morales MT, Jiménez-González M, Martínez de Soto L, Bajo-Martínez AI, del Palacio-Tamarit M, López-García R, Díaz-García L, Queiruga-Parada J, Giesen C, Pérez-Villena A, de Castro-Martínez M, González-García JJ, Rodriguez-Rubio M, de la Oliva P, Arribas JR, Carcas AJ, Borobia AM. Melatonin in the Prophylaxis of SARS-CoV-2 Infection in Healthcare Workers (MeCOVID): A Randomised Clinical Trial. J Clin Med 2022; 11:jcm11041139. [PMID: 35207411 PMCID: PMC8876218 DOI: 10.3390/jcm11041139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/29/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
We evaluated in this randomised, double-blind clinical trial the efficacy of melatonin as a prophylactic treatment for prevention of SARS-CoV-2 infection among healthcare workers at high risk of SARS-CoV-2 exposure. Healthcare workers fulfilling inclusion criteria were recruited in five hospitals in Spain and were randomised 1:1 to receive melatonin 2 mg administered orally for 12 weeks or placebo. The main outcome was the number of SARS-CoV-2 infections. A total of 344 volunteers were screened, and 314 were randomised: 151 to placebo and 163 to melatonin; 308 received the study treatment (148 placebo; 160 melatonin). We detected 13 SARS-CoV-2 infections, 2.6% in the placebo arm and 5.5% in the melatonin arm (p = 0.200). A total of 294 adverse events were detected in 127 participants (139 in placebo; 155 in melatonin). We found a statistically significant difference in the incidence of adverse events related to treatment: 43 in the placebo arm and 67 in the melatonin arm (p = 0.040), and in the number of participants suffering from somnolence related to treatment: 8.8% (n = 14) in the melatonin versus 1.4% (n = 2) in the placebo arm (p = 0.008). No severe adverse events related to treatment were reported. We cannot confirm our hypothesis that administration of melatonin prevents the development of SARS-CoV-2 infection in healthcare workers.
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Affiliation(s)
- Irene García-García
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
| | - Enrique Seco-Meseguer
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
| | - Pilar Ruiz-Seco
- Internal Medicine Department, Infanta Sofía University Hospital, 28702 San Sebastián de los Reyes, Spain; (P.R.-S.); (G.N.-J.)
| | - Gema Navarro-Jimenez
- Internal Medicine Department, Infanta Sofía University Hospital, 28702 San Sebastián de los Reyes, Spain; (P.R.-S.); (G.N.-J.)
| | - Raúl Martínez-Porqueras
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (R.M.-P.); (M.E.-D.); (M.d.P.-T.); (M.d.C.-M.)
| | - María Espinosa-Díaz
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (R.M.-P.); (M.E.-D.); (M.d.P.-T.); (M.d.C.-M.)
| | - Juan José Ortega-Albás
- Sleep Unit, Hospital General Universitario de Castellón, 12004 Castellón de la Plana, Spain; (J.J.O.-A.); (R.L.-G.)
| | - Iñigo Sagastagoitia
- Internal Medicine/Infectious Diseases Department, Hospital Clínico San Carlos, IdiSSC, 28040 Madrid, Spain;
| | - María Teresa García-Morales
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
| | - María Jiménez-González
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
- Infectious Diseases Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.J.G.-G.); (J.R.A.)
| | - Lucía Martínez de Soto
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
| | - Ana Isabel Bajo-Martínez
- Emergency Department, Infanta Sofía University Hospital, 28702 San Sebastián de los Reyes, Spain;
| | - María del Palacio-Tamarit
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (R.M.-P.); (M.E.-D.); (M.d.P.-T.); (M.d.C.-M.)
| | - Raquel López-García
- Sleep Unit, Hospital General Universitario de Castellón, 12004 Castellón de la Plana, Spain; (J.J.O.-A.); (R.L.-G.)
| | - Lucía Díaz-García
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
| | - Javier Queiruga-Parada
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Infectious Diseases Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.J.G.-G.); (J.R.A.)
| | - Christine Giesen
- Preventive Medicine Unit, Infanta Sofia University Hospital, 28702 San Sebastián de los Reyes, Spain;
| | - Ana Pérez-Villena
- Pediatric Department, Infanta Sofia University Hospital, 28702 San Sebastián de los Reyes, Spain;
| | - Marta de Castro-Martínez
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (R.M.-P.); (M.E.-D.); (M.d.P.-T.); (M.d.C.-M.)
| | - Juan J. González-García
- Infectious Diseases Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.J.G.-G.); (J.R.A.)
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Miguel Rodriguez-Rubio
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Pediatric Intensive Care Department, La Paz University Hospital-IdiPAZ, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Pedro de la Oliva
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Pediatric Intensive Care Department, La Paz University Hospital-IdiPAZ, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - José R. Arribas
- Infectious Diseases Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.J.G.-G.); (J.R.A.)
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Antonio J. Carcas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
- Correspondence: (A.J.C.); (A.M.B.)
| | - Alberto M. Borobia
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
- Correspondence: (A.J.C.); (A.M.B.)
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Oliveira HAD, Ferri CP, Boszczowski I, Oliveira GBF, Cavalcanti AB, Rosa RG, Lopes RD, Azevedo LCP, Veiga VC, Berwanger O, Avezum Á. Justificativa e Desenho do Ensaio Clínico Randomizado COVID-19 Outpatient Prevention Evaluation (COPE - Coalition V): Hidroxicloroquina vs. Placebo em Pacientes Não Hospitalizados. Arq Bras Cardiol 2022; 118:378-387. [PMID: 35262569 PMCID: PMC8856682 DOI: 10.36660/abc.20210832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/24/2021] [Indexed: 01/31/2023] Open
Abstract
Fundamento Apesar da necessidade de opções terapêuticas específicas para a doença do coronavírus 2019 (covid-19), ainda não há evidências da eficácia de tratamentos específicos no contexto ambulatorial. Há poucos estudos randomizados que avaliam a hidroxicloroquina (HCQ) em pacientes não hospitalizados. Esses estudos não indicaram benefício com o uso da HCQ; no entanto, avaliaram desfechos primários diferentes e apresentaram vieses importantes na avaliação dos desfechos. Objetivo Investigar se a HCQ possui o potencial de prevenir hospitalizações por covid-19 quando comparada ao placebo correspondente. Métodos O estudo COVID-19 Outpatient Prevention Evaluation (COPE) é um ensaio clínico randomizado, pragmático, duplo-cego, multicêntrico e controlado por placebo que avalia o uso da HCQ (800 mg no dia 1 e 400 mg do dia 2 ao dia 7) ou placebo correspondente na prevenção de hospitalizações por covid-19 em casos precoces confirmados ou suspeitos de pacientes não hospitalizados. Os critérios de inclusão são adultos (≥ 18 anos) que procuraram atendimento médico com sintomas leves de covid-19, com randomização ≤ 7 dias após o início dos sintomas, sem indicação de hospitalização na triagem do estudo e com pelo menos um fator de risco para complicações (> 65 anos, hipertensão, diabetes melito, asma, doença pulmonar obstrutiva crônica ou outras doenças pulmonares crônicas, tabagismo, imunossupressão ou obesidade). Todos os testes de hipótese serão bilaterais. Um valor de p < 0,05 será considerado estatisticamente significativo em todas as análises. Clinicaltrials.gov: NCT04466540. Resultados Os desfechos clínicos serão avaliados centralmente por um comitê de eventos clínicos independente cegado para a alocação dos grupos de tratamento. O desfecho primário de eficácia será avaliado de acordo com o princípio da intenção de tratar. Conclusão Este estudo apresenta o potencial de responder de forma confiável a questão científica do uso da HCQ em pacientes ambulatoriais com covid-19. Do nosso conhecimento, este é o maior estudo avaliando o uso de HCQ em indivíduos com covid-19 não hospitalizados.
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Memirie ST, Yigezu A, Zewdie SA, Mirkuzie AH, Bolongaita S, Verguet S. Hospitalization costs for COVID-19 in Ethiopia: Empirical data and analysis from Addis Ababa's largest dedicated treatment center. PLoS One 2022; 17:e0260930. [PMID: 35061674 PMCID: PMC8782501 DOI: 10.1371/journal.pone.0260930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/21/2021] [Indexed: 01/08/2023] Open
Abstract
Background The COVID-19 pandemic has caused profound health, economic, and social disruptions globally. We assessed the full costs of hospitalization for COVID-19 disease at Ekka Kotebe COVID-19 treatment center in Addis Ababa, the largest hospital dedicated to COVID-19 patient care in Ethiopia. Methods and findings We retrospectively collected and analysed clinical and cost data on patients admitted to Ekka Kotebe with laboratory-confirmed COVID-19 infections. Cost data included personnel time and salaries, drugs, medical supplies and equipment, facility utilities, and capital costs. Facility medical records were reviewed to assess the average duration of stay by disease severity (either moderate, severe, or critical). The data collected covered the time-period March-November 2020. We then estimated the cost per treated COVID-19 episode, stratified by disease severity, from the perspective of the provider. Over the study period there were 2,543 COVID-19 cases treated at Ekka Kotebe, of which, 235 were critical, 515 were severe, and 1,841 were moderate. The mean patient duration of stay varied from 9.2 days (95% CI: 7.6–10.9; for moderate cases) to 19.2 days (17.9–20.6; for critical cases). The mean cost per treated episode was USD 1,473 (95% CI: 1,197–1,750), but cost varied by disease severity: the mean cost for moderate, severe, and critical cases were USD 1,266 (998–1,534), USD 1,545 (1,413–1,677), and USD 2,637 (1,788–3,486), respectively. Conclusions Clinical management and treatment of COVID-19 patients poses an enormous economic burden to the Ethiopian health system. Such estimates of COVID-19 treatment costs inform financial implications for resource-constrained health systems and reinforce the urgency of implementing effective infection prevention and control policies, including the rapid rollout of COVID-19 vaccines, in low-income countries like Ethiopia.
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Affiliation(s)
- Solomon Tessema Memirie
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Amanuel Yigezu
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Samuel Abera Zewdie
- Partnership and Cooperation Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Alemnesh H. Mirkuzie
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sarah Bolongaita
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Vegivinti CTR, Evanson KW, Lyons H, Akosman I, Barrett A, Hardy N, Kane B, Keesari PR, Pulakurthi YS, Sheffels E, Balasubramanian P, Chibbar R, Chittajallu S, Cowie K, Karon J, Siegel L, Tarchand R, Zinn C, Gupta N, Kallmes KM, Saravu K, Touchette J. Efficacy of antiviral therapies for COVID-19: a systematic review of randomized controlled trials. BMC Infect Dis 2022; 22:107. [PMID: 35100985 PMCID: PMC8802260 DOI: 10.1186/s12879-022-07068-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) continues to pose a significant threat to public health worldwide. The purpose of this study was to review current evidence obtained from randomized clinical trials on the efficacy of antivirals for COVID-19 treatment. METHODS A systematic literature search was performed using PubMed to identify randomized controlled trials published up to September 4, 2021 that examined the efficacy of antivirals for COVID-19 treatment. Studies that were not randomized controlled trials or that did not include treatment of COVID-19 with approved antivirals were excluded. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) method. Due to study heterogeneity, inferential statistics were not performed and data were expressed as descriptive statistics. RESULTS Of the 2,284 articles retrieved, 31 (12,440 patients) articles were included. Overall, antivirals were more effective when administered early in the disease course. No antiviral treatment demonstrated efficacy at reducing COVID-19 mortality. Sofosbuvir/daclatasvir results suggested clinical improvement, although statistical power was low. Remdesivir exhibited efficacy in reducing time to recovery, but results were inconsistent across trials. CONCLUSIONS Although select antivirals have exhibited efficacy to improve clinical outcomes in COVID-19 patients, none demonstrated efficacy in reducing mortality. Larger RCTs are needed to conclusively establish efficacy.
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Affiliation(s)
- Charan Thej Reddy Vegivinti
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Pkwy S, Bronx, NY, USA
| | - Kirk W Evanson
- Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA
| | - Hannah Lyons
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
- Ohio University Heritage College of Osteopathic Medicine, 6775 Bobcat Way, Dublin, OH, 43016, USA
| | - Izzet Akosman
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Averi Barrett
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Nicole Hardy
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Bernadette Kane
- Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA
| | - Praneeth Reddy Keesari
- Kamineni Academy of Medical Sciences and Research Center, Hyderabad, Telangana, 500068, India
| | | | - Erin Sheffels
- Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA.
| | - Prasanth Balasubramanian
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Pkwy S, Bronx, NY, USA
| | - Richa Chibbar
- Department of Medicine, Lakeridge Health, 1 Hospital Crt, Oshawa, ON, L1G 2B9, Canada
| | | | - Kathryn Cowie
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - J Karon
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Lauren Siegel
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Ranita Tarchand
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Caleb Zinn
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Nitin Gupta
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kevin M Kallmes
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Kavitha Saravu
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Jillienne Touchette
- Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA
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Sala L, Leonov V, Mura M, Giannetti F, Khudiakov A, Moretti A, Crotti L, Gnecchi M, Schwartz PJ. Use of hiPSC-Derived Cardiomyocytes to Rule Out Proarrhythmic Effects of Drugs: The Case of Hydroxychloroquine in COVID-19. Front Physiol 2022; 12:730127. [PMID: 35153806 PMCID: PMC8829511 DOI: 10.3389/fphys.2021.730127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
In the early phases of the COVID-19 pandemic, drug repurposing was widely used to identify compounds that could improve the prognosis of symptomatic patients infected by SARS-CoV-2. Hydroxychloroquine (HCQ) was one of the first drugs used to treat COVID-19 due to its supposed capacity of inhibiting SARS-CoV-2 infection and replication in vitro. While its efficacy is debated, HCQ has been associated with QT interval prolongation and potentially Torsades de Pointes, especially in patients predisposed to developing drug-induced Long QT Syndrome (LQTS) as silent carriers of variants associated with congenital LQTS. If confirmed, these effects represent a limitation to the at-home use of HCQ for COVID-19 infection as adequate ECG monitoring is challenging. We investigated the proarrhythmic profile of HCQ with Multi-Electrode Arrays after exposure of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) from two healthy donors, one asymptomatic and two symptomatic LQTS patients. We demonstrated that: I) HCQ induced a concentration-dependent Field Potential Duration (FPD) prolongation and halted the beating at high concentration due to the combined effect of HCQ on multiple ion currents. II) hiPSC-CMs from healthy or asymptomatic carriers tolerated higher concentrations of HCQ and showed lower susceptibility to HCQ-induced electrical abnormalities regardless of baseline FPD. These findings agree with the clinical safety records of HCQ and demonstrated that hiPSC-CMs potentially discriminates symptomatic vs. asymptomatic mutation carriers through pharmacological interventions. Disease-specific cohorts of hiPSC-CMs may be a valid preliminary addition to assess drug safety in vulnerable populations, offering rapid preclinical results with valuable translational relevance for precision medicine.
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Affiliation(s)
- Luca Sala
- Istituto Auxologico Italiano IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
- *Correspondence: Luca Sala,
| | - Vladislav Leonov
- Istituto Auxologico Italiano IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Cardiovascular Science, The University of Verona, Verona, Italy
| | - Manuela Mura
- Coronary Care Unit and Laboratory of Experimental Cardiology, Department of Cardiothoracic and Vascular Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Giannetti
- Istituto Auxologico Italiano IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Aleksandr Khudiakov
- Istituto Auxologico Italiano IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Alessandra Moretti
- First Department of Medicine, Cardiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research)—Partner Site Munich Heart Alliance, Munich, Germany
| | - Lia Crotti
- Istituto Auxologico Italiano IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Massimiliano Gnecchi
- Coronary Care Unit and Laboratory of Experimental Cardiology, Department of Cardiothoracic and Vascular Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Unit of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Peter J. Schwartz
- Istituto Auxologico Italiano IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
- Peter J. Schwartz,
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Kerai S, Singh R, Saxena KN, Desai SD. Assessment of Risk Factors for Coronavirus Disease-2019 in Healthcare Workers: A Case–Control Study. Indian J Crit Care Med 2022; 26:76-84. [PMID: 35110849 PMCID: PMC8783233 DOI: 10.5005/jp-journals-10071-24071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background and aims With the rise of coronavirus disease-2019 (COVID-19) cases globally, the infection among frontline healthcare workers (HCWs) escalates many folds. There is, however, limited literature from low middle-income countries regarding risk factors for COVID-19 infection in HCWs. We conducted a case–control study to evaluate the risk factors of COVID-19 infection to HCWs. Materials and methods This case–control study was conducted in a designated COVID-19 hospital. Eighty-one HCWs involved in direct care of COVID-19 patients, identified as cases, and 266 were recruited as controls. Telephonic interviews with participants were conducted, and information regarding demographic variables, chemoprophylaxis, exposure to infected patients, and adherence to infection prevention and control (IPC) measures was collected. Results We observed a statistically significant difference in the number of times training session for IPC measures attended by HCWs (p = 0.02), performance of aerosol-generating medical procedures (AGMPs) (p <0.001), practices of donning and doffing of personal protective equipment (PPE) (p <0.001), hand hygiene (p <0.001), and decontamination of highly touched surfaces (p <0.001). Logistic regression analysis revealed if the decontamination of highly touched surfaces is decreased by one unit, the odds of getting COVID-19 infection is multiplied by a factor of 0.41 and AGMPs decrease the risk of being a case by 0.76. Conclusion This study highlighted that inadequate observation of IPC methods increases the risk of COVID-19 infection to frontline HCWs, whereas performance of AGMPs does not enhance the risk. In this study, HCWs undertaking an AGMP, because of concern of acquiring infection, were more diligent during procedures and hence had lesser infection. How to cite this article Kerai S, Singh R, Saxena KN, Desai SD. Assessment of Risk Factors for Coronavirus Disease-2019 in Healthcare Workers: A Case–Control Study. Indian J Crit Care Med 2022;26(1):76–84.
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Affiliation(s)
- Sukhyanti Kerai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Rahil Singh
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
- Rahil Singh, Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India, Phone: +91 9810719025, e-mail:
| | - Kirti N Saxena
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Suraj D Desai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
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Kerai S, Singh R, Saxena KN, Desai SD, Bhalotra AR. A Retrospective Study on Experience of High-flow Nasal Cannula Oxygen in Critically Ill COVID-19 Adult Patients Admitted to Intensive Care Unit. Indian J Crit Care Med 2022; 26:62-66. [PMID: 35110846 PMCID: PMC8783255 DOI: 10.5005/jp-journals-10071-24097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Sukhyanti Kerai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Rahil Singh
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
- Rahil Singh, Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India, Phone: +91 9810719025, e-mail:
| | - Kirti N Saxena
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Suraj D Desai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Anju R Bhalotra
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
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