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Cheema HA, Jafar U, Shahid A, Masood W, Usman M, Hermis AH, Naseem MA, Sahra S, Sah R, Lee KY. Colchicine for the treatment of patients with COVID-19: an updated systematic review and meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e074373. [PMID: 38631824 PMCID: PMC11029412 DOI: 10.1136/bmjopen-2023-074373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES We conducted an updated systematic review and meta-analysis to investigate the effect of colchicine treatment on clinical outcomes in patients with COVID-19. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed, Embase, the Cochrane Library, medRxiv and ClinicalTrials.gov from inception to January 2023. ELIGIBILITY CRITERIA All randomised controlled trials (RCTs) that investigated the efficacy of colchicine treatment in patients with COVID-19 as compared with placebo or standard of care were included. There were no language restrictions. Studies that used colchicine prophylactically were excluded. DATA EXTRACTION AND SYNTHESIS We extracted all information relating to the study characteristics, such as author names, location, study population, details of intervention and comparator groups, and our outcomes of interest. We conducted our meta-analysis by using RevMan V.5.4 with risk ratio (RR) and mean difference as the effect measures. RESULTS We included 23 RCTs (28 249 participants) in this systematic review. Colchicine did not decrease the risk of mortality (RR 0.99; 95% CI 0.93 to 1.05; I2=0%; 20 RCTs, 25 824 participants), with the results being consistent among both hospitalised and non-hospitalised patients. There were no significant differences between the colchicine and control groups in other relevant clinical outcomes, including the incidence of mechanical ventilation (RR 0.75; 95% CI 0.48 to 1.18; p=0.22; I2=40%; 8 RCTs, 13 262 participants), intensive care unit admission (RR 0.77; 95% CI 0.49 to 1.22; p=0.27; I2=0%; 6 RCTs, 961 participants) and hospital admission (RR 0.74; 95% CI 0.48 to 1.16; p=0.19; I2=70%; 3 RCTs, 8572 participants). CONCLUSIONS The results of this meta-analysis do not support the use of colchicine as a treatment for reducing the risk of mortality or improving other relevant clinical outcomes in patients with COVID-19. However, RCTs investigating early treatment with colchicine (within 5 days of symptom onset or in patients with early-stage disease) are needed to fully elucidate the potential benefits of colchicine in this patient population. PROSPERO REGISTRATION NUMBER CRD42022369850.
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Affiliation(s)
| | - Uzair Jafar
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Abia Shahid
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Waniyah Masood
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Usman
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Alaa Hamza Hermis
- Nursing College, Al-Mustaqbal University, 51001 Hillah, Babylon, Iraq
| | | | - Syeda Sahra
- Department of Infectious Diseases, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ranjit Sah
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune 411018, Maharashtra, India
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Sohail A, Cheema HA, Mithani MS, Shahid A, Nawaz A, Hermis AH, Chinnam S, Nashwan AJ, Cherrez-Ojeda I, Awan RU, Ahmad S. Probiotics for the prevention and treatment of COVID-19: a rapid systematic review and meta-analysis. Front Nutr 2023; 10:1274122. [PMID: 37964926 PMCID: PMC10641770 DOI: 10.3389/fnut.2023.1274122] [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: 08/07/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Background Although numerous modalities are currently in use for the treatment and prophylaxis of COVID-19, probiotics are a cost-effective alternative that could be used in diverse clinical settings. Hence, we conducted a meta-analysis to investigate the role of probiotics in preventing and treating COVID-19 infection. Methods We searched several databases from inception to 30 May 2023 for all randomized controlled trials (RCTs) and comparative observational studies that evaluated probiotics (irrespective of the regimen) for the treatment or prevention of COVID-19. We conducted our meta-analysis using RevMan 5.4 with risk ratio (RR) and mean difference (MD) as the effect measures. Results A total of 18 studies (11 RCTs and 7 observational studies) were included in our review. Probiotics reduced the risk of mortality (RR 0.40; 95% CI: 0.25-0.65, I2 = 0%). Probiotics also decreased the length of hospital stay, rate of no recovery, and time to recovery. However, probiotics had no effect on the rates of ICU admission. When used prophylactically, probiotics did not decrease the incidence of COVID-19 cases (RR 0.65; 95% CI: 0.37-1.12; I2 = 66%). The results for all outcomes were consistent across the subgroups of RCTs and observational studies (P for interaction >0.05). Conclusion The results of this meta-analysis support the use of probiotics as an adjunct treatment for reducing the risk of mortality or improving other clinical outcomes in patients with COVID-19. However, probiotics are not useful as a prophylactic measure against COVID-19. Large-scale RCTs are still warranted for determining the most efficacious and safe probiotic strains. Systematic Review Registration PROSPERO (CRD42023390275: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=390275).
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Affiliation(s)
- Aruba Sohail
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Huzaifa Ahmad Cheema
- Division of Infectious Diseases, Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Abia Shahid
- Division of Infectious Diseases, Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ahmad Nawaz
- Division of Infectious Diseases, Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Alaa Hamza Hermis
- Nursing Department, Al-Mustaqbal University College, Hillah, Babylon, Iraq
| | - Sampath Chinnam
- Department of Chemistry, M. S. Ramaiah Institute of Technology (Affiliated to Visvesvaraya Technological University, Belgaum), Bengaluru, Karnataka, India
| | | | - Ivan Cherrez-Ojeda
- Respiralab Research Center, Guayaquil, Ecuador
- Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Rehmat Ullah Awan
- Department of Medicine, Ochsner Rush Medical Center, Meridian, MS, United States
| | - Sharjeel Ahmad
- Department of Medicine, Section of Infectious Diseases, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
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Alcoceba-Herrero I, Coco-Martín MB, Leal-Vega L, Martín-Gutiérrez A, Peña-de Diego L, Dueñas-Gutiérrez C, de Castro-Rodríguez F, Royuela-Ruiz P, Arenillas-Lara JF. Randomized Controlled Trial Evaluating the Benefit of a Novel Clinical Decision Support System for the Management of COVID-19 Patients in Home Quarantine: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2300. [PMID: 36767667 PMCID: PMC9915322 DOI: 10.3390/ijerph20032300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: We present the protocol of a randomized controlled trial designed to evaluate the benefit of a novel clinical decision support system for the management of patients with COVID-19. (2) Methods: The study will recruit up to 500 participants (250 cases and 250 controls). Both groups will receive the conventional telephone follow-up protocol by primary care and will also be provided with access to a mobile application, in which they will be able to report their symptoms three times a day. In addition, patients in the active group will receive a wearable smartwatch and a pulse oximeter at home for real-time monitoring. The measured data will be visualized by primary care and emergency health service professionals, allowing them to detect in real time the progression and complications of the disease in order to promote early therapeutic interventions based on their clinical judgement. (3) Results: Ethical approval for this study was obtained from the Drug Research Ethics Committee of the Valladolid East Health Area (CASVE-NM-21-516). The results obtained from this study will form part of the thesis of two PhD students and will be disseminated through publication in a peer-reviewed journal. (4) Conclusions: The implementation of this telemonitoring system can be extrapolated to patients with other similar diseases, such as chronic diseases, with a high prevalence and need for close monitoring.
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Affiliation(s)
- Irene Alcoceba-Herrero
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, 47005 Valladolid, Spain
| | - María Begoña Coco-Martín
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, 47005 Valladolid, Spain
| | - Luis Leal-Vega
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, 47005 Valladolid, Spain
| | - Adrián Martín-Gutiérrez
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, 47005 Valladolid, Spain
| | - Lidia Peña-de Diego
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, 47005 Valladolid, Spain
| | - Carlos Dueñas-Gutiérrez
- COVID-19 Unit, Department of Internal Medicine, University Clinical Hospital of Valladolid, 47003 Valladolid, Spain
| | | | | | - Juan F. Arenillas-Lara
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, 47005 Valladolid, Spain
- Stroke Unit, Department of Neurology, University Clinical Hospital of Valladolid, 47003 Valladolid, Spain
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Akinosoglou K, Schinas G, Gogos C. Oral Antiviral Treatment for COVID-19: A Comprehensive Review on Nirmatrelvir/Ritonavir. Viruses 2022; 14:2540. [PMID: 36423149 PMCID: PMC9696049 DOI: 10.3390/v14112540] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Despite the rapid development of efficient and safe vaccines against COVID-19, the need to confine the pandemic and treat infected individuals on an outpatient basis has led to the approval of oral antiviral agents. Taking into account the viral kinetic pattern of SARS-CoV-2, it is of high importance to intervene at the early stages of the disease. A protease inhibitor called nirmatrelvir coupled with ritonavir (NMV/r), which acts as a CYP3A inhibitor, delivered as an oral formulation, has shown much promise in preventing disease progression in high-risk patients with no need for supplemental oxygen administration. Real-world data seem to confirm the drug combination's efficacy and safety against all viral variants of concern in adult populations. Although, not fully clarified, viral rebound and recurrence of COVID-19 symptoms have been described following treatment; however, more data on potential resistance issues concerning the Mpro gene, which acts as the drug's therapeutic target, are needed. NMV/r has been a gamechanger in the fight against the pandemic by preventing hospitalizations and halting disease severity; therefore, more research on future development and greater awareness on its use are warranted.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine, Medical School, University of Patras, 26504 Rio, Greece
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Efficacy of a multiple-indication antiviral herbal drug (Saliravira®) for COVID-19 outpatients: A pre-clinical and randomized clinical trial study. Biomed Pharmacother 2022; 149:112729. [PMID: 35276467 PMCID: PMC8850097 DOI: 10.1016/j.biopha.2022.112729] [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: 11/18/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background The scientific researches on COVID-19 pandemic topics are headed to an explosion of scientific literature. Despite these global efforts, the efficient treatment of patients is an in-progress challenge. Based on a meta-study of published shreds of evidence about compounds and their botanic sources in the last six decades, a novel multiple-indication herbal compound (Saliravira®) has been developed. Based on the antiviral, anti-inflammatory, and immune-enhancing properties of its ingredients, we hypothesized that Saliravira® has the potential to act as an antiviral agent, accelerate treatment, and reduce undesirable effects of COVID-19. Methods In this randomized, controlled, open-label clinical trial, COVID-19 outpatients were included by RT-PCR test or diagnosis of physicians according to the symptoms. Participants were randomly divided into intervention and control groups to receive Saliravira® package plus routine treatments of COVID-19 or routine treatments of COVID-19 alone, respectively. Saliravira® package includes tablets, nasal-sinuses spray, oral-pharynx spray, and inhaler drops. The treatment was for 10 days and followed up till 23 days after admission. Results On the 8th day, the “mean reduction rates” of viral load of the patients in the intervention group was 50% lower compared to the control group with a p-value < 0.05. The improvement of 10 out of 14 COVID-19 symptoms in the intervention group was significantly accelerated. The mean treatment duration of patients in the intervention group was 4.9 days less than the control group. In addition, no patients in the intervention group were hospitalized compared to 28% of the control group needed to be hospitalized.
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Bosaeed M, Alharbi A, Mahmoud E, Alrehily S, Bahlaq M, Gaifer Z, Alturkistani H, Alhagan K, Alshahrani S, Tolbah A, Musattat A, Alanazi M, Jaha R, Sultana K, Alqahtani H, Al Aamer K, Jaser S, Alsaedy A, Ahmad A, Abalkhail M, AlJohani S, Al Jeraisy M, Almaziad S, Albaalharith N, Alabdulkareem K, Alshowair A, Alharbi NK, Alrabiah F, Alshamrani M, Aldibasi O, Alaskar A. Efficacy of favipiravir in adults with mild COVID-19: a randomized, double-blind, multicentre, placebo-controlled clinical trial. Clin Microbiol Infect 2022; 28:602-608. [PMID: 35026375 PMCID: PMC8747778 DOI: 10.1016/j.cmi.2021.12.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate whether favipiravir reduces the time to viral clearance as documented by negative RT-PCR results for severe acute respiratory syndrome coronavirus 2 in mild cases of coronavirus disease 2019 (COVID-19) compared to placebo. METHODS In this randomized, double-blinded, multicentre, and placebo-controlled trial, adults with PCR-confirmed mild COVID-19 were recruited in an outpatient setting at seven medical facilities across Saudi Arabia. Participants were randomized in a 1:1 ratio to receive either favipiravir 1800 mg by mouth twice daily on day 1 followed by 800 mg twice daily (n = 112) or a matching placebo (n = 119) for a total of 5 to 7 days. The primary outcome was the effect of favipiravir on reducing the time to viral clearance (by PCR test) within 15 days of starting the treatment compared to the placebo group. The trial included the following secondary outcomes: symptom resolution, hospitalization, intensive care unit admissions, adverse events, and 28-day mortality. RESULTS Two hundred thirty-one patients were randomized and began the study (median age, 37 years; interquartile range (IQR): 32-44 years; 155 [67%] male), and 112 (48.5%) were assigned to the treatment group and 119 (51.5%) into the placebo group. The data and safety monitoring board recommended stopping enrolment because of futility at the interim analysis. The median time to viral clearance was 10 days (IQR: 6-12 days) in the favipiravir group and 8 days (IQR: 6-12 days) in the placebo group, with a hazard ratio of 0.87 for the favipiravir group (95% CI 0.571-1.326; p = 0.51). The median time to clinical recovery was 7 days (IQR: 4-11 days) in the favipiravir group and 7 days (IQR: 5-10 days) in the placebo group. There was no difference between the two groups in the secondary outcome of hospital admission. There were no drug-related severe adverse events. CONCLUSION In this clinical trial, favipiravir therapy in mild COVID-19 patients did not reduce the time to viral clearance within 15 days of starting the treatment.
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Affiliation(s)
- Mohammad Bosaeed
- Department of Medicine, King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Ahmad Alharbi
- Department of Medicine, King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ebrahim Mahmoud
- Department of Medicine, King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sanaa Alrehily
- King Fahad Hospital-Almadinah, Ministry of Health, Saudi Arabia
| | - Mohannad Bahlaq
- Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Zied Gaifer
- Department of Medicine, Prince Mohammed Bin Abdul Aziz Hospital-Almadinah, Ministry of National Guard Health Affairs, Saudi Arabia
| | | | - Khaled Alhagan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saad Alshahrani
- Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Ali Tolbah
- Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Abrar Musattat
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maha Alanazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Raniah Jaha
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khizra Sultana
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hajar Alqahtani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Kholoud Al Aamer
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saud Jaser
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alsaedy
- Department of Medicine, King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ayoub Ahmad
- Department of Medicine, King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Abalkhail
- Infection Prevention and Control Program, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sameera AlJohani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Majed Al Jeraisy
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sultan Almaziad
- Infection Prevention and Control Program, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Nahlah Albaalharith
- Department of Nursing, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | | | - Naif Khalaf Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fahad Alrabiah
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Majid Alshamrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Infection Prevention and Control Program, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Omar Aldibasi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Guo CM, Harari O, Chernecki C, Thorlund K, Forrest JI. Fluvoxamine for the Early Treatment of COVID-19: A Meta-analysis of Randomized Clinical Trials. Am J Trop Med Hyg 2022; 106:tpmd211310. [PMID: 35263710 PMCID: PMC9128689 DOI: 10.4269/ajtmh.21-1310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/21/2022] [Indexed: 11/07/2022] Open
Abstract
Fluvoxamine is widely prescribed as an antidepressant. Recent studies show the drug may have a clinical benefit in treating COVID-19. We aimed to perform a meta-analysis of the existing randomized trials of fluvoxamine compared with placebo on the early treatment of COVID-19 patients. We included only randomized clinical trials enrolling ambulatory patients with early-stage disease (symptoms > 7 days) for the prevention of hospitalization. We searched MEDLINE, and clinicaltrials.gov databases to identify trials and extract data with clarifications from the study investigators. We performed a fixed-effects meta-analysis and sensitivity analyses via R to evaluate the pooled estimate of hospitalization. We included three randomized trials: STOP COVID 1 and 2, and the TOGETHER Trial. The studies included a total of 2,196 patients. The STOP COVID trials measured clinical deterioration whereas the TOGETHER Trial measured hospitalization as the primary outcome. All trials reported on hospitalization up to day 28. The meta-analysis results show that patients receiving fluvoxamine were 31% less likely to experience clinical deterioration or hospitalization compared with placebo (risk ratio, 0.69; 95% CI, 0.54-0.88). A sensitivity analysis using the definition of hospitalization resulted in a risk reduction of 21% (95% CI, 0.60-1.03). Data from three randomized controlled trials show that fluvoxamine was associated with a reduction in the primary outcome measure (either clinical deterioration or composite outcome of hospitalization or extended emergency setting observation), although analysis of hospitalization-only was not statistically significant. More evidence from future trials is still needed to support the findings of this meta-analysis.
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Affiliation(s)
- Christina M. Guo
- Department of Public Health, University of Aberdeen, Aberdeen, Scotland
| | - Ofir Harari
- Cytel Inc., Vancouver, British Columbia, Canada
| | | | - Kristian Thorlund
- Cytel Inc., Vancouver, British Columbia, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jamie I. Forrest
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Chua PEY, Gwee SXW, Wang MX, Gui H, Pang J. Severe Acute Respiratory Syndrome Coronavirus 2 Diagnostic Tests for Border Screening During the Very Early Phase of Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:748522. [PMID: 35237618 PMCID: PMC8882616 DOI: 10.3389/fmed.2022.748522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during border screening among returning residents and prioritized travelers during the early phase of a pandemic can reduce the risk of importation and transmission in the community. This study aimed to compare the accuracy of various SARS-CoV-2 diagnostics and assess their potential utility as border screening for infection and immunity. Systematic literature searches were conducted in six electronic databases for studies reporting SARS-CoV-2 diagnostics (up to April 30, 2020). Meta-analysis and methodological assessment were conducted for all included studies. The performance of the diagnostic tests was evaluated with pooled sensitivity, specificity, and their respective 95% confidence intervals. A total of 5,416 unique studies were identified and 95 studies (at least 29,785 patients/samples) were included. Nucleic acid amplification tests (NAAT) consistently outperformed all other diagnostic methods regardless of the selected viral genes with a pooled sensitivity of 98% and a pooled specificity of 99%. Point-of-care (POC) serology tests had moderately high pooled sensitivity (69%), albeit lower than laboratory-based serology tests (89%), but both had high pooled specificity (96-98%). Serology tests were more sensitive for sampling collected at ≥ 7 days than ≤ 7 days from the disease symptoms onset. POC NAAT and POC serology tests are suitable for detecting infection and immunity against the virus, respectively as border screening. Independent validation in each country is highly encouraged with the preferred choice of diagnostic tool/s.
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Affiliation(s)
- Pearleen Ee Yong Chua
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Sylvia Xiao Wei Gwee
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Min Xian Wang
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Hao Gui
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
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Reis G, Dos Santos Moreira Silva EA, Medeiros Silva DC, Thabane L, Cruz Milagres A, Ferreira TS, Quirino Dos Santos CV, de Figueiredo Neto AD, Diniz Callegari E, Monteiro Savassi LC, Campos Simplicio MI, Barra Ribeiro L, Oliveira R, Harari O, Bailey H, Forrest JI, Glushchenko A, Sprague S, McKay P, Rayner CR, Ruton H, Guyatt GH, Mills EJ. Effect of early treatment with metformin on risk of emergency care and hospitalization among patients with COVID-19: The TOGETHER randomized platform clinical trial. LANCET REGIONAL HEALTH. AMERICAS 2022; 6:100142. [PMID: 34927127 PMCID: PMC8668402 DOI: 10.1016/j.lana.2021.100142] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Observational studies have postulated a therapeutic role of metformin in treating COVID-19. We conducted an adaptive platform clinical trial to determine whether metformin is an effective treatment for high-risk patients with early COVID-19 in an outpatient setting. Methods The TOGETHER Trial is a placebo-controled, randomized, platform clinical trial conducted in Brazil. Eligible participants were symptomatic adults with a positive antigen test for SARS-CoV-2. We enroled eligible patients over the age of 50 years or with a known risk factor for disease severity. Patients were randomly assigned to receive either placebo or metformin (750 mg twice daily for 10 days or placebo, twice daily for 10 days). The primary outcome was hospitalization defined as either retention in a COVID-19 emergency setting for > 6 h or transfer to tertiary hospital due to COVID-19 at 28 days post randomization. Secondary outcomes included viral clearance at day 7, time to hospitalization, mortality, and adverse drug reactions. We used a Bayesian framework to determine probability of success of the intervention compared to placebo. Findings The TOGETHER Trial was initiated June 2, 2020. We randomized patients to metformin starting January 15, 2021. On April 3, 2021, the Data and Safety Monitoring Committee recommended stopping enrollment into the metformin arm due to futility. We recruited 418 participants, 215 were randomized to the metformin arm and 203 to the placebo arm. More than half of participants (56.0%) were over the age of 50 years and 57.2% were female. Median age was 52 years. The proportion of patients with the primary outcome at 28 days was not different between the metformin and placebo group (relative risk [RR] 1.14[95% Credible Interval 0.73; 1.81]), probability of superiority 0.28. We found no significant differences between the metformin and placebo group on viral clearance through to day 7 (Odds ratio [OR], 0.99, 95% Confidence Intervals 0.88–1.11) or other secondary outcomes. Interpretation In this randomized trial, metformin did not provide any clinical benefit to ambulatory patients with COVID-19 compared to placebo, with respect to reducing the need for retention in an emergency setting or hospitalization due to worsening COVID-19. There were also no differences between metformin and placebo observed for other secondary clinical outcomes. Funding The trial was supported by FastGrants and The Rainwater Foundation.
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Affiliation(s)
- Gilmar Reis
- Research Division, Cardresearch Cardiologia Assistencial e de Pesquisa, Pontifícia Universidade Católica de Minas Gerais, Rua Domingos Vieira 300, Sala 606 Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil.,Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Brazil
| | | | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aline Cruz Milagres
- Public Health Care Division, Ibirité, Brazil.,Family Medicine, Mental and Public Health Department, Ouro Preto Federal University, Ouro Preto, Brazil
| | - Thiago Santiago Ferreira
- Research Division, Cardresearch Cardiologia Assistencial e de Pesquisa, Pontifícia Universidade Católica de Minas Gerais, Rua Domingos Vieira 300, Sala 606 Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil
| | - Castilho Vitor Quirino Dos Santos
- Research Division, Cardresearch Cardiologia Assistencial e de Pesquisa, Pontifícia Universidade Católica de Minas Gerais, Rua Domingos Vieira 300, Sala 606 Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil.,Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Brazil
| | - Adhemar Dias de Figueiredo Neto
- Public Health Fellowship Program, Governador Valadares Public Health Authority, Brazil.,Department of Medicine, Juiz de Fora Federal University, Juiz de Fora, Brazil
| | | | - Leonardo Cançado Monteiro Savassi
- Public Health Care Division, Ibirité, Brazil.,Family Medicine, Mental and Public Health Department, Ouro Preto Federal University, Ouro Preto, Brazil
| | - Maria Izabel Campos Simplicio
- Research Division, Cardresearch Cardiologia Assistencial e de Pesquisa, Pontifícia Universidade Católica de Minas Gerais, Rua Domingos Vieira 300, Sala 606 Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil
| | - Luciene Barra Ribeiro
- Research Division, Cardresearch Cardiologia Assistencial e de Pesquisa, Pontifícia Universidade Católica de Minas Gerais, Rua Domingos Vieira 300, Sala 606 Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil
| | - Rosemary Oliveira
- Research Division, Cardresearch Cardiologia Assistencial e de Pesquisa, Pontifícia Universidade Católica de Minas Gerais, Rua Domingos Vieira 300, Sala 606 Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil
| | - Ofir Harari
- Cytel Inc., Vancouver, British Columbia, Canada
| | | | - Jamie I Forrest
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alla Glushchenko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paula McKay
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Craig R Rayner
- Research Division, Cardresearch Cardiologia Assistencial e de Pesquisa, Pontifícia Universidade Católica de Minas Gerais, Rua Domingos Vieira 300, Sala 606 Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil.,Certara Inc. NJ, USA
| | - Hinda Ruton
- Cytel Inc., Vancouver, British Columbia, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Edward J Mills
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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10
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Affiliation(s)
| | - Harm Jan de Grooth
- Amsterdam Infection and Immunity Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam UMC, location VUmc, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, Amsterdam, The Netherlands
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11
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Reis G, Silva EADSM, Silva DCM, Thorlund K, Thabane L, Guyatt GH, Forrest JI, Glushchenko AV, Chernecki C, McKay P, Sprague S, Harari O, Ruton H, Rayner CR, Mills EJ. A multi-center, adaptive, randomized, platform trial to evaluate the effect of repurposed medicines in outpatients with early coronavirus disease 2019 (COVID-19) and high-risk for complications: the TOGETHER master trial protocol. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13304.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: There remains a need for an effective and affordable outpatient treatment for early COVID-19. Multiple repurposed drugs have shown promise in treating COVID-19. We describe a master protocol that will assess the efficacy of different repurposed drugs as treatments for early COVID-19 among outpatients at a high risk for severe complications. Methods: The TOGETHER Trial is a multi-center platform adaptive randomized, placebo-controlled, clinical trial. Patients are included if they are at least 18 years of age, have a positive antigen test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and have an indication for high risk of disease severity, including co-morbidities, older age, or high body mass index. Eligible patients are randomized with equal chance to an investigational product (IP) or to placebo.The primary endpoint is hospitalization defined as either retention in a COVID-19 emergency setting for greater than 6 hours or transfer to tertiary hospital due to COVID-19. Secondary outcomes include mortality, adverse events, adherence, and viral clearance. Scheduled interim analyses are conducted and reviewed by the Data and Safety Monitoring Committee (DSMC), who make recommendations on continuing or stopping each IP. The platform adaptive design go-no-go decision rules are extended to dynamically incorporate external evidence on COVID-19 interventions from ongoing independent randomized clinical trials. Discussion: Results from this trial will assist in the identification of therapeutics for the treatment of early diagnosed COVID-19. The novel methodological extension of the platform adaptive design to dynamically incorporate external evidence is one of the first of its kind and may provide highly valuable information for all COVID-19 trials going forward. Clinicaltrials.gov registration: NCT04727424 (27/01/2021)
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12
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Reis G, Silva EADSM, Silva DCM, Thorlund K, Thabane L, Guyatt GH, Forrest JI, Glushchenko AV, Chernecki C, McKay P, Sprague S, Harari O, Ruton H, Rayner CR, Mills EJ. A multi-center, adaptive, randomized, platform trial to evaluate the effect of repurposed medicines in outpatients with early coronavirus disease 2019 (COVID-19) and high-risk for complications: the TOGETHER master trial protocol. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13304.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Although vaccines are currently available for coronavirus disease 2019 (COVID-19), there remains a need for an effective and affordable outpatient treatment for early COVID-19. Multiple repurposed drugs have shown promise in treating COVID-19. We describe a master protocol that will assess the efficacy of different repurposed drugs as treatments for early COVID-19 among outpatients at a high risk for severe complications. Methods: The TOGETHER Trial is an international (currently in Brazil and Africa), multi-center platform adaptive randomized, placebo-controlled, clinical trial. Patients are included if they are at least 18 years of age, have a positive antigen test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and have an indication for high risk of disease severity, including co-morbidities, older age, or high body mass index. Eligible patients are randomized with equal chance to an investigational product (IP) or to placebo. The primary endpoint is hospitalization due to clinical worsening of COVID-19 or emergency room required observation for more than 6 hours up to 28 days after randomization. Key secondary endpoints include viral clearance, clinical improvement, hospitalization for any cause, mortality for any cause, and safety and tolerability of each IP. Scheduled interim analyses are conducted and reviewed by the Data and Safety Monitoring Committee (DSMC), who make recommendations on continuing or stopping each IP. The platform adaptive design go-no-go decision rules are extended to dynamically incorporate external evidence on COVID-19 interventions from ongoing independent randomized clinical trials. Discussion: Results from this trial will assist in the identification of therapeutics for COVID-19 that can easily be scaled in low- and middle-income settings. The novel methodological extension of the platform adaptive design to dynamically incorporate external evidence is one of the first of its kind and may provide highly valuable information for all COVID-19 trials going forward. Clinicaltrials.gov registration: NCT04727424 (27/01/2021)
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13
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Chen L, Chang K. A novel corpus-based computing method for handling critical word-ranking issues: An example of COVID-19 research articles. INT J INTELL SYST 2021; 36:3190-3216. [PMID: 38607844 PMCID: PMC8207067 DOI: 10.1002/int.22413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/10/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022]
Abstract
A corpus is a massive body of structured textual data that are stored and operated electronically. It usually combines with statistics, machine learning algorithms, or artificial intelligence (AI) technologies to explore the semantic relationship between lexical units, and beneficial when applied to language learning, information processing, translation, and so forth. In the face of a novel disease, like, COVID-19, establishing medical-specific corpus will enhance frontline medical personnel's information acquisition efficiency, guiding them on the right approaches to respond to and prevent the novel disease. To effectively retrieve critical messages from the corpus, appropriately handling word-ranking issues is quite crucial. However, traditional frequency-based approaches may cause bias in handling word-ranking issues because they neither optimize the corpus nor integrally take words' frequency dispersion and concentration criteria into consideration. Thus, this paper develops a novel corpus-based approach that combines a corpus software and Hirsch index (H-index) algorithm to handle the aforementioned issues simultaneously, making word-ranking processes more accurate. This paper compiled 100 COVID-19-related research articles as an empirical example of the target corpus. To verify the proposed approach, this study compared the results of two traditional frequency-based approaches and the proposed approach. The results indicate that the proposed approach can refine corpus and simultaneously compute words' frequency dispersion and concentration criteria in handling word-ranking issues.
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Affiliation(s)
- Liang‐Ching Chen
- Department of Foreign LanguagesR.O.C. Military AcademyKaohsiungTaiwan
- Institute of Education, National Sun Yat‐sen UniversityKaohsiungTaiwan
| | - Kuei‐Hu Chang
- Department of Management SciencesR.O.C. Military AcademyKaohsiungTaiwan
- Institute of Innovation and Circular Economy, Asia UniversityTaichungTaiwan
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14
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Zhou J, Lee S, Wang X, Li Y, Wu WKK, Liu T, Cao Z, Zeng DD, Leung KSK, Wai AKC, Wong ICK, Cheung BMY, Zhang Q, Tse G. Development of a multivariable prediction model for severe COVID-19 disease: a population-based study from Hong Kong. NPJ Digit Med 2021; 4:66. [PMID: 33833388 PMCID: PMC8032826 DOI: 10.1038/s41746-021-00433-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Recent studies have reported numerous predictors for adverse outcomes in COVID-19 disease. However, there have been few simple clinical risk scores available for prompt risk stratification. The objective is to develop a simple risk score for predicting severe COVID-19 disease using territory-wide data based on simple clinical and laboratory variables. Consecutive patients admitted to Hong Kong’s public hospitals between 1 January and 22 August 2020 and diagnosed with COVID-19, as confirmed by RT-PCR, were included. The primary outcome was composite intensive care unit admission, need for intubation or death with follow-up until 8 September 2020. An external independent cohort from Wuhan was used for model validation. COVID-19 testing was performed in 237,493 patients and 4442 patients (median age 44.8 years old, 95% confidence interval (CI): [28.9, 60.8]); 50% males) were tested positive. Of these, 209 patients (4.8%) met the primary outcome. A risk score including the following components was derived from Cox regression: gender, age, diabetes mellitus, hypertension, atrial fibrillation, heart failure, ischemic heart disease, peripheral vascular disease, stroke, dementia, liver diseases, gastrointestinal bleeding, cancer, increases in neutrophil count, potassium, urea, creatinine, aspartate transaminase, alanine transaminase, bilirubin, D-dimer, high sensitive troponin-I, lactate dehydrogenase, activated partial thromboplastin time, prothrombin time, and C-reactive protein, as well as decreases in lymphocyte count, platelet, hematocrit, albumin, sodium, low-density lipoprotein, high-density lipoprotein, cholesterol, glucose, and base excess. The model based on test results taken on the day of admission demonstrated an excellent predictive value. Incorporation of test results on successive time points did not further improve risk prediction. The derived score system was evaluated with out-of-sample five-cross-validation (AUC: 0.86, 95% CI: 0.82–0.91) and external validation (N = 202, AUC: 0.89, 95% CI: 0.85–0.93). A simple clinical score accurately predicted severe COVID-19 disease, even without including symptoms, blood pressure or oxygen status on presentation, or chest radiograph results.
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Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Xiansong Wang
- Li Ka Shing Institute of Health Sciences, Hong Kong, China
| | - Yi Li
- Department of Cardiothoracic Surgery, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Hubei, Wuhan, China
| | | | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhidong Cao
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Daniel Dajun Zeng
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Keith Sai Kit Leung
- Emergency Medicine Unit, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong, China.,Medicines Optimisation Research and Education (CMORE), UCL School of Pharmacy, London, United Kingdom
| | | | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China.
| | - Gary Tse
- Department of Cardiothoracic Surgery, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Hubei, Wuhan, China.
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15
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Reis G, Moreira Silva EADS, Medeiros Silva DC, Thabane L, Singh G, Park JJH, Forrest JI, Harari O, Quirino dos Santos CV, Guimarães de Almeida APF, de Figueiredo Neto AD, Savassi LCM, Milagres AC, Teixeira MM, Simplicio MIC, Ribeiro LB, Oliveira R, Mills EJ. Effect of Early Treatment With Hydroxychloroquine or Lopinavir and Ritonavir on Risk of Hospitalization Among Patients With COVID-19: The TOGETHER Randomized Clinical Trial. JAMA Netw Open 2021; 4:e216468. [PMID: 33885775 PMCID: PMC8063069 DOI: 10.1001/jamanetworkopen.2021.6468] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Data on the efficacy of hydroxychloroquine or lopinavir-ritonavir for the treatment of high-risk outpatients with COVID-19 in developing countries are needed. OBJECTIVE To determine whether hydroxychloroquine or lopinavir-ritonavir reduces hospitalization among high-risk patients with early symptomatic COVID-19 in an outpatient setting. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted in Brazil. Recently symptomatic adults diagnosed with respiratory symptoms from SARS-CoV-2 infection were enrolled between June 2 and September 30, 2020. The planned sample size was 1476 patients, with interim analyses planned after 500 patients were enrolled. The trial was stopped after the interim analysis for futility with a sample size of 685 patients. Statistical analysis was performed in December 2020. INTERVENTIONS Patients were randomly assigned to hydroxychloroquine (800 mg loading dose, then 400 mg daily for 9 days), lopinavir-ritonavir (loading dose of 800 mg and 200 mg, respectively, every 12 hours followed by 400 mg and 100 mg, respectively, every 12 hours for the next 9 days), or placebo. MAIN OUTCOMES AND MEASURES The primary outcomes were COVID-19-associated hospitalization and death assessed at 90 days after randomization. COVID-19-associated hospitalization was analyzed with a Cox proportional hazards model. The trial included the following secondary outcomes: all-cause hospitalization, viral clearance, symptom resolution, and adverse events. RESULTS Of 685 participants, 632 (92.3%) self-identified as mixed-race, 377 (55.0%) were women, and the median (range) age was 53 (18-94) years. A total of 214 participants were randomized to hydroxychloroquine; 244, lopinavir-ritonavir; and 227, placebo. At first interim analysis, the data safety monitoring board recommended stopping enrollment of both hydroxychloroquine and lopinavir-ritonavir groups because of futility. The proportion of patients hospitalized for COVID-19 was 3.7% (8 participants) in the hydroxychloroquine group, 5.7% (14 participants) in the lopinavir-ritonavir group, and 4.8% (11 participants) in the placebo group. We found no significant differences between interventions for COVID-19-associated hospitalization (hydroxychloroquine: hazard ratio [HR], 0.76 [95% CI, 0.30-1.88]; lopinavir-ritonavir: HR, 1.16 [95% CI, 0.53-2.56] as well as for the secondary outcome of viral clearance through day 14 (hydroxychloroquine: odds ratio [OR], 0.91 [95% CI, 0.82-1.02]; lopinavir-ritonavir: OR, 1.04 [95% CI, 0.94-1.16]). At the end of the trial, there were 3 fatalities recorded, 1 in the placebo group and 2 in the lopinavir-ritonavir intervention group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, neither hydroxychloroquine nor lopinavir-ritonavir showed any significant benefit for decreasing COVID-19-associated hospitalization or other secondary clinical outcomes. This trial suggests that expedient clinical trials can be implemented in low-income settings even during the COVID-19 pandemic. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04403100.
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Affiliation(s)
- Gilmar Reis
- Research Division, Cardresearch—Cardiologia Assistencial e de Pesquisa, Brazil
- Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Brazil
| | | | - Daniela Carla Medeiros Silva
- Research Division, Cardresearch—Cardiologia Assistencial e de Pesquisa, Brazil
- Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Brazil
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gurmit Singh
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jay J. H. Park
- Experimental Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Cytel Inc, Vancouver, British Columbia, Canada
| | - Jamie I. Forrest
- Experimental Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Cytel Inc, Vancouver, British Columbia, Canada
| | - Ofir Harari
- Cytel Inc, Vancouver, British Columbia, Canada
| | - Castilho Vitor Quirino dos Santos
- Research Division, Cardresearch—Cardiologia Assistencial e de Pesquisa, Brazil
- Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Brazil
| | | | | | | | - Aline Cruz Milagres
- Public Health, Mental and Family Medicine Department, Ouro Preto Federal University, Ouro Preto, Brazil
- Public Health Care Division, City of Ibirité, Brazil
| | - Mauro Martins Teixeira
- Drug Research and Development Center, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Rosemary Oliveira
- Research Division, Cardresearch—Cardiologia Assistencial e de Pesquisa, Brazil
| | - Edward J. Mills
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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16
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Silveira MAD, De Jong D, Berretta AA, Galvão EBDS, Ribeiro JC, Cerqueira-Silva T, Amorim TC, Conceição LFMRD, Gomes MMD, Teixeira MB, Souza SPD, Santos MHCAD, San Martin RLA, Silva MDO, Lírio M, Moreno L, Sampaio JCM, Mendonça R, Ultchak SS, Amorim FS, Ramos JGR, Batista PBP, Guarda SNFD, Mendes AVA, Passos RDH. Efficacy of Brazilian green propolis (EPP-AF®) as an adjunct treatment for hospitalized COVID-19 patients: A randomized, controlled clinical trial. Biomed Pharmacother 2021; 138:111526. [PMID: 34311528 PMCID: PMC7980186 DOI: 10.1016/j.biopha.2021.111526] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) promotes challenging immune and inflammatory phenomena. Though various therapeutic possibilities have been tested against coronavirus disease 2019 (COVID-19), the most adequate treatment has not yet been established. Propolis is a natural product with considerable evidence of immunoregulatory and anti-inflammatory activities, and experimental data point to potential against viral targets. We hypothesized that propolis can reduce the negative effects of COVID-19. Methods In a randomized, controlled, open-label, single-center trial, hospitalized adult COVID-19 patients were treated with a standardized green propolis extract (EPP-AF®️) as an adjunct therapy. Patients were allocated to receive standard care plus an oral dose of 400 mg or 800 mg/day of green propolis for seven days, or standard care alone. Standard care included all necessary interventions, as determined by the attending physician. The primary end point was the time to clinical improvement, defined as the length of hospital stay or oxygen therapy dependency duration. Secondary outcomes included acute kidney injury and need for intensive care or vasoactive drugs. Patients were followed for 28 days after admission. Results We enrolled 124 patients; 40 were assigned to EPP-AF®️ 400 mg/day, 42 to EPP-AF®️ 800 mg/day, and 42 to the control group. The length of hospital stay post-intervention was shorter in both propolis groups than in the control group; lower dose, median 7 days versus 12 days (95% confidence interval [CI] −6.23 to −0.07; p = 0.049) and higher dose, median 6 days versus 12 days (95% CI −7.00 to −1.09; p = 0.009). Propolis did not significantly affect the need for oxygen supplementation. In the high dose propolis group, there was a lower rate of acute kidney injury than in the controls (4.8 vs 23.8%), (odds ratio [OR] 0.18; 95% CI 0.03–0.84; p = 0.048). No patient had propolis treatment discontinued due to adverse events. Conclusions Addition of propolis to the standard care procedures resulted in clinical benefits for the hospitalized COVID-19 patients, especially evidenced by a reduction in the length of hospital stay. Consequently, we conclude that propolis can reduce the impact of COVID-19.
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Affiliation(s)
- Marcelo Augusto Duarte Silveira
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil.
| | - David De Jong
- Genetics Department, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, SP 14049-900, Brazil
| | - Andresa Aparecida Berretta
- Research, Development and Innovation Department, Apis Flora Indl. Coml. Ltda, Rua Triunfo 945, Subsetor Sul 3, Ribeirão Preto, SP 14020-670, Brazil
| | - Erica Batista Dos Santos Galvão
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Juliana Caldas Ribeiro
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil; Universidade de Salvador - UNIFACS, Avenida Luís Viana, 3100-3146 Pituaçu, Imbuí, Salvador 41720-200, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, EBMSP, Av. Dom João VI, 275 - Brotas, Salvador 40290-000, BA, Brazil
| | - Thiago Cerqueira-Silva
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Rua Waldemar Falcão 121, Candeal, Salvador 40296-710, BA, Brazil; School of Medicine, Federal University of Bahia, Rua Augusto Viana s/n, Canela, Salvador 40110-909, BA, Brazil
| | - Thais Chaves Amorim
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | | | - Marcel Miranda Dantas Gomes
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Maurício Brito Teixeira
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, EBMSP, Av. Dom João VI, 275 - Brotas, Salvador 40290-000, BA, Brazil; Universidade do Estado da Bahia (UNEB), Rua Silveira Martin 2555, Cabula, Salvador 41150-000, BA , Brazil
| | - Sergio Pinto de Souza
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, EBMSP, Av. Dom João VI, 275 - Brotas, Salvador 40290-000, BA, Brazil
| | | | - Raissa Lanna Araújo San Martin
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Márcio de Oliveira Silva
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Monique Lírio
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Lis Moreno
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Julio Cezar Miranda Sampaio
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Renata Mendonça
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Silviana Salles Ultchak
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Fabio Santos Amorim
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - João Gabriel Rosa Ramos
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Paulo Benigno Pena Batista
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Suzete Nascimento Farias da Guarda
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil; School of Medicine, Federal University of Bahia, Rua Augusto Viana s/n, Canela, Salvador 40110-909, BA, Brazil
| | - Ana Verena Almeida Mendes
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
| | - Rogerio da Hora Passos
- D'Or Institute for Research and Education (IDOR), Hospital São Rafael, Avenida São Rafael 2152, São Marcos, Salvador 41253-190, BA, Brazil
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Mattoli S. Filling the Gap Until Full Vaccine Deployment in the War on Coronavirus Disease-19. Infect Dis Ther 2021; 10:27-34. [PMID: 33420955 PMCID: PMC7796690 DOI: 10.1007/s40121-020-00394-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 12/05/2022] Open
Abstract
The authorization for emergency use of a vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been issued in diverse countries in December 2020, and additional vaccine candidates soon may be cleared for a similar emergency use. If it is reasonable to believe that in some Western countries most people may be vaccinated by the end of 2021, insufficient supplies, access inequities across countries, and deficiencies in enforcing the participatory engagement of communities will present important challenges for the achievement of sufficient vaccination coverage worldwide in less than 2–3 years. A possible strategy for bridging the gap until full vaccine deployment is based on the integration of improved non-pharmaceutical measures and recently authorized pharmaceutical interventions to reduce as much as possible hospitalizations and deaths in the coming months, when recurring infection peaks are expected.
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Affiliation(s)
- Sabrina Mattoli
- Center of Expertise in Research and Innovation of the International Network for the Advancement of Viable Applicable Innovations in Life Sciences (InAvail), Basel, Switzerland. .,Avail Biomedical Research Institute, Munich, Germany.
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