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Molaei E, Molaei A, Hayes AW, Karimi G. Remdesivir: treatment of COVID-19 in special populations. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:3829-3855. [PMID: 38180557 DOI: 10.1007/s00210-023-02927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Abstract
Remdesivir (RDV) is the mainstay antiviral therapy for moderate to severe COVID-19. Although remdesivir was the first drug approved for COVID-19, information about its efficacy and safety profile is limited in a significant segment of the population, such as people with underlying diseases, the elderly, children, and pregnant and lactating women. The efficacy and safety profile of RDV in disease progression, renal impairment, liver impairment, immunosuppression, geriatrics, pediatrics, pregnancy, and breastfeeding in COVID-19 patients was evaluated. The databases searched included Embase, Scopus, and PubMed. Only English language studies enrolling specific subpopulations with COVID-19 and treated with RDV were included. Thirty-nine clinical trials, cohorts, cross-sectional studies, and case series/reports were included. Most supported the benefits of RDV therapy for COVID-19 patients, such as lessening the duration of hospitalization, alleviating respiratory complications, and reducing mortality. Adverse effects of RDV, including liver and kidney impairment, were, for the most part, moderate to mild, supporting the safety profile of RDV therapy. RDV therapy was well tolerated, no new safety signals were detected, and liver function test abnormalities were the most common adverse events. Moreover, RDV, for the most part, was effective in managing the complications of COVID-19 and reducing mortality in these patients, except for patients with kidney impairment. Future studies, including RCTs, should include these subpopulations of patients to avoid delays associated with receiving proper medication through compassionate use programs.
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Affiliation(s)
- Emad Molaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Molaei
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Wallace Hayes
- University of South Florida College of Public Health, Tampa, FL, USA
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA
| | - Gholamreza Karimi
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Pharmacodynamics and Toxicology, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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2
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Tomasicchio M, Jaumdally S, Wilson L, Kotze A, Semple L, Meier S, Pooran A, Esmail A, Pillay K, Roberts R, Kriel R, Meldau R, Oelofse S, Mandviwala C, Burns J, Londt R, Davids M, van der Merwe C, Roomaney A, Kühn L, Perumal T, Scott AJ, Hale MJ, Baillie V, Mahtab S, Williamson C, Joseph R, Sigal A, Joubert I, Piercy J, Thomson D, Fredericks DL, Miller MGA, Nunes MC, Madhi SA, Dheda K. SARS-CoV-2 Viral Replication Persists in the Human Lung for Several Weeks after Symptom Onset. Am J Respir Crit Care Med 2024; 209:840-851. [PMID: 38226855 PMCID: PMC10995573 DOI: 10.1164/rccm.202308-1438oc] [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: 08/17/2023] [Accepted: 01/12/2024] [Indexed: 01/17/2024] Open
Abstract
Rationale: In the upper respiratory tract, replicating (culturable) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is recoverable for ∼4-8 days after symptom onset, but there is a paucity of data about the frequency and duration of replicating virus in the lower respiratory tract (i.e., the human lung).Objectives: We undertook lung tissue sampling (needle biopsy) shortly after death in 42 mechanically ventilated decedents during the Beta and Delta waves. An independent group of 18 ambulatory patients served as a control group.Methods: Lung biopsy cores from decedents underwent viral culture, histopathological analysis, electron microscopy, transcriptomic profiling, and immunohistochemistry.Measurements and Main Results: Thirty-eight percent (16 of 42) of mechanically ventilated decedents had culturable virus in the lung for a median of 15 days (persisting for up to 4 wk) after symptom onset. Lung viral culture positivity was not associated with comorbidities or steroid use. Delta but not Beta variant lung culture positivity was associated with accelerated death and secondary bacterial infection (P < 0.05). Nasopharyngeal culture was negative in 23.1% (6 of 26) of decedents despite lung culture positivity. This hitherto undescribed biophenotype of lung-specific persisting viral replication was associated with an enhanced transcriptomic pulmonary proinflammatory response but with concurrent viral culture positivity.Conclusions: Concurrent rather than sequential active viral replication continues to drive a heightened proinflammatory response in the human lung beyond the second week of illness and was associated with variant-specific increased mortality and morbidity. These findings have potential implications for the design of interventional strategies and clinical management of patients with severe coronavirus disease (COVID-19).
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Affiliation(s)
- Michele Tomasicchio
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Shameem Jaumdally
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Lindsay Wilson
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Andrea Kotze
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Lynn Semple
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Stuart Meier
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Anil Pooran
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Komala Pillay
- Division of Anatomical Pathology, Department of Pathology, and
| | - Riyaadh Roberts
- Division of Anatomical Pathology, Department of Pathology, and
| | - Raymond Kriel
- Division of Anatomical Pathology, Department of Pathology, and
| | - Richard Meldau
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Suzette Oelofse
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Carley Mandviwala
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Jessica Burns
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Rolanda Londt
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Malika Davids
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Charnay van der Merwe
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Aqeedah Roomaney
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Louié Kühn
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Tahlia Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Alex J. Scott
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | | | - Vicky Baillie
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, and
- Department of Science and Technology/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, and
- Department of Science and Technology/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Alex Sigal
- Africa Health Research Institute, Durban, South Africa; and
| | - Ivan Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenna Piercy
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - David Thomson
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - David L. Fredericks
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Malcolm G. A. Miller
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Marta C. Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, and
- Department of Science and Technology/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre of Excellence in Respiratory Pathogens, Hospices Civils de Lyon and Centre International de Recherche en Infectiologie, Équipe Santé Publique, Épidémiologie et Écologie Évolutive des Maladies Infectieuses, Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard – Lyon 1, Lyon, France
| | - Shabir A. Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, and
- Department of Science and Technology/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
- Institute of Infectious Disease and Molecular Medicine
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Chen C, Fang J, Chen S, Rajaofera MJN, Li X, Wang B, Xia Q. The efficacy and safety of remdesivir alone and in combination with other drugs for the treatment of COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:672. [PMID: 37814214 PMCID: PMC10563317 DOI: 10.1186/s12879-023-08525-0] [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: 10/10/2022] [Accepted: 08/09/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Remdesivir is considered to be a specific drug for treating coronavirus disease 2019. This systematic review aims to evaluate the clinical efficacy and risk of remdesivir alone and in combination with other drugs. RESEARCH DESIGN AND METHODS The PubMed, Embase, SCIE, Cochrane Library, and American Clinical trial Center databases were searched up to 1 April 2022 to identify. Randomized controlled trials (RCTs) and observational studies comparing the efficacy of remdesivir monotherapy and combination therapy with that of control drugs. RESULTS Ten RCTs and 32 observational studies were included in the analysis. Regarding the primary outcome, remdesivir use reduced mortality in patients with severe COVID-19 (RR = 0.57, 95% CI (0.48,0.68)) and shortened the time to clinical improvement (MD = -2.51, 95% CI (-2.75, -2.28)). Regarding other clinical outcomes, remdesivir use was associated with improved clinical status (RR = 1.08, 95%CI (1.01, 1.17)). Regarding safety outcomes, remdesivir use did not cause liver or kidney damage (RR = 0.87, 95%CI (0.68, 1.11)) (RR = 0.88, 95%CI (0.70,1.10)). Compared with remdesivir alone, remdesivir combined with other drugs (e.g., steroids, favipiravir, and convalescent plasma) had no effect on mortality. CONCLUSION The use of remdesivir can help to reduce the mortality of patients with severe COVID-19 and shorten the time to clinical improvement. There was no benefit of remdesivir combination therapy for other clinical outcomes. TRIAL REGISTRATION PROSPERO registration number: CRD42022322859.
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Affiliation(s)
- Chuizhe Chen
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Junde Fang
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
- The First Clinical College, Hainan Medical University, Haikou, China
| | - Shu Chen
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Mamy Jayne Nelly Rajaofera
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Xuemiao Li
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Bo Wang
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China.
| | - Qianfeng Xia
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China.
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Yasir M, Lankala CR, Kalyankar P, Ishak A, Mekhail M, Sestacovschi C, Kima E. An Updated Systematic Review on Remdesivir's Safety and Efficacy in Patients Afflicted With COVID-19. Cureus 2023; 15:e43060. [PMID: 37680394 PMCID: PMC10481368 DOI: 10.7759/cureus.43060] [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: 05/31/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023] Open
Abstract
Globally, the coronavirus disease 2019 (COVID-19) had a significant impact on everyone's lives and put a tremendous strain on healthcare systems. Since the outbreak began, remdesivir has been investigated as a potential treatment for COVID-19 that may be both effective and safe. Remdesivir has had a huge impact on the disease's progression, complications, and mortality. This review provides an updated assessment of the literature regarding remdesivir's efficacy and safety for the treatment of patients with COVID-19. The search was performed through PubMed, Web of Science, Cochrane, and Scopus for articles published from 2019 to September 20, 2022. Studies that assessed remdesivir's efficacy and safety were included in this review, with clinical improvements as the primary outcome measure. Seventeen studies were identified following the implementation of the search strategy. Among them, 11 corroborated remdesivir's efficacy. Meanwhile, the remaining six studies did not observe a statistically significant difference in clinical improvement. Remdesivir is a potentially safe and effective antiviral that shows clinical improvement especially when used during the early course of the disease. However, current literature still questions its safety in patients who are afflicted with the complications of COVID-19, highlighting the need for studies on a large scale.
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Affiliation(s)
- Mohamed Yasir
- Division of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Pravin Kalyankar
- Department of Internal Medicine, Fortis Escorts Hospital, Faridabad, IND
| | - Angela Ishak
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Mario Mekhail
- Department of Internal Medicine, New York University (NYU) Langone Long Island Community Hospital, New York, USA
| | | | - Elias Kima
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
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5
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Hajimoradi M, Sharif Kashani B, Dastan F, Aghdasi S, Abedini A, Naghashzadeh F, Mohamadifar A, Keshmiri MS, Noorali S, Lookzadeh S, Alizadeh N, Siri MA, Tavasolpanahi M, Abdolmohammadi Y, Shafaghi M, Rouhani ZS, Shafaghi S. Remdesivir associated sinus bradycardia in patients with COVID-19: A prospective longitudinal study. Front Pharmacol 2023; 13:1107198. [PMID: 36733376 PMCID: PMC9888491 DOI: 10.3389/fphar.2022.1107198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Remdesivir is effective against SARS-Cov-2 with little evidence of its adverse effect on the cardiac system. The aim of the present study is investigating the incidence of bradycardia in COVID-19 patients treated with Remdesivir. Methods: This prospective longitudinal study was conducted in a tertiary center on COVID-19 patients for Remdesivir therapy. The objectives were to investigate the incidence of sinus bradycardia, and also the association between their demographics, underlying diseases, and the disease severity with developing bradycardia in COVID-19 patients treated with Remdesivir. Results: Of 177 patients, 44% were male. The mean (±standard deviation) age of patients was 49.79 ± 15.16 years old. Also, 33% were hospitalized due to more severe symptoms. Oxygen support was required for all hospitalized subjects. A total of 40% of the patients had comorbidities, with the most common comorbidity being hypertension. The overall incidence of bradycardia (heart rate<60 bpm) in patients receiving Remdesivir was 27%, of whom 70% had extreme bradycardia (heart rate <50 bpm). There was also a statistically significant reduction in heart rate after five doses of Remdesivir compared to the baseline heart rates. In the multivariable model, none of the covariates including age above 60 years, female sex, CRP>50 mg/L, O2 saturation<90%, underlying cardiovascular disease, hypertension and diabetes mellitus, and beta-blockers were associated with Remdesivir-induced bradycardia. No association was found between the COVID-19 severity indicators and bradycardia. Conclusion: As sinus bradycardia is a prevalent adverse cardiac effect of Remdesivir, it is recommended that all COVID-19 patients receiving Remdesivir, be evaluated for heart rate based on examination; and in the case of bradyarrhythmia, cardiac monitoring should be performed during administration to prevent adverse drug reactions.
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Affiliation(s)
- Maryam Hajimoradi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif Kashani
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Dastan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Aghdasi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naghashzadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Mohamadifar
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Keshmiri
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima Noorali
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Lookzadeh
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Alizadeh
- Department of Biostatistics, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Siri
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadali Tavasolpanahi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yazdan Abdolmohammadi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Shafaghi
- Strategic Planning and Executive Office Manager of International Federation of Inventors' Associations-IFIA, Geneva, Switzerland
| | - Zahra Sadat Rouhani
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Shadi Shafaghi,
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Elly USMAN, Yusticia KATAR. THE ROLE OF AGE AND COMORBIDITIES ON THE OUTCOME OF CONFIRMED CLINICALLY CRITICAL COVID-19 PATIENTS TREATED WITH REMDESIVIR AT INDONESIA'S NATIONAL REFERRAL HOSPITAL. Afr J Infect Dis 2022; 17:55-59. [PMID: 36756490 PMCID: PMC9885022 DOI: 10.21010/ajidv17i1.5] [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: 11/17/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background There is currently no viable pharmaceutical therapy for COVID-19 illness that has been validated. The use of remdesivir is one of the medications for which there is no consistent evidence of a significant therapeutic benefit or a meaningful effect on survival. Aim The aim of this study was to determine the role of age and comorbidities on the outcome of confirmed clinically critical COVID-19 patients treated with remdesivir at Indonesia's National Referral Hospital. Methods A retrospective cohort study was used in this study. The subjects in this study were confirmed clinically critical COVID-19 patients who were treated at Dr. M Djamil Hospital Padang, one of Indonesia's national referral hospitals, from January 2 to June 30, 2021. The number of sample size in this study was 90 patients. The variables of this study were divided into three independent variables (age, comorbidities, and a number of comorbidities). A dependent variable was the outcome of confirmed clinically critical COVID-19 patients. The Chi-square test was performed in bivariate analysis, and the odds ratio was calculated. SPSS version 17.0 was used to analyze the data. Results The results of this study found that there was an association between ages 50-59 years (OR = 10.23, 95% CI 1.89-55.53), 60-69 years (OR = 4.58, 95% CI 1.25-16.76), and > 70 years (OR = 1.91, 95% CI 1.38 -9.59), comorbid diabetes mellitus (OR = 9.78, 95% CI 1.23-77.66), the number of comorbid > 1 (OR = 10.97, 95% CI 2.19-54.96, and the number of comorbid 1 (OR = 5.69, 95% CI 1.59- 20.41) with the outcome of confirmed clinically critical COVID-19 patients treated with remdesivir. Conclusion The significance of age and comorbidities on the outcome of COVID-19 patients treated with remdesivir at Indonesia's national referral hospital was confirmed in this study. This study could assist in the management of patient therapy, potentially decreasing morbidity and even patient mortality.
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Affiliation(s)
- USMAN Elly
- Department of Pharmacology, Faculty of Medicine, Universitas Andalas, Padang, Indonesia,Corresponding author E-mail:
| | - KATAR Yusticia
- Department of Pharmacology, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
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Sharun K, Tiwari R, Yatoo MI, Natesan S, Megawati D, Singh KP, Michalak I, Dhama K. A comprehensive review on pharmacologic agents, immunotherapies and supportive therapeutics for COVID-19. NARRA J 2022; 2:e92. [PMID: 38449903 PMCID: PMC10914132 DOI: 10.52225/narra.v2i3.92] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/06/2022] [Indexed: 03/08/2024]
Abstract
The emergence of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected many countries throughout the world. As urgency is a necessity, most efforts have focused on identifying small molecule drugs that can be repurposed for use as anti-SARS-CoV-2 agents. Although several drug candidates have been identified using in silico method and in vitro studies, most of these drugs require the support of in vivo data before they can be considered for clinical trials. Several drugs are considered promising therapeutic agents for COVID-19. In addition to the direct-acting antiviral drugs, supportive therapies including traditional Chinese medicine, immunotherapies, immunomodulators, and nutritional therapy could contribute a major role in treating COVID-19 patients. Some of these drugs have already been included in the treatment guidelines, recommendations, and standard operating procedures. In this article, we comprehensively review the approved and potential therapeutic drugs, immune cells-based therapies, immunomodulatory agents/drugs, herbs and plant metabolites, nutritional and dietary for COVID-19.
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Affiliation(s)
- Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, UP Pandit Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura, India
| | - Mohd I. Yatoo
- Division of Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, Alusteng Srinagar, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shalimar, Jammu and Kashmir, India
| | - Senthilkumar Natesan
- Department of Infectious Diseases, Indian Institute of Public Health Gandhinagar, Opp to Airforce station HQ, Gandhinagar, India
| | - Dewi Megawati
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Warmadewa University, Denpasar, Indonesia
- Department of Medical Microbiology and Immunology, University of California, Davis, California, USA
| | - Karam P. Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Izabela Michalak
- Faculty of Chemistry, Department of Advanced Material Technologies, Wrocław University of Science and Technology, Wrocław, Poland
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
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Hanafusa M, Nawa N, Goto Y, Kawahara T, Miyamae S, Ueki Y, Nosaka N, Wakabayashi K, Tohda S, Tateishi U, Fujiwara T. Effectiveness of remdesivir with corticosteroids for COVID-19 patients in intensive care unit: A hospital-based observational study. J Med Virol 2022; 95:e28168. [PMID: 36148941 PMCID: PMC9538844 DOI: 10.1002/jmv.28168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/03/2022] [Accepted: 09/21/2022] [Indexed: 01/11/2023]
Abstract
The effectiveness of remdesivir on survival in coronavirus disease 2019 (COVID-19), especially in cases treated in the intensive care unit (ICU), is controversial. We investigated the effectiveness of remdesivir with corticosteroids on the survival of COVID-19 patients in a real ICU clinical practice. For laboratory-confirmed COVID-19 patients admitted to the ICU of a tertiary hospital in Tokyo (April 2020-November 2021) and who received corticosteroids, the effectiveness of remdesivir for survival, stratified by interval length (within 9 or 10+ days), was retrospectively analyzed using Cox regression model. A total of 168 patients were included: 35 with no remdesivir use (control), 96 with remdesivir use within 9 days, and 37 with remdesivir use with an interval of 10+ days. In-hospital mortality was 45.7%, 10.4%, and 16.2%, respectively. After adjusting for possible covariates including comorbidities, laboratory data, oxygen demand, or level of pneumonia, remdesivir use within 9 days from symptom onset reduced mortality risk (hazard ratio [HR]: 0.10; 95% confidence interval (CI): 0.025-0.428) compared to the control group. However, remdesivir use with an interval of 10+ days showed no significant association with mortality (HR: 0.42; 95% CI: 0.117-1.524). Among COVID-19 patients who received corticosteroids in ICU, remdesivir use within 9 days from symptom onset was associated with reduced in-hospital mortality risk.
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Affiliation(s)
- Mariko Hanafusa
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
| | - Nobutoshi Nawa
- Department of Medical Education Research and DevelopmentTokyo Medical and Dental UniversityTokyoJapan
| | - Yuki Goto
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
| | - Tomoki Kawahara
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
| | - Shigeru Miyamae
- Disaster Medical Care OfficeTokyo Medical and Dental UniversityTokyoJapan
| | - Yutaka Ueki
- Department of Trauma and Acute Critical Care Medical CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Nobuyuki Nosaka
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Kenji Wakabayashi
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Shuji Tohda
- Department of Clinical Laboratory, Medical HospitalTokyo Medical and Dental UniversityTokyoJapan
| | - Ukihide Tateishi
- Department of Diagnostic RadiologyTokyo Medical and Dental UniversityTokyoJapan
| | - Takeo Fujiwara
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
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9
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Sellitto C, Corbi G, Bertini N, Ascione T, Costantino M, Scarpati G, Piazza O, Filippelli A, Conti V, Pagliano P. Effect of remdesivir on mortality rate and clinical status of COVID-19 patients: a systematic review with meta-analysis. J Chemother 2022:1-14. [PMID: 36102273 DOI: 10.1080/1120009x.2022.2121091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Remdesivir (RDV) is a broad-spectrum antiviral drug, now approved by Regulatory Agencies for COVID-19 treatment. RDV is associated with improvements in clinical outcomes, but no conclusive studies have shown an effect in reducing mortality. This study aimed to carry out a systematic review with meta-analysis to investigate whether RDV can significantly modify the outcome of COVID-19 patients evaluating its effects on mortality, length of stay, time to clinical improvement and need for oxygen supplementation. No significant improvement in terms of survival in patients treated with standard therapy (ST)+RDV as compared to ST alone (P = 0.24) was found. The duration of oxygen support was significantly lower in patients treated with ST + RDV compared with ST alone (P = 0.03). Further investigations should be planned to assess the real impact of RDV in the management of COVID-19 patients.
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Affiliation(s)
- Carmine Sellitto
- Unit of Pharmacology, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Nicola Bertini
- Unit of Pharmacology, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Tiziana Ascione
- Department of Medicine, Service of Infectious Diseases, Cardarelli Hospital, Naples, Italy
| | - Maria Costantino
- Unit of Pharmacology, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
- Association Non-Profit F.I.R.S.Thermae (Interdisciplinary Training, Researches and Spa Sciences), Naples, Italy
| | - Giuliana Scarpati
- Unit of Anesthesiology, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Ornella Piazza
- Unit of Anesthesiology, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Amelia Filippelli
- Unit of Pharmacology, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Valeria Conti
- Unit of Pharmacology, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Pasquale Pagliano
- Unit of Infectious Diseases, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
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10
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Remdesivir plus Dexamethasone in COVID-19: A cohort study of severe patients requiring high flow oxygen therapy or non-invasive ventilation. PLoS One 2022; 17:e0267038. [PMID: 35482703 PMCID: PMC9049343 DOI: 10.1371/journal.pone.0267038] [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: 11/26/2021] [Accepted: 03/31/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Remdesivir and Dexamethasone represent the cornerstone of therapy for critically ill patients with acute hypoxemic respiratory failure caused by Coronavirus Disease 2019 (COVID-19). However, clinical efficacy and safety of concomitant administration of Remdesivir and Dexamethasone (Rem-Dexa) in severe COVID-19 patients on high flow oxygen therapy (HFOT) or non-invasive ventilation (NIV) remains unknown. Materials and methods Prospective cohort study that was performed in two medical Intensive Care Units (ICUs) of a tertiary university hospital. The clinical impact of Rem-Dexa administration in hypoxemic patients with COVID-19, who required NIV or HFOT and selected on the simplified acute physiology score II, the sequential organ failure assessment score and the Charlson Comorbidity Index score, was investigated. The primary outcome was 28-day intubation rate; secondary outcomes were end-of-treatment clinical improvement and PaO2/FiO2 ratio, laboratory abnormalities and clinical complications, ICU and hospital length of stay, 28-day and 90-day mortality. Results We included 132 patients and found that 28-day intubation rate was significantly lower among Rem-Dexa group (19.7% vs 48.5%, p<0.01). Although the end-of-treatment clinical improvement was larger among Rem-Dexa group (69.7% vs 51.5%, p = 0.05), the 28-day and 90-day mortalities were similar (4.5% and 10.6% vs. 15.2% and 16.7%; p = 0.08 and p = 0.45, respectively). The logistic regression and Cox-regression models showed that concomitant Rem-Dexa therapy was associated with a reduction of 28-day intubation rate (OR 0.22, CI95% 0.05–0.94, p = 0.04), in absence of laboratory abnormalities and clinical complications (p = ns). Conclusions In COVID-19 critically ill patients receiving HFO or NIV, 28-day intubation rate was lower in patients who received Rem-Dexa and this finding corresponded to lower end-of-treatment clinical improvement. The individual contribution of either Remdesevir or Dexamethasone to the observed clinical effect should be further investigated.
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11
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Development of Evidence-Based COVID-19 Management Guidelines for Local Context: The Methodological Challenges. Glob Health Epidemiol Genom 2022; 2022:4240378. [PMID: 35492871 PMCID: PMC9020141 DOI: 10.1155/2022/4240378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has presented as a therapeutic challenge for clinicians worldwide due to its rapid spread along with evolving evidence and understanding of the disease. Internationally, recommendations to guide the management of COVID-19 have been created and updated continuously by the WHO and CDC, which have been locally adapted by different countries. Similarly, Pakistan's National Command Operation Center (NCOC), in its national COVID-19 management strategy, generated guidelines for national implementation. Keeping the guidelines updated has proved challenging globally and locally. Here, we present a summary of the process to assess the evidence, including a time-restricted systematic review based on NCOC Clinical Management Guidelines for COVID-19 Infections v4 published on 11th December 2020 version, correlating it with current recommendations and with input one of the guidelines authors, particularly noting the methodological challenges. Methods We conducted a systematic review synthesizing global research on treatment options for COVID-19 hospitalized patients, limiting it to pharmacological interventions for hospitalized COVID-19 patients included in Pakistan's NCOC's national guidelines v4 published on 11th December 2020. Each treatment recommendation's strength and quality of evidence was assessed based on the grading of recommendations assessment, development, and evaluation (GRADE) methodology. These were then compared to the most current living WHO COVID-19 pharmacological treatment guidelines v7.1. One of the authors of the NCOC guidelines reviewed and commented on the findings as well. Results We note that the data from our systematic review strongly supports corticosteroids use in treating severe and critically ill COVID-19 hospitalized patients correlating with WHO v7.1 guidelines 24 September 2021. However, evidence from our review and WHO v7.1 for the use of tocilizumab had some conflicting evidence, with data from our review until December 2020 supporting only a weak recommendation for its use, compared to the strong recommendation by the WHO for the use of tocilizumab in patients with severe or critical COVID-19 infection. Regarding the use of antibiotics and ivermectin use in treating COVID-19 hospitalized patients, data from our review and WHO v 7.1 recommend against their use. Conclusion Research data about the efficacy and safety of pharmacological interventions to treat hospitalized patients with COVID-19 are rapidly evolving, and based on it, the evidence for or against recommendations changes accordingly. Our study illustrates the challenges of keeping up with the evidence; the recommendations were based on studies up till December 2021, and we have compared our recommendations with the WHO v7.1, which showed some significant changes in the use of pharmacological treatment options.
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12
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He X, Zeng XX. Immunotherapy and CRISPR Cas Systems: Potential Cure of COVID-19? Drug Des Devel Ther 2022; 16:951-972. [PMID: 35386853 PMCID: PMC8979261 DOI: 10.2147/dddt.s347297] [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: 11/01/2021] [Accepted: 03/16/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 has plunged the world into a pandemic that affected millions. The continually emerging new variants of concern raise the question as to whether the existing vaccines will continue to provide sufficient protection for individuals from SARS-CoV-2 during natural infection. This narrative review aims to briefly outline various immunotherapeutic options and discuss the potential of clustered regularly interspaced short palindromic repeat (CRISPR Cas system technology against COVID-19 treatment as specific cure. As the development of vaccine, convalescent plasma, neutralizing antibodies are based on the understanding of human immune responses against SARS-CoV-2, boosting human body immune responses in case of SARS-CoV-2 infection, immunotherapeutics seem feasible as specific cure against COVID-19 if the present challenges are overcome. In cell based therapeutics, apart from the high costs, risks and side effects, there are technical problems such as the production of sufficient potent immune cells and antibodies under limited time to treat the COVID-19 patients in mild conditions prior to progression into a more severe case. The CRISPR Cas technology could be utilized to refine the specificity and safety of CAR-T cells, CAR-NK cells and neutralizing antibodies against SARS-CoV-2 during various stages of the COVID-19 disease progression in infected individuals. Moreover, CRISPR Cas technology are proposed in hypotheses to degrade the viral RNA in order to terminate the infection caused by SARS-CoV-2. Thus personalized cocktails of immunotherapeutics and CRISPR Cas systems against COVID-19 as a strategy might prevent further disease progression and circumvent immunity escape.
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Affiliation(s)
- Xuesong He
- Department of Cardiology, Changzhou Jintan First People’s Hospital, Changzhou City, Jiangsu Province, 213200, People’s Republic of China
| | - Xiao Xue Zeng
- Department of Health Management, Centre of General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan City, Guangdong Province, 528000, People’s Republic of China
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13
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De Cassai A, Longhini F, Romagnoli S, Cavaliere F, Caroleo A, Foti L, Furlani E, Gianoli S, Monteleone F, Saraco G, Villa G, Conti G, Navalesi P. Research on SARS-COV-2 pandemic: a narrative review focused on the Italian contribution. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8596088 DOI: 10.1186/s44158-021-00017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Since late 2019, a severe acute respiratory syndrome, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread with overwhelming speed causing over 214 million confirmed infections and more than 4.5 million deaths worldwide. In this framework, Italy had the second highest number of SARS-CoV-2 infections worldwide, and the largest number of deaths. A global effort of both the scientific community and governments has been undertaken to stem the pandemic. The aim of this paper is to perform a narrative review of the Italian contribution to the scientific literature regarding intensive care management of patients suffering from COVID-19, being one of the first western countries to face an outbreak of SARS-CoV-2 infection.
Main body
We performed a narrative review of the literature, dedicating particular attention and a dedicated paragraph to ventilatory support management, chest imaging findings, biomarkers, possible pharmacological interventions, bacterial superinfections, prognosis and non-clinical key aspects such as communication and interaction with relatives.
Conclusions
Many colleagues, nurses and patients died leaving their families alone. To all of them, we send our thoughts and dedicate these pages.
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14
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Veronin MA, Lang A, Reinert JP. Remdesivir and Coronavirus Disease 2019 (COVID-19): Essential Questions and Answers for Pharmacists and Pharmacy Technicians. J Pharm Technol 2021; 37:62-74. [PMID: 34752546 DOI: 10.1177/8755122520967634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: To conduct a review of the investigational drug remdesivir and its therapeutic potential for treatment of COVID-19, in the form of a series of questions and answers. The purpose of the review is to narrow gaps in knowledge, clarify concepts, and to investigate research advancements for health care professionals. Data Sources: From June 2020 to August 2020, we conducted comprehensive searches of MEDLINE-PubMed, Scopus, and Google Scholar databases with no time limitations. Search terms were included that contained the terms "remdesivir," "COVID-19," "novel coronavirus" and "evidence," "therapy," "safety," "effectiveness," "efficacy," "clinical trial." Study Selection and Data Extraction: The sources of information include all publicly available data from previously published research reports. Reports must have at least one reference to remdesivir as a treatment modality for COVID-19 with no specified outcomes. Data Synthesis: Major research findings on the efficacy and safety of remdesivir are summarized in tabular format and presented in chronological order. Results of this review reveal remdesivir to be an effective therapy in specific clinical contexts; however, in several areas, available data are insufficient to support evidence-based guidance for remdesivir in the treatment of COVID-19. Conclusions: Clinical trials on remdesivir are ongoing, yet questions remain and further research is needed as to the selection of patients, effectiveness, and duration of treatment in the use of remdesivir for treatment of COVID-19.
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15
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Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1990838. [PMID: 34733336 PMCID: PMC8560253 DOI: 10.1155/2021/1990838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022]
Abstract
Objective To probe into the influence of dexmedetomidine (DEX) on diaphragm function and postoperative outcomes of mechanically ventilated patients in the intensive care unit (ICU). Methods 84 patients with mechanical ventilation (MV) in the ICU of our hospital were selected as the research participants, including 38 patients in the control group (CG) sedated with midazolam (MZ) and 46 patients in the research group (RG) with DEX sedation. Ramsay sedation score, visual analogue scale (VAS), and restlessness score (RS) were used to evaluate their state before sedation (T0), as well as 2 h (T1), 6 h (T2), and 24 h (T3) after sedation, and the alterations of mean arterial pressure (MAP) and heart rate (HR) were recorded. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin- (IL-) 1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and 24 h after sedation. The end-inspiratory diaphragm thickness (DTei) and end-expiratory diaphragm thickness (DTee) were measured within 2 h after the initiation of MV and 5 min after the spontaneous breathing test (SBT), and the diaphragm thickening fraction (DTF) was calculated. Finally, the ventilator weaning, MV time, and the incidence of adverse reactions (ADs) of the two groups were counted. Results T0 and T3 witnessed no distinct difference in Ramsay, VAS, and RS scores between the two arms (P > 0.05), but at T1 and T2, RG had better sedation state and lower VAS and RS scores than CG (P < 0.05), with more stable vital signs (P < 0.05). After sedation, the contents of oxidative stress and inflammatory factors in RG were lower, while DTee, DTei, and DTF were higher, versus CG (P < 0.05). Moreover, RG presented higher success rate of first ventilator weaning, less MV time, and lower incidence of ADs than CG (P < 0.05). Conclusions DEX is effective in mechanically ventilated patients in the ICU, which can protect patients against diaphragm function damage, improve the success rate of ventilator weaning, and benefit the postoperative outcome, with excellent and rapid sedation effect and less stress damage to patients.
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16
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Zhang Y, Cao S, Lin B, Chen J, Chen X, Lin S, Zhuang C. A best evidence synthesis in practicing early active movements in ICU patients with mechanical ventilation. Am J Transl Res 2021; 13:11948-11957. [PMID: 34786127 PMCID: PMC8581916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study summarized the best evidence of early active movements in mechanically ventilated patients in the ICU and applied it in the intensive care unit of our hospital to evaluate the practical effects. METHODS The best evidence for early activity in patients with mechanical ventilation in the ICU was summarized by using an evidence-based nursing method, and the results were clinically applied in the ICU. Patients who were mechanically ventilated in the ICU from January to March 2020 were selected as the control-group, and their counterparts from April to June 2020 were enrolled as the practice-group. The control-group-patients received conventional early active mobilities, and the practice-group-patients performed the best evidence-based early active mobilities. The Barthel index, muscle strength, duration of mechanical ventilation and length of ICU stay between the two groups were compared. RESULTS The scores of Barthel index and muscle strength of the practice group were remarkably higher than those of the control group, and the duration of mechanical ventilation and length of ICU stay were obviously shorter than those of the control group, and the difference was statistically significant (P<0.05). The incidence of deep vein thrombosis in practice group was substantially lower than that in control group (P<0.05), and the incidence of ICU acquired weakness in in practice group was critically lower than that in control group (P<0.05). The anxiety and depression scores of the two groups post-intervention were remarkably less than those before intervention (P<0.05), and the observation group had apparently lower scores than the control group (P<0.05). CONCLUSION The application of the best evidence of early active movement in ICU patients with mechanical ventilation can improve the daily life ability, promote the recovery of muscle strength, reduce the incidence of deep vein thrombosis and ICU acquired weakness, decrease the duration of mechanical ventilation and length of ICU hospital stay, thereby improving the clinical outcomes.
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Affiliation(s)
- Yuqiang Zhang
- Department of Obstetrics and Gynecology, Haikou Hospital of The Maternal and Child HealthHaikou 570203, Hainan, China
| | - Sufen Cao
- Department of Obstetrics and Gynecology, Haikou Hospital of The Maternal and Child HealthHaikou 570203, Hainan, China
| | - Bailang Lin
- Department of Nursing, Haikou Hospital of The Maternal and Child HealthHaikou 570203, Hainan, China
| | - Jiacheng Chen
- Department of Hepatobiliary Surgery, Haikou Hospital of The Maternal and Child HealthHaikou 570203, Hainan, China
| | - Xiaojing Chen
- Department of Medical, Haikou Hospital of The Maternal and Child HealthHaikou 570203, Hainan, China
| | - Shengying Lin
- Department of Operating Room, Haikou Hospital of The Maternal and Child HealthHaikou 570203, Hainan, China
| | - Chunyu Zhuang
- Department of Nursing, Haikou Hospital of The Maternal and Child HealthHaikou 570203, Hainan, China
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17
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Mozaffari E, Chandak A, Zhang Z, Liang S, Thrun M, Gottlieb RL, Kuritzkes DR, Sax PE, Wohl DA, Casciano R, Hodgkins P, Haubrich R. Remdesivir treatment in hospitalized patients with COVID-19: a comparative analysis of in-hospital all-cause mortality in a large multi-center observational cohort. Clin Infect Dis 2021; 75:e450-e458. [PMID: 34596223 PMCID: PMC9402660 DOI: 10.1093/cid/ciab875] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Remdesivir (RDV) improved clinical outcomes among hospitalized patients with coronavirus disease 2019 (COVID-19) in randomized trials, but data from clinical practice are limited. Methods We examined survival outcomes for US patients hospitalized with COVID-19 between August and November 2020 and treated with RDV within 2 days of hospitalization vs those not receiving RDV during their hospitalization using the Premier Healthcare Database. Preferential within-hospital propensity score matching with replacement was used. Additionally, patients were also matched on baseline oxygenation level (no supplemental oxygen charges [NSO], low-flow oxygen [LFO], high-flow oxygen/noninvasive ventilation [HFO/NIV], and invasive mechanical ventilation/extracorporeal membrane oxygenation [IMV/ECMO]) and 2-month admission window and excluded if discharged within 3 days of admission (to exclude anticipated discharges/transfers within 72 hours, consistent with the Adaptive COVID-19 Treatment Trial [ACTT-1] study). Cox proportional hazards models were used to assess time to 14-/28-day mortality overall and for patients on NSO, LFO, HFO/NIV, and IMV/ECMO. Results A total of 28855 RDV patients were matched to 16687 unique non-RDV patients. Overall, 10.6% and 15.4% RDV patients died within 14 and 28 days, respectively, compared with 15.4% and 19.1% non-RDV patients. Overall, RDV was associated with a reduction in mortality at 14 days (hazard ratio [95% confidence interval]: 0.76 [0.70–0.83]) and 28 days (0.89 [0.82–0.96]). This mortality benefit was also seen for NSO, LFO, and IMV/ECMO at 14 days (NSO: 0.69 [0.57–0.83], LFO: 0.68 [0.80–0.77], IMV/ECMO: 0.70 [0.58–0.84]) and 28 days (NSO: 0.80 [0.68–0.94], LFO: 0.77 [0.68–0.86], IMV/ECMO: 0.81 [0.69–0.94]). Additionally, HFO/NIV RDV group had a lower risk of mortality at 14 days (0.81 [0.70–0.93]) but no statistical significance at 28 days. Conclusions RDV initiated upon hospital admission was associated with improved survival among patients with COVID-19. Our findings complement ACTT-1 and support RDV as a foundational treatment for hospitalized COVID-19 patients.
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Affiliation(s)
- Essy Mozaffari
- Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA
| | | | - Zhiji Zhang
- Certara, 295 Madison Ave, 23rd Fl, New York, NY, USA
| | - Shuting Liang
- Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA
| | - Mark Thrun
- Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA
| | - Robert L Gottlieb
- Baylor University Medical Center Dallas; Baylor Scott and White Heart and Vascular Hospital; Baylor Scott and White The Heart Hospital Plano, and Baylor Scott and White Research Institute, 3410 Worth St, Suite 250, Dallas TX, USA
| | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne St, Cambridge, MA, USA
| | - Paul E Sax
- Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - David A Wohl
- University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, USA
| | | | - Paul Hodgkins
- Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA
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Hossain MJ, Jannat T, Brishty SR, Roy U, Mitra S, Rafi MO, Islam MR, Nesa ML, Islam MA, Emran TB. Clinical Efficacy and Safety of Antiviral Drugs in the Extended Use against COVID-19: What We Know So Far. BIOLOGICS 2021; 1:252-284. [DOI: 10.3390/biologics1020016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Human beings around the globe have been suffering from a devastating novel pandemic and public health emergency, coronavirus disease 2019 (COVID-19), for more than one and a half years due to the deadly and highly pathogenic severe acute respiratory coronavirus 2 (SARS-CoV-2) infection worldwide. Notably, no effective treatment strategy has been approved for the complete recovery of COVID-19 patients, though several vaccines have been rolled out around the world upon emergency use authorization. After the emergence of the COVID-19 outbreak globally, plenty of clinical investigations commenced to screen the safety and efficacy of several previously approved drugs to be repurposed against the SARS-CoV-2 pathogen. This concise review aims at exploring the current status of the clinical efficacy and safety profile of several antiviral medications for the treatment of patients with COVID-19 and other respiratory complications caused by SARS-CoV-2 infection. The paper covers all kinds of human studies (January 2020 to June 2021) except case reports/series to highlight the clear conclusion based on the current clinical evidence. Among the promising repositioned antivirals, remdesivir has been recommended in critical conditions to mitigate the fatality rate and improve clinical conditions. In addition, boosting the immune system is believed to be beneficial in treating COVID-19 patients, so interferon type I might exert immunomodulation through its antiviral effects by stimulating interferon-stimulated gene (ISG). However, more extensive clinical studies covering all ethnic groups globally are warranted based on current data to better understand the clinical efficacy of the currently proposed repurposed drugs against COVID-19.
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19
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Pasquini Z, Barocci I, Brescini L, Candelaresi B, Castelletti S, Iencinella V, Mazzanti S, Procaccini G, Orsetti E, Pallotta F, Amadio G, Giacometti A, Tavio M, Barchiesi F. Bloodstream infections in the COVID-19 era: results from an Italian multi-centre study. Int J Infect Dis 2021; 111:31-36. [PMID: 34416402 PMCID: PMC8372445 DOI: 10.1016/j.ijid.2021.07.065] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Correlation between coronavirus disease 2019 (COVID-19) and superinfections has been investigated, but remains to be fully assessed. This multi-centre study reports the impact of the pandemic on bloodstream infections (BSIs). METHODS This study included all patients with BSIs admitted to four Italian hospitals between 1 January and 30 June 2020. Clinical, demographic and microbiologic data were compared with data for patients hospitalized during the same period in 2019. RESULTS Among 26,012 patients admitted between 1 January and 30 June 2020, 1182 had COVID-19. Among the patients with COVID-19, 107 BSIs were observed, with an incidence rate of 8.19 episodes per 1000 patient-days. The incidence of BSI was significantly higher in these patients compared with patients without COVID-19 (2.72/1000 patient-days) and patients admitted in 2019 (2.76/1000 patient-days). In comparison with patients without COVID-19, BSI onset in patients with COVID-19 was delayed during the course of hospitalization (16.0 vs 5 days, respectively). Thirty-day mortality among patients with COVID-19 was 40.2%, which was significantly higher compared with patients without COVID-19 (23.7%). BSIs in patients with COVID-19 were frequently caused by multi-drug-resistant pathogens, which were often centre-dependent. CONCLUSIONS BSIs are a common secondary infection in patients with COVID-19, characterized by increased risk during hospitalization and potentially burdened with high mortality.
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Affiliation(s)
- Zeno Pasquini
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy; Azienda Ospedaliera Ospedali Riuniti Marche Nord, Malattie Infettive, Pesaro, Italy.
| | - Iacopo Barocci
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy
| | - Lucia Brescini
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy
| | - Bianca Candelaresi
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy
| | - Sefora Castelletti
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Divisione Malattie Infettive, Ancona, Italy
| | - Valentina Iencinella
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy
| | - Sara Mazzanti
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy
| | - Gaia Procaccini
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy
| | - Elena Orsetti
- Ospedale Augusto Murri, Malattie Infettive, Fermo, Italy
| | - Francesco Pallotta
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy
| | - Giorgio Amadio
- Ospedale Augusto Murri, Malattie Infettive, Fermo, Italy
| | - Andrea Giacometti
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy
| | - Marcello Tavio
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Divisione Malattie Infettive, Ancona, Italy
| | - Francesco Barchiesi
- Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Macerata, Italy; Azienda Ospedaliera Ospedali Riuniti Marche Nord, Malattie Infettive, Pesaro, Italy
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20
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Evaluation of the Treatment Efficacy and Safety of Remdesivir for COVID-19: a Meta-analysis. ACTA ACUST UNITED AC 2021; 3:2443-2454. [PMID: 34396045 PMCID: PMC8346348 DOI: 10.1007/s42399-021-01014-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/18/2022]
Abstract
Remdesivir is one of few FDA-approved treatments for severe cases of Coronavirus Disease 2019 (COVID-19). To better assess its efficacy and safety, we conducted a meta-analysis to systematically identify and synthesize existing findings. We conducted a comprehensive literature search among six electronic databases and unpublished studies. Random-effects meta-analyses were performed to summarize the risk ratio (RR) and rate estimates from eligible studies. Funnel plots, the Egger test, and the trim and fill analysis were used to detect publication bias. Thirteen eligible studies were included in this meta-analysis, giving a pooled sample size of 10,002 COVID-19 hospitalized patients (5068 administered remdesivir; 4934 control). Among patients on remdesivir, we synthesized mortality (15%, 95% confidence interval [CI]: 9%, 22%), clinical improvement (64%, 95% CI: 51%, 78%), recovery (70%, 95% CI: 57%, 83%), hospital discharge (74%, 95% CI: 60%, 87%), serious adverse effect (SAE) (21%, 95% CI:13%, 29%), and Grade 3 or 4 adverse effect (AE) (30%, 95% CI: 12%, 48%). Patients on remdesivir were 17% (RR: 0.83, 95% CI: 0.65, 1.06) less likely to die than those within the control group. Additionally, remdesivir had favorable outcomes in terms of clinical improvement, recovery, and hospital discharge. Lastly, non-mechanically ventilated patients had better overall clinical outcomes than mechanically ventilated patients. Remdesivir shows a moderate-favorable treatment efficacy among hospitalized COVID-19 patients with disproportionate impact among non-mechanically ventilated patients; however, a substantial proportion of COVID-19 patients may suffer from SAE or Grade 3 or 4 AE during the treatment course.
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21
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Saini M, Rana M, Bhatti K, Das R, Mehta DK, Chidurala RM. Clinical Efficacy of Remdesivir and Favipiravir in the Treatment of Covid-19 Patients: Scenario So Far. Curr Drug Res Rev 2021; 14:11-19. [PMID: 34365935 DOI: 10.2174/2589977513666210806122901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/17/2021] [Accepted: 04/28/2021] [Indexed: 11/22/2022]
Abstract
The novel SARS-CoV-2 is a new disease that has caused severe destruction to human lives across the globe, including infection, mortality and financial crises, for which, scientific researchers have been directed towards the development of treatment and controlling measures against coronavirus. Currently, there has been no approved drug for the treatment of the disease, but several antiviral drugs have shown therapeutic effects from which, remdesivir and favipiravir are two such drugs. These drugs have shown some therapeutic potential in the treatment of COVID-19 by inhibiting viral enzyme RNA-dependent RNA polymerase. The purpose of this systematic review is to provide an overview of the effectiveness of these two drugs based on the clinical trials reported in current published data.
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Affiliation(s)
- Manisha Saini
- M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be) University, Mullana, Ambala, HR. India
| | - Minakshi Rana
- M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be) University, Mullana, Ambala, HR. India
| | - Karun Bhatti
- Department of Medicine, M.M. Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be) University, Mullana, Ambala, HR. India
| | - Rina Das
- M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be) University, Mullana, Ambala, HR. India
| | - Dinesh Kumar Mehta
- M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be) University, Mullana, Ambala, HR. India
| | - Ram Mohan Chidurala
- Hospitalist, Department of Medicine, Medstar southern Maryland hospital,7503, Surratts Rd, Clinton, Maryland 20735. United States
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22
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Thiruchelvam K, Kow CS, Hadi MA, Hasan SS. The use of remdesivir for the management of patients with moderate-to-severe COVID-19: a systematic review. Expert Rev Anti Infect Ther 2021; 20:211-229. [PMID: 34192469 PMCID: PMC8477583 DOI: 10.1080/14787210.2021.1949984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective We systematically reviewed the evidence of published original research to determine the role of remdesivir in the management of patients with COVID-19 and a moderate-to-severe course of illness. Methods A systematic search of articles was conducted in scientific databases, with the latest update in May 2021. This paper systematically reviewed the clinical evidence available (randomized controlled trials, compassionate use studies, and case reports) on the use of remdesivir for patients with moderate or severe COVID-19. Results A total of eleven studies were included: four studies based on compassionate use of remdesivir, three randomized, double-blind, placebo-controlled, multicentre trials, three randomized, open-label, phase III trials, and one case report. Clinical improvement and mortality rates in patients who used remdesivir varied across studies. Conclusion Given the current evidence, there is insufficient data to confidently recommend the use of remdesivir alone for the treatment of adult hospitalized patients with moderate-to-severe COVID-19. However, remdesivir may be considered along with an anti-inflammatory agent in patients with pneumonia, on oxygen support, provided there is close monitoring of clinical and laboratory parameters and adverse events.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Chia Siang Kow
- School of Postgraduate Studies, International Medical University School of Medicine, Kuala Lumpur, Malaysia.,School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, Selangor, Malaysia
| | - Muhammad Abdul Hadi
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Syed Shahzad Hasan
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom of Great Britain and Northern Ireland.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
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23
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Gil Martínez V, Avedillo Salas A, Santander Ballestín S. Antiviral Therapeutic Approaches for SARS-CoV-2 Infection: A Systematic Review. Pharmaceuticals (Basel) 2021; 14:736. [PMID: 34451833 PMCID: PMC8398077 DOI: 10.3390/ph14080736] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 12/12/2022] Open
Abstract
Due to the lack of an etiologic treatment for SARS-CoV-2 and the difficulties involved in developing new drugs, some drugs already approved for other diseases or with efficacy against SARS and MERS, have been used in patients with COVID-19. This systematic review aims to summarize evidence on the efficacy and safety of five antivirals applied to patients with COVID-19, that have proven to be effective either in vitro studies or in studies on SARS-CoV and MERS.; An intensive search of different databases (Pub Med, WoS, MEDLINE and Cochrane COVID-19 Study Register) has been carried out until the end of April 2021. This systematic review has been conducted according to the PRISMA statement. From each of the included studies, the characteristics of the intervention and comparison groups, demographic data and results were extracted independently; Remdesivir is well tolerated and helps to accelerate clinical improvement but is ineffective in reducing mortality. Favipiravir is safe and shows promising results regarding symptom resolution but does not improve viral clearance. The use of lopinavir/ritonavir has been associated with an increased risk of gastrointestinal adverse events and it has not proven to be effective. No significant differences were observed between patients treated with ribavirin or umifenovir and their respective control groups; Remdesivir and favipiravir are well tolerated and effective in accelerating clinical improvement. This systematic review does not support the use of lopinavir/ritonavir, ribavirin and umifenovir in hospitalized patients with COVID-19.
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Affiliation(s)
| | | | - Sonia Santander Ballestín
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain; (V.G.M.); (A.A.S.)
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24
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Complex analysis of the personalized pharmacotherapy in the management of COVID-19 patients and suggestions for applications of predictive, preventive, and personalized medicine attitude. EPMA J 2021; 12:307-324. [PMID: 34306260 PMCID: PMC8283099 DOI: 10.1007/s13167-021-00247-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
Aims Coronavirus disease 2019 (COVID-19) is rapidly spreading worldwide. Drug therapy is one of the major treatments, but contradictory results of clinical trials have been reported among different individuals. Furthermore, comprehensive analysis of personalized pharmacotherapy is still lacking. In this study, analyses were performed on 47 well-characterized COVID-19 drugs used in the personalized treatment of COVID-19. Methods Clinical trials with published results of drugs use for COVID-19 treatment were collected to evaluate drug efficacy. Drug-to-Drug Interactions (DDIs) were summarized and classified. Functional variations in actionable pharmacogenes were collected and systematically analysed. “Gene Score” and “Drug Score” were defined and calculated to systematically analyse ethnicity-based genetic differences, which are important for the safer use of COVID-19 drugs. Results Our results indicated that four antiviral agents (ritonavir, darunavir, daclatasvir and sofosbuvir) and three immune regulators (budesonide, colchicine and prednisone) as well as heparin and enalapril could generate the highest number of DDIs with common concomitantly utilized drugs. Eight drugs (ritonavir, daclatasvir, sofosbuvir, ribavirin, interferon alpha-2b, chloroquine, hydroxychloroquine (HCQ) and ceftriaxone had actionable pharmacogenomics (PGx) biomarkers among all ethnic groups. Fourteen drugs (ritonavir, daclatasvir, prednisone, dexamethasone, ribavirin, HCQ, ceftriaxone, zinc, interferon beta-1a, remdesivir, levofloxacin, lopinavir, human immunoglobulin G and losartan) showed significantly different pharmacogenomic characteristics in relation to the ethnic origin of the patient. Conclusion We recommend that particularly for patients with comorbidities to avoid serious DDIs, the predictive, preventive, and personalized medicine (PPPM, 3 PM) strategies have to be applied for COVID-19 treatment, and genetic tests should be performed for drugs with actionable pharmacogenes, especially in some ethnic groups with a higher frequency of functional variations, as our analysis showed. We also suggest that drugs associated with higher ethnic genetic differences should be given priority in future pharmacogenetic studies for COVID-19 management. To facilitate translation of our results into clinical practice, an approach conform with PPPM/3 PM principles was suggested. In summary, the proposed PPPM/3 PM attitude should be obligatory considered for the overall COVID-19 management. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-021-00247-0.
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25
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Almaghlouth NK, Anyiam FE, Shah S, Haq S, Attia MJ, Guevara R, Antony S. The Use of Single Therapy With Tocilizumab Versus Combination Therapy With Remdesivir and Tocilizumab in SARS-CoV-2 Patients in El Paso, Texas. Cureus 2021; 13:e16351. [PMID: 34277310 PMCID: PMC8276197 DOI: 10.7759/cureus.16351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Currently, the management of SARS-CoV-2 varies with no definitive clinical guidelines, as scientific evidence across the globe differs in therapeutic options. This study intended to provide some clarity to the insufficient data based on the role of monotherapy with tocilizumab (TCZ) and combination therapy with remdesivir (RDV) and TCZ among patients with SARS-CoV-2 infection in El Paso, Texas. We evaluated the use of each therapy in the presence of steroids as the standard of care. Methods: One hundred and fifty-four SARS-CoV-2-infected patients from four different medical centers in El Paso, Texas, were screened, with 113 eligible for this longitudinal comparative observational study (February 1, 2020 to October 31, 2020). Group 1 (80 patients) received TCZ in the first 24 hours following admission, then methylprednisolone for the next 72 hours and group 2 (33 patients) were given TCZ as detailed in the single therapy group, plus RDV within the first 24 hours. Mann Whitney U test assessed median differences in laboratory biomarkers and Bivariate Logistic Regression assessed the odds of risk. An observation is considered statistically significant when P-value is ≤0.05. Results: Patients in group 1 had a statistically significant lower odds for ventilation use than group 2 (OR=0.34, 95%CI=0.12-0.95, p=0.034), although no statistically significant difference in mortality outcomes was observed across groups (OR=0.43, 95%CI:0.13-1.39, p=0.269). Conclusions: We concluded that the use of TCZ in SARS-CoV-2-infected patients in El Paso, with or without RDV, reported no mortality benefit. However, some minimal/non-use of ventilation benefit was observed in group 1. Nonetheless, a randomized controlled trial study is recommended to ultimately determine the combination role of TCZ and RDV among this highly vulnerable group of patients.
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Affiliation(s)
- Nouf K Almaghlouth
- Department of Medicine, MountainView Regional Medical Center, Las Cruces, USA.,Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Felix E Anyiam
- Centre for Health and Development (CHD), University of Port Harcourt, Port Harcourt, NGA
| | - Sidra Shah
- Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Syed Haq
- Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Mohamed J Attia
- Department of Emergency Medicine, Kasr Alainy University Hospitals, Cairo, EGY
| | - Roberto Guevara
- Department of Clinical Pharmacy, The Hospitals of Providence Transmountain Campus, El Paso, USA
| | - Suresh Antony
- Department of Medicine, Texas Tech University Health Sciences Center, El Paso, USA.,Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
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26
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Bonazzetti C, Milazzo L, Giacomelli A, Oreni L, Colombo R, Ridolfo AL, Antinori S. Comment on: Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU. J Antimicrob Chemother 2021; 76:1650-1651. [PMID: 33561203 PMCID: PMC7928882 DOI: 10.1093/jac/dkab033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 01/17/2023] Open
Affiliation(s)
- Cecilia Bonazzetti
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy.,Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | - Laura Milazzo
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy.,Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | - Letizia Oreni
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Riccardo Colombo
- Department of Anaesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Anna Lisa Ridolfo
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy.,Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
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27
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Pasquini Z, Montalti R, Barchiesi F. Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU-authors' response. J Antimicrob Chemother 2021; 76:1651-1652. [PMID: 33792713 PMCID: PMC8083596 DOI: 10.1093/jac/dkab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Zeno Pasquini
- Malattie Infettive, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy.,Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Roberto Montalti
- Unità di Chirurgia Epato-bilio-pancreatica, Mininvasiva e Robotica, Dipartimento di Sanità Pubblica, Università Federico II, Napoli, Italy
| | - Francesco Barchiesi
- Malattie Infettive, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy.,Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
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28
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Tsikala Vafea M, Zhang R, Kalligeros M, Mylona EK, Shehadeh F, Mylonakis E. Mortality in mechanically ventilated patients with COVID-19: a systematic review. Expert Rev Med Devices 2021; 18:457-471. [PMID: 33836621 DOI: 10.1080/17434440.2021.1915764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: The use of mechanical ventilation associated with acute hypoxemic respiratory failure, the most common complication in critically ill COVID-19 patients, defines a high risk population that requires specific consideration of outcomes and treatment practices.Areas covered: This review evaluates existing information about mortality rates and effectiveness of antiviral, immune-modulating, and anticoagulation treatments in COVID-19 patients who received mechanical ventilation. The mortality rate and follow-up periods in patients receiving mechanical ventilation ranged widely. Antivirals, including remdesivir and convalescent plasma, have shown no definitive mortality benefit in this population despite positive results in other COVID-19 patients. Dexamethasone was associated with an absolute reduction in 28-day mortality by 12.3% (95% CI, 6.3 to 17.6), after adjusting for age. Reduced mortality has been demonstrated with tocilizumab use alongside corticosteroids. Evidence is inconclusive for therapeutic anticoagulation, and further studies are needed to determine the comparative benefit of prophylactic anticoagulation.Expert opinion: Significant variation and high mortality rates in mechanically ventilated patients necessitate more standardized outcome measurements, increased consideration of risk factors to reduce intubation, and improved treatment practices. Anticoagulation and dexamethasone should be incorporated in the treatment of patients receiving invasive mechanical ventilation, while more rigorous studies are required for other potential treatments.
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Affiliation(s)
- Maria Tsikala Vafea
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Raina Zhang
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Markos Kalligeros
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Evangelia K Mylona
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
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29
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Abdelrahman Z, Liu Q, Jiang S, Li M, Sun Q, Zhang Y, Wang X. Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis. Front Pharmacol 2021; 12:607408. [PMID: 33790785 PMCID: PMC8005525 DOI: 10.3389/fphar.2021.607408] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Limited data on the efficacy and safety of currently applied COVID-19 therapeutics and their impact on COVID-19 outcomes have raised additional concern. Objective and Methods: To estimate the efficacy and safety of COVID-19 therapeutics, we performed meta-analyses of the studies reporting clinical features and treatments of COVID-19 published from January 21 to September 6, 2020. Results: We included 136 studies that involved 102,345 COVID-19 patients. The most prevalent treatments were antibiotics (proportion: 0.59, 95% CI: [0.51, 0.67]) and antivirals (proportion: 0.52, 95% CI: [0.44, 0.60]). The combination of lopinavir/ritonavir and Arbidol was the most effective in treating COVID-19 (standardized mean difference (SMD) = 0.68, 95% CI: [0.15, 1.21]). The use of corticosteroids was associated with a small clinical improvement (SMD = -0.40, 95% CI: [-0.85, -0.23]), but with a higher risk of disease progression and death (mortality: RR = 9.26, 95% CI: [4.81, 17.80]; hospitalization length: RR = 1.54, 95% CI: [1.39, 1.72]; severe adverse events: RR = 2.65, 95% CI: [2.09, 3.37]). The use of hydroxychloroquine was associated with a higher risk of death (RR = 1.68, 95% CI: [1.18, 2.38]). The combination of lopinavir/ritonavir, ribavirin, and interferon-β (RR = 0.34, 95% CI: [0.22, 0.54]); hydroxychloroquine (RR = 0.58, 95% CI: [0.39, 0.58]); and lopinavir/ritonavir (RR = 0.72, 95% CI: [0.56, 0.91]) was associated with reduced hospitalization length. Hydrocortisone (RR = 0.05, 95% CI: [0.03, 0.10]) and remdesivir (RR = 0.74, 95% CI: [0.62, 0.90]) were associated with lower incidence of severe adverse events. Dexamethasone was not significant in reducing disease progression (RR = 0.45, 95% CI: [0.16, 1.25]) and mortality (RR = 0.90, 95% CI: [0.70, 1.16]). The estimated combination of corticosteroids with antivirals was associated with a better clinical improvement than antivirals alone (SMD = -1.09, 95% CI: [-1.64, -0.53]). Conclusion: Antivirals are safe and effective in COVID-19 treatment. Remdesivir cannot significantly reduce COVID-19 mortality and hospitalization length, while it is associated with a lower incidence of severe adverse events. Corticosteroids could increase COVID-19 severity, but it could be beneficial when combined with antivirals. Our data are potentially valuable for the clinical treatment and management of COVID-19 patients.
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Affiliation(s)
- Zeinab Abdelrahman
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Qian Liu
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Shanmei Jiang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Mengyuan Li
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Qingrong Sun
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Yue Zhang
- Pinghu Hospital of Shenzhen University, Shenzhen, China
- Futian Hospital for Rheumatic Diseases, Shenzhen, China
- Department of Rheumatology and Immunology, The First Clinical College of Harbin Medical University, Harbin, China
| | - Xiaosheng Wang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
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30
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Pallotto C, Suardi LR, Gabbuti A, Esperti S, Mecocci L, Blanc P. Potential remdesivir-related transient bradycardia in patients with coronavirus disease 2019 (COVID-19). J Med Virol 2021; 93:2631-2634. [PMID: 33620107 PMCID: PMC8013491 DOI: 10.1002/jmv.26898] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Carlo Pallotto
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy.,Section of Infectious Diseases, Department of Medicine, University of Perugia, Perugia, Italy
| | - Lorenzo R Suardi
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Andrea Gabbuti
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Sara Esperti
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Lorenzo Mecocci
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Pierluigi Blanc
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
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31
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Rezagholizadeh A, Khiali S, Sarbakhsh P, Entezari-Maleki T. Remdesivir for treatment of COVID-19; an updated systematic review and meta-analysis. Eur J Pharmacol 2021; 897:173926. [PMID: 33549577 PMCID: PMC7859696 DOI: 10.1016/j.ejphar.2021.173926] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 02/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has become a global health crisis. Considering the recent food and drug administration (FDA) approval of remdesivir as the first officially approved agent for COVID-19 treatment, we performed this systematic review and meta-analysis to evaluate the efficacy and safety of remdesivir administration in COVID-19 patients. A systematic literature search was done through MEDLINE, Google Scholar, Web of Science, Scopus, Science Direct, Cochrane Library, medRxiv, and bioRxiv from their inception to December 22nd, 2020. Five randomized controlled trials (RCTs) and five non-randomized studies of intervention (NRSI) were entered into the meta-analysis. The results showed that remdesivir administration was associated with a significant improvement in the 28-day recovery (RR = 1.09, 95%CI, 1.04-1.15), low flow oxygen support through days one to 14 (RR = 2.88, 95%CI, 1.80-4.60), and invasive mechanical ventilation or extracorporeal membrane oxygenation requirement through days 14-28 of the follow-up time (RR = 5.34, 95%CI, 2.37-12.05). The risk of experiencing serious adverse drug reactions (ADRs) was significantly lower (RR = 0.75, 95%CI, 0.63-0.90) in the remdesivir group than the comparison/control group. The pooled median difference of the time to clinical improvement was 2.99 (95%CI = 2.71-3.28), which did not remain significant during the sensitivity analysis. The clinical output comparison of the 5-day and 10-day remdesivir courses revealed that the 5-day regimen might provide similar benefits while causing fewer serious ADRs than 10-day. The current meta-analysis provided an updated evaluation of scientific evidence on the use of remdesivir in COVID-19 patients. Performing adequate well-designed RCTs are needed to show more accurate results.
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Affiliation(s)
- Afra Rezagholizadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sajad Khiali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Assistant Professor of Biostatistics, Department of Statistics and Epidemiology, Faculty of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Shrestha DB, Budhathoki P, Syed NIH, Rawal E, Raut S, Khadka S. Remdesivir: A potential game-changer or just a myth? A systematic review and meta-analysis. Life Sci 2021; 264:118663. [PMID: 33121991 PMCID: PMC7586105 DOI: 10.1016/j.lfs.2020.118663] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
AIMS COVID-19 outbreak has created a public health catastrophe all over the world. Here, we have aimed to conduct a systematic review and meta-analysis on remdesivir use for COVID-19. MAIN METHODS We searched Pubmed, Scopus, Embase, and preprint sites and identified ten studies for qualitative and four studies for quantitative analysis using PRISMA guidelines. The quantitative synthesis was performed using fixed and random effect models in RevMan 5.4. Heterogeneity was assessed using the I-squared (I2) test. KEY FINDINGS Comparing 10-day remdesivir group with placebo or standard of care (SOC) group, remdesivir reduced 14 days mortality (OR 0.61, CI 0.41-0.91), need for mechanical ventilation (OR 0.73, CI 0.54-0.97), and severe adverse effects (OR 0.69, 95% CI 0.54 to 0.88). Clinical improvement on day 28 (OR 1.59, CI 1.06-2.39), day 14 clinical recovery (OR 1.48, CI 1.19-1.84), and day 14 discharge rate (OR 1.41, CI 1.15-1.73) were better among remdesivir group. Earlier clinical improvement (MD -2.51, CI -4.16 to -0.85); and clinical recovery (MD -4.69, CI -5.11 to -4.28) were seen among the remdesivir group. Longer course (10 days) of remdesivir showed a higher discharge rate at day 14 (OR 2.11, CI 1.50-2.97), but there were significantly higher rates of serious adverse effects, and drug discontinuation than the 5-day course. SIGNIFICANCE Remdesivir showed a better 14 days mortality profile, clinical recovery, and discharge rate. Overall clinical improvement and clinical recovery were earlier among the remdesivir group. 10-day remdesivir showed more adverse outcome than 5-day course with no significant benefits.
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Affiliation(s)
| | - Pravash Budhathoki
- Department of Emergency Medicine, Dr Iwamura Memorial Hospital, Bhaktapur 44800, Nepal
| | - Nawazish-I-Husain Syed
- Department of Pharmacology, Punjab University College of Pharmacy, University of the Punjab, Old Campus, Lahore 54000, Pakistan.
| | - Era Rawal
- Department of Emergency Medicine, Kathmandu Medical College, Kathmandu 44600, Nepal
| | - Sumit Raut
- Department of Emergency Medicine, Kathmandu Medical College, Kathmandu 44600, Nepal
| | - Sitaram Khadka
- Department of Pharmacology, Punjab University College of Pharmacy, University of the Punjab, Old Campus, Lahore 54000, Pakistan; Department of Pharmacy, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu 44600, Nepal
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Pimentel J, Laurie C, Cockcroft A, Andersson N. Clinical studies assessing the efficacy, effectiveness and safety of remdesivir in management of COVID-19: A scoping review. Br J Clin Pharmacol 2020; 87:2663-2684. [PMID: 33245577 PMCID: PMC7753529 DOI: 10.1111/bcp.14677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
Aims Remdesivir is 1 of the repurposed drugs under investigation to treat patients with COVID‐19. Clinicians and decision‐makers need a summary of the most recent evidence. This scoping review maps the evidence on the efficacy, effectiveness and safety of remdesivir for patients with COVID‐19, up to 14 September 2020. Methods Our scoping review searched Pubmed, Embase (Ovid), Scopus and 17 primary trial registries for empirical publications or active registered clinical trials for data on the efficacy, effectiveness, or safety of remdesivir for COVID‐19 or SARS‐CoV‐2. We conducted a narrative synthesis of the included publications. Results Seventeen empirical studies and 23 clinical trial registrations (n = 40) accumulated 46 508 participants. We found 4 published randomized–controlled trials accumulating 2293 patients. Two trials reported shorter median recovery time and better clinical status among patients who received remdesivir compared with the control groups. Observational studies report an association between remdesivir treatment and decreased mortality, as well as increased survival. The most common adverse reaction was hepatic impairment, although the trials reported a similar proportion of adverse events in the intervention and control groups. Conclusion Remdesivir might shorten the time to clinical improvement among hospitalized adults with severe COVID‐19. Trial data report a similar proportion of adverse events in treated and control groups. The results of the 23 registered active trials, including more than 30 000 participants, will shed light on the efficacy and safety of the antiviral. The findings of the remaining clinical trials expected to report results in 2020 will allow a quantitative synthesis of available evidence.
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Affiliation(s)
- Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada.,Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia.,Grupo de Estudios en Sistemas Tradicionales de Salud, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Cassandra Laurie
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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Bruno RR, Wolff G, Kelm M, Jung C. COVID-19: Intensivmedizinische Aspekte und Langzeitfolgen. AKTUELLE KARDIOLOGIE 2020. [DOI: 10.1055/a-1314-9342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ZusammenfassungEtwa 14% der COVID-19-Patienten weisen einen schwereren und ca. 5% einen kritischen Krankheitsverlauf auf. Besonders gefährdet sind ältere Personen, männliches Geschlecht, Raucher und stark adipöse Menschen. Wird der Patient invasiv oder nichtinvasiv beatmet, so steigt die Mortalität auf 53% respektive 50% an. In der Regel beträgt die Dauer vom Beginn der Symptome bis zur Aufnahme auf die Intensivstation 10 Tage. Die mittlere Verweildauer auf der Intensivstation beträgt 9 Tage. Für die Priorisierung sind die klinische Erfolgsaussicht einer intensivmedizinischen Behandlung sowie der Wunsch des Patienten maßgebend. Zentrale Kriterien für die Aufnahme auf die Intensivstation sind eine Hypoxämie (SpO2 < 90% unter 2 – 4 Liter Sauerstoff/min bei nicht vorbestehender Therapie), Dyspnoe, eine erhöhte Atemfrequenz (> 25 – 30/min) und ein systolischer Blutdruck ≤ 100 mmHg. Der Schutz des Personals genießt bei allen Maßnahmen Vorrang. Alle aerosolgenerierenden
Prozeduren sollten nur mit großer Vorsicht erfolgen. Wird unter High Flow keine adäquate Oxygenierung erreicht (SpO2 ≥ 90% oder ein paO2 > 55 mmHg), sollte über eine Eskalation nachgedacht werden (NIV, invasive Beatmung). Die Patienten sollten lungenprotektiv beatmet werden. Die Intubation sollte als Rapid Sequence Induction erfolgen. Eine ECMO kann erwogen werden. Thrombembolische Komplikationen sind sehr häufig. Antibiotika sollten nicht routinemäßig gegeben werden. Die aktuell beste Datenlage liegt für Dexamethason vor. Remdesivir kann die Rekonvaleszenz beschleunigen. Langzeitfolgen nach COVID-19 sind sehr häufig. Kardiale, pulmonale und neurologische Probleme stehen dabei im Vordergrund.
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Affiliation(s)
- Raphael Romano Bruno
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Deutschland
| | - Georg Wolff
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Deutschland
| | - Malte Kelm
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Deutschland
- CARID – Cardiovascular Research Institute Düsseldorf, Universitätsklinikum Düsseldorf, Deutschland
| | - Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Deutschland
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