1
|
Narayanasamy S, Curtis LH, Hernandez AF, Woods CW, Moody MA, Sulkowski M, Turbett SE, Baden LR, Gulick RM, Pau AK, Adam SJ, Marks P, Stockbridge NL, Dobbins JR, Krofah E, Leav B, Pang P, Roessig L, Vedin O, Waldstreicher J, Berman SC, Cremisi H, Schofield L, Gandhi RT, Naggie S. Lessons From COVID-19 for Pandemic Preparedness: Proceedings From a Multistakeholder Think Tank. Clin Infect Dis 2023; 77:1635-1643. [PMID: 37435958 PMCID: PMC10724451 DOI: 10.1093/cid/ciad418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
While the coronavirus disease 2019 (COVID-19) pandemic continues to present global challenges, sufficient time has passed to reflect on lessons learned and use those insights to inform policy and approaches to prepare for the next pandemic. In May 2022, the Duke Clinical Research Institute convened a think tank with thought leaders from academia, clinical practice, the pharmaceutical industry, patient advocacy, the National Institutes of Health, the US Food and Drug Administration, and the Centers for Disease Control and Prevention to share, firsthand, expert knowledge of the insights gained from the COVID-19 pandemic and how this acquired knowledge can help inform the next pandemic response. The think tank focused on pandemic preparedness, therapeutics, vaccines, and challenges related to clinical trial design and scale-up during the early phase of a pandemic. Based on the multi-faceted discussions, we outline 10 key steps to an improved and equitable pandemic response.
Collapse
Affiliation(s)
- Shanti Narayanasamy
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina, USA
| | - Lesley H Curtis
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Christopher W Woods
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina, USA
| | - M Anthony Moody
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Human Vaccine Institute, Durham, North Carolina, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah E Turbett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Alice K Pau
- National Institutes of Health, Bethesda, Maryland, USA
| | - Stacey J Adam
- Foundation for the National Institutes of Health, North Bethesda, Maryland, USA
| | - Peter Marks
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Esther Krofah
- FasterCures & Center for Public Health, Milken Institute, Washington, DC, USA
| | | | - Phil Pang
- Vir Biotechnology, Inc, San Francisco, California, USA
| | | | - Ola Vedin
- Boehringer Ingelheim AB, Stockholm, Sweden
| | | | | | | | - Lesley Schofield
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Rajesh T Gandhi
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanna Naggie
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| |
Collapse
|
2
|
Morales-Jadan D, Castro-Rodriguez B, Viteri-Dávila C, Orlando SA, Bruno A, Perez F, Garcia-Bereguiain MA. The quality of commercial SARS-CoV-2 nucleic acid tests in Ecuador: lessons from COVID-19 pandemic for advancing social equity through microbiology. Front Cell Infect Microbiol 2023; 13:1179786. [PMID: 37351183 PMCID: PMC10283003 DOI: 10.3389/fcimb.2023.1179786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/25/2023] [Indexed: 06/24/2023] Open
|
3
|
Knowlson C, Byrne A, Wilkinson J, Whitmore C, Torgerson D. The evidence base for emergency use authorizations for COVID-19 treatments: A rapid review. Health Sci Rep 2023; 6:e1051. [PMID: 36644312 PMCID: PMC9831114 DOI: 10.1002/hsr2.1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
Background and Aims During the COVID-19 pandemic, US Food and Drug Administration (FDA) permitted emergency use authorizations (EUAs) for vaccines/treatments with promising data. Eight treatments were issued EUAs by May 31, 2021; one of these was approved (Remdesivir for certain populations) and two were revoked (chloroquine phosphate/hydroxychloroquine and bamlanivimab) by September 30, 2021. The aim of this study is to find out what evidence the EUAs were based on and how many studies were published while they remained active (up to September 30, 2021). Methods A review of published clinical studies for the 6 months before each EUA was issued, and the time after (until September 30, 2021, or until revoked). PubMed and the identified systematic reviews were the sources for identifying published literature. Results The number of clinical studies published pre-EUA varied from a single case study (for chloroquine phosphate/hydroxychloroquine) to numerous studies of multiple types (for convalescent plasma). Four treatments had a single randomized controlled trial (RCT) as evidence (bamlanivimab monotherapy, REGN-COV, bamlanivimab + etesevimab, sotrovimab) and two also had other study types (remdesivir and baricitinib). The number of clinical studies published post-EUA (for those active on September 30, 2021) was widely varied. Eighteen RCTs were published for Convalescent plasma, while Remdesivir had eight. Baricitinib, REGN-COV, and bamlanivimab + etesevimab all had one, but none were published for sotrovimab. Conclusion The number of trials for treatments with EUAs was limited in all cases before the EUA was issued, and in most cases for those with EUAs ongoing at the end of September 2021. The presence of EUAs may discourage participation in relevant clinical trials, which delays the widespread implementation of evidenced-based therapies. Large, robust RCTs should be completed, such as the RECOVERY trial in the United Kingdom, to quickly find the answers desperately required during a pandemic.
Collapse
Affiliation(s)
- Catherine Knowlson
- Department of Health Sciences, York Trials UnitUniversity of YorkYorkUnited Kingdom
| | - Ailish Byrne
- Department of Health Sciences, York Trials UnitUniversity of YorkYorkUnited Kingdom
| | - Jacqueline Wilkinson
- Department of Health Sciences, York Trials UnitUniversity of YorkYorkUnited Kingdom
| | - Claire Whitmore
- Department of Health Sciences, York Trials UnitUniversity of YorkYorkUnited Kingdom
| | - David Torgerson
- Department of Health Sciences, York Trials UnitUniversity of YorkYorkUnited Kingdom
| |
Collapse
|
4
|
Paruchuri S, Yetukuri K, Nadendla R. Repurposing Molnupiravir as a new opportunity to treat COVID-19. J Generic Med 2022; 18:205-213. [PMID: 38603247 PMCID: PMC9357751 DOI: 10.1177/17411343221115819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With the emergence of new and re-emerging viral diseases, scientists have been working to produce new medications with novel targets and pathways. The discovery of safe and efficacious antiviral medicines is critical due to the constant introduction of new virus types and short lifetime of protection. Since the outbreak, there have been significant efforts to repurpose existing and licensed medications for rapid human testing and possible emergency use authorizations. The exploration of surviving medications for new restorative motives is known as drug repurposing. It is a successful, rapid, and highly reliable alternative to traditional drug methods. COVID-19 is being treated using a number of repurposed and new medicines. Molnupiravir is a repurposed Covid-19 medicine that was specifically developed to cure influenza and is used to treat mild to moderately ill Covid-19 patients with high risk of becoming seriously ill. The importance of medication repurposing, as well as the regulatory procedure for repurposed pharmaceuticals and Emergency Use Authorization in the United States, are summarized in this article.
Collapse
Affiliation(s)
- Sahithi Paruchuri
- Department of Pharmaceutical Regulatory Affairs, Chalapathi Institute of
Pharmaceutical Sciences (Autonomous), Guntur, India
| | - Koushik Yetukuri
- Department of Pharmaceutical Regulatory Affairs, Chalapathi Institute of
Pharmaceutical Sciences (Autonomous), Guntur, India
| | - RamaRao Nadendla
- Department of Pharmaceutical Regulatory Affairs, Chalapathi Institute of
Pharmaceutical Sciences (Autonomous), Guntur, India
| |
Collapse
|
5
|
Saint-Raymond A, Valentin M, Nakashima N, Orphanos N, Santos G, Balkamos G, Azatyan S. Reliance is key to effective access and oversight of medical products in case of public health emergencies. Expert Rev Clin Pharmacol 2022; 15:805-810. [PMID: 35945703 DOI: 10.1080/17512433.2022.2088503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Responding to new threats and public health emergencies (PHE) creates serious challenges to regulators. The pandemic due to SARS-CoV-2 has been the catalyzer for change in global and local regulatory practices. Intensified collaboration, rapid and coordinated actions, and reliance mechanisms were key elements of the regulators' response to COVID-19 for all regulatory functions. AREAS COVERED This article presents how collaboration and reliance among regulators were crucial tools for the regulatory responses to COVID-19, describes the reliance approaches for authorization of COVID-19 vaccines and other commodities, and the importance of reliance for other regulatory functions to avoid duplication and save resources where possible. This article also presents the results of a follow-up survey of reliance approaches in case of public health emergencies conducted between the International Pharmaceutical Regulators Programme (IPRP) members and discusses the forward-looking potential of reliance, analyzing the journey from theoretical concepts to real-life implementation. EXPERT OPINION Regulatory reliance is an essential tool for regulators to act quickly and collectively in times of public health emergencies. Reliance approaches facilitate regulatory approvals and allow a more efficient use of resources, ultimately serving patients by facilitating earlier access to quality assured, safe and effective medicines.
Collapse
Affiliation(s)
| | - Marie Valentin
- Regulation and Prequalification Department, World Health Organization (WHO), Geneva, Switzerland
| | - Nobumasa Nakashima
- International Programs, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Nick Orphanos
- Office of policy and international collaboration, Health Canada, Ottawa, Canada
| | - Gustavo Santos
- General Office of Medicines and Biological Products, ANVISA, Brasília, Brazil
| | - Georgios Balkamos
- Unit B4 - Medical products: quality, safety, innovation, European Commission, Brussels, Belgium
| | - Samvel Azatyan
- Regulation and Prequalification Department, World Health Organization (WHO), Geneva, Switzerland
| |
Collapse
|
6
|
Koritala T, Hussain A, Pleshkova Y, Dondapati L, Tirupathi R, Rabaan AA, Al Mutair A, Alhumaid S, Al-Tawfiq JA, Kashyap R. A narrative review of emergency use authorization versus full FDA approval and its effect on COVID-19 vaccination hesitancy. Infez Med 2022; 29:339-344. [PMID: 35146338 DOI: 10.53854/liim-2903-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 01/17/2023]
Abstract
COVID-19 pandemic affected the lives of many with its devastating mortality and morbidity. Acquisition of herd immunity is one way to mitigate the spread of infection. Many factors influence the acceptance of vaccination including the regulatory process of the vaccines. This review article will briefly summarize the Emergency Use Authorization, Full FDA Approval process and highlight how the key factors affecting the vaccination hesitancy, are being influenced by the lack of Full FDA Approval.
Collapse
Affiliation(s)
- Thoyaja Koritala
- Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Akbar Hussain
- Department of Internal Medicine, Keystone Health, Chambersburg, PA, USA
| | - Yelena Pleshkova
- Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX, USA
| | - Lavanya Dondapati
- Department of Internal Medicine, Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Raghavendra Tirupathi
- Department of Medicine, Keystone Health, Penn state College of Medicine, Chambersburg, PA, USA
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Department of Public Health and Nutrition, University of Haripur, Haripur, Pakistan
| | - Abbas Al Mutair
- Research center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.,College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia.,School of Nursing, Wollongong University, Wollongong NSW, Australia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine and Infection Control Unit, Quality and Patient Safety, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rahul Kashyap
- Department of Anesthesiology and Peri-operative Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
7
|
Lynch HF, Caplan A, Furlong P, Bateman-House A. Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases? Am J Bioeth 2021; 21:4-19. [PMID: 34665689 DOI: 10.1080/15265161.2021.1974975] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
After witnessing extraordinary scientific and regulatory efforts to speed development of and access to new COVID-19 interventions, patients facing other serious diseases have begun to ask "where's our Operation Warp Speed?" and "why isn't Emergency Use Authorization an option for our health crises?" Although this pandemic bears a number of unique features, the response to COVID-19 offers translatable lessons, in both its successes and failures, for non-pandemic diseases. These include the importance of collaborating across sectors, supporting the highest-priority research efforts, adopting rigorous and innovative trial designs, and sharing reliable information quickly. In addition, the regulatory response to the pandemic demonstrates that lowering standards for marketing authorization can result in increased safety concerns, missed opportunities for research and treatment, and delays in determining what works. Accordingly, policymakers and patient advocates seeking to build on the COVID-19 experience for non-pandemic diseases with unmet treatment needs should focus their efforts on promoting robust and efficient research designs, improving access to clinical trials, and facilitating use of the Food and Drug Administration's existing Expanded Access pathway.
Collapse
|
8
|
Xiao Q, Liu X, Wang R, Mao Y, Chen H, Li X, Liu X, Dai J, Gao J, Fu H, Zheng P. Predictors of Willingness to Receive the COVID-19 Vaccine after Emergency Use Authorization: The Role of Coping Appraisal. Vaccines (Basel) 2021; 9:967. [PMID: 34579204 DOI: 10.3390/vaccines9090967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
The current study aims to identify psychosocial factors based on protection motivation theory (PMT) influencing Chinese adults’ willingness to receive the COVID-19 vaccine after the emergency use authorization of the New Coronavirus Inactivated Vaccine in China. A cross-sectional online survey was conducted among Chinese residents aged 18–59 years, and 2528 respondents from 31 provinces and autonomous regions were included in the current study. Based on PMT, threat appraisals and coping appraisals were measured. Hierarchical multiple regressions and multivariate logistic regressions were used to identify the relationships between the PMT constructs and vaccination willingness after other covariates were controlled for. A total of 1411 (55.8%) respondents reported being willing to receive the COVID-19 vaccine. The PMT model explained 26.6% (p < 0.001) of the variance in the vaccine willingness. The coping appraisals, including response efficacy, self-efficacy, and response costs, were significantly correlated with the willingness to receive the COVID-19 vaccine, and response efficacy was the strongest influencing factor (adjusted OR = 2.93, 95% CI: 2.42–3.54). In conclusion, the coping appraisals for vaccination, instead of threat appraisals regarding the pandemic itself, mainly influenced people’s willingness to get vaccinated after the emergency use authorization of the COVID-19 vaccine in China. These findings are helpful for developing education and interventions to promote vaccination willingness and enhance public health outcomes during a pandemic.
Collapse
|
9
|
Guharoy R, Krenzelok EP. US Food and Drug Administration (FDA) Emergency Use Authorization: Glass Half Full or Glass Half Empty? Clin Infect Dis 2021; 73:549-552. [PMID: 33104216 PMCID: PMC7665427 DOI: 10.1093/cid/ciaa1653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/23/2020] [Indexed: 12/27/2022] Open
Abstract
Recently, the US Food and Drug Administration (FDA) issued emergency use authorization (EUA) for convalescent plasma (CP) for the treatment of hospitalized patients with coronavirus disease 2019 based on a non-peer-reviewed, open-label, observational study. Issuance of an EUA without a proven randomized, controlled trial (RCT) sets a dangerous precedent since the premature action drives healthcare providers and patients away from RCTs that are essential for determining the efficacy and safety of CP. More caution should have been taken based on what was learned from the recent debacle related to the rescinded EUA of hydroxychloroquine and chloroquine, which were approved initially based on an anecdotal report. The FDA process for determining efficacy and safety must be based solely on data from RCTs in order to sustain public and professional trust for future treatment and vaccine efforts to be successful.
Collapse
Affiliation(s)
- Roy Guharoy
- Pharmacy, Baptist Health, Montgomery, AL and Infectious Diseases, University of Massachusetts Medical School, Worcester, MA, USA
| | | |
Collapse
|
10
|
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Collapse
Affiliation(s)
- Mia Lussier
- Center for Pharmacy Innovation and Outcomes, Geisinger, Forty Fort, PA, USA
| | | | - Eric Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, Forty Fort, PA, USA
| |
Collapse
|
11
|
Weaver MS, Alfandre DJ. Informed Consent by Any Other Name: Consent Processes for Emergency Use Authorization. J Clin Pharmacol 2021; 61:731-733. [PMID: 33645658 DOI: 10.1002/jcph.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/22/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Meaghann S Weaver
- VHA National Center for Ethics in Health Care, Washington, DC, USA.,University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - David J Alfandre
- VHA National Center for Ethics in Health Care, Washington, DC, USA.,NYU School of Medicine, New York, New York, USA
| |
Collapse
|
12
|
Sarfraz A, Sarfraz Z, Sanchez-Gonzalez M, Michel J, Michel G, Frontela O, Posada J, Cardona J, Angueira E. Randomized controlled trials of remdesivir in hospitalized coronavirus disease 2019 patients: A meta-analysis. Turk J Emerg Med 2021; 21:43-50. [PMID: 33969238 PMCID: PMC8091999 DOI: 10.4103/2452-2473.309139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND: The first cases of the coronavirus disease 2019 (COVID-19) were reported in Wuhan, China. No antiviral treatment options are currently available with proven clinical efficacy. However, preliminary findings from phase III trials suggest that remdesivir is an effective and safe treatment option for COVID-19 patients with both moderate and severe disease. OBJECTIVE: The aim of the present meta-analysis was to investigate whether remdesivir was effective for treating COVID-19 including reduced in-hospital adverse events, oxygen support, and mortality rates. METHODS: According to the PRISMA reporting guidelines, a review was conducted from January 1, 2020, until August 25, 2020, with MeSH terms including COVID-19, COVID, coronavirus, SARS-CoV-2, remdesivir, adenosine nucleoside triphosphate analog, and Veklury using MEDLINE, Scopus, and CINAHL Plus. A modified Delphi process was utilized to include the studies and ensure that the objectives were addressed. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel–Haenszel random-effects method in Review Manager 5.4. RESULTS: Randomized controlled trials pooled in 3013 participants with 46.3% (n = 1395) in the remdesivir group and 53.7% (n = 1618) in the placebo group. The placebo group had a higher risk of mortality as compared to the intervention group with significant OR (0.61) (95% confidence interval of 0.45–0.82; P = 0.001). There was minimal heterogeneity among the studies (I2 = 0%). CONCLUSIONS: Our findings suggest that remdesivir extends clinical benefits by reducing mortality, adverse events, and oxygen support in moderate to severely ill COVID-19 patients. Concerted efforts and further randomized placebo-controlled trials are warranted to examine the potency of antiviral drugs and immunopathological host responses contributing to the severity of COVID-19.
Collapse
Affiliation(s)
- Azza Sarfraz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Zouina Sarfraz
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA.,Department of Research and Publication, Fatima Jinnah Medical University, Lahore, Pakistan
| | | | - Jack Michel
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - George Michel
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Odalys Frontela
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Jorge Posada
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Jose Cardona
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Eugenio Angueira
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| |
Collapse
|
13
|
Vanuytsel K, Mithal A, Giadone RM, Yeung AK, Matte TM, Dowrey TW, Werder RB, Miller GJ, Miller NS, Andry CD, Murphy GJ. Rapid Implementation of a SARS-CoV-2 Diagnostic Quantitative Real-Time PCR Test with Emergency Use Authorization at a Large Academic Safety Net Hospital. Med 2020; 1:152-157.e3. [PMID: 32838351 PMCID: PMC7235561 DOI: 10.1016/j.medj.2020.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Significant delays in the rapid development and distribution of diagnostic testing for SARS-CoV-2 (COVID-19) infection have prevented adequate public health management of the disease, impacting the timely mapping of viral spread and the conservation of personal protective equipment. Furthermore, vulnerable populations, such as those served by the Boston Medical Center (BMC), the largest safety net hospital in New England, represent a high-risk group across multiple dimensions, including a higher prevalence of pre-existing conditions and substance use disorders, lower health maintenance, unstable housing, and a propensity for rapid community spread, highlighting the urgent need for expedient and reliable in-house testing. METHODS We developed a SARS-CoV-2 diagnostic medium-throughput qRT-PCR assay with rapid turnaround time and utilized this Clinical Laboratory Improvement Amendments (CLIA)-certified assay for testing nasopharyngeal swab samples from BMC patients, with emergency authorization from the Food and Drug Administration (FDA) and the Massachusetts Department of Public Health. FINDINGS The in-house testing platform displayed robust accuracy and reliability in validation studies and reduced institutional sample turnaround time from 5-7 days to less than 24 h. Of over 1,000 unique patient samples tested, 44.1% were positive for SARS-CoV-2 infection. CONCLUSIONS This work provides a blueprint for academic centers and community hospitals lacking automated laboratory machinery to implement rapid in-house testing. FUNDING This study was supported by funding from the Boston University School of Medicine, the National Institutes of Health, Boston Medical Center, and the Massachusetts Consortium on Pathogen Readiness (MASS CPR).
Collapse
Affiliation(s)
- Kim Vanuytsel
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
- Section of Hematology and Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA 02218, USA
| | - Aditya Mithal
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
| | - Richard M Giadone
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
| | - Anthony K Yeung
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
| | - Taylor M Matte
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
| | - Todd W Dowrey
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
| | - Rhiannon B Werder
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
| | - Gregory J Miller
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
| | - Nancy S Miller
- Department of Pathology and Laboratory Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02218, USA
| | - Christopher D Andry
- Department of Pathology and Laboratory Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02218, USA
| | - George J Murphy
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02218, USA
- Section of Hematology and Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA 02218, USA
| |
Collapse
|
14
|
Theel ES, Couturier MR, Filkins L, Palavecino E, Mitchell S, Campbell S, Pentella M, Butler-Wu S, Jerke K, Dharmarha V, McNult P, Schuetz AN. Application, Verification, and Implementation of SARS-CoV-2 Serologic Assays with Emergency Use Authorization. J Clin Microbiol 2020; 59:e02148-20. [PMID: 33020185 PMCID: PMC7771455 DOI: 10.1128/jcm.02148-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Interest continues to grow regarding the role of serologic assays for the detection of prior infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The U.S. Food and Drug Administration (FDA) has granted emergency use authorization (EUA) status to many SARS-CoV-2 serologic assays. In this document, expert recommendations from clinical microbiologist members of the American Society for Microbiology (ASM) concerning detailed verification strategies for SARS-CoV-2 serologic assays with FDA EUA are provided, as are insights into assay limitations and reporting considerations for laboratories. Assessments concerning single-antibody and multiantibody isotype detection assays, which may provide either differentiated or nondifferentiated (i.e., total antibody) antibody class results, are addressed. Additional considerations prior to assay implementation are also discussed, including biosafety, quality control, and proficiency testing strategies. As the landscape of SARS-CoV-2 serologic testing is rapidly changing, this document provides updated guidance for laboratorians on application of these assays.
Collapse
Affiliation(s)
- Elitza S Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marc Roger Couturier
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- ARUP Laboratories, Salt Lake City, Utah, USA
| | - Laura Filkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth Palavecino
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Stephanie Mitchell
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sheldon Campbell
- Department of Laboratory Medicine, Yale School of Medicine, West Haven, Connecticut, USA
- Department of Pathology and Laboratory Medicine, VA Connecticut Health Care, West Haven, Connecticut, USA
| | - Michael Pentella
- College of Public Health, University of Iowa, Iowa City, Iowa, USA
- State Hygienic Laboratory, University of Iowa, Coralville, Iowa, USA
| | - Susan Butler-Wu
- Department of Pathology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Kurt Jerke
- Department of Pathology and Area Laboratory Services, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | | | - Peggy McNult
- American Society for Microbiology, Washington, DC, USA
| | - Audrey N Schuetz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
15
|
Fatima U, Rizvi SSA, Fatima S, Hassan MI. Impact of Hydroxychloroquine/Chloroquine in COVID-19 Therapy: Two Sides of the Coin. J Interferon Cytokine Res 2020; 40:469-471. [PMID: 32881593 DOI: 10.1089/jir.2020.0105] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), has recently emerged as a global health threat. To address this health emergency, various therapeutic approaches are currently under investigation. There is limited evidence on the effectiveness of hydroxychloroquine (HCQ) and chloroquine (CQ) as COVID-19 therapies, and thus World Health Organization (WHO) mentioned that "Current data shows that this drug does not reduce deaths among hospitalized COVID-19 patients, nor help people with mild or moderate disease." CQ and HCQ are typically used for the treatment of malaria but have been recognized for certain beneficial effects in COVID-19 patients based on some clinical outcomes from the clinical treatment of COVID-19. A standard dose of HCQ has been proven effective and less toxic than CQ in COVID-19 patients; however, a comprehensive understanding of a patient's clinical condition is necessary. Based on several hospital findings, the Food and Drug Administration (FDA) has officially cancelled the emergency use authorization for HCQ and CQ for treating hospitalized COVID-19 patients on June 15, 2020. In this review, we highlight both pros and cons of the clinical use of CQ and HCQ in COVID-19 patients.
Collapse
Affiliation(s)
- Urooj Fatima
- Department of Botany, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | | | - Saher Fatima
- Department Agricultural Microbiology, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Md Imtaiyaz Hassan
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar New Delhi, India
| |
Collapse
|
16
|
Abstract
Against the backdrop of the COVID pandemic, the scientific and medical communities are working with all deliberate speed with state-of-the-art technologies to develop diagnostic and therapeutic products that can identify, treat, and prevent infection with SARS-CoV-2. These activities may only be legally conducted with the necessary statutes and regulations in place to facilitate the timely development, manufacturing, evaluation, and distribution of products that meet quality standards. The present regulatory landscape for medicinal and medical products for human use has been shaped by nearly 12 decades of statutory history that followed in reaction to disasters and tragedies. Five distinct, closely woven threads of statutory history have led to the regulatory infrastructure we have in place: (1) standardized processes for routine development of medicinal and medical device products for human use; (2) processes for expedited development to shorten time frames and expand patient populations; (3) mechanisms of Expanded Access to make medicinal products available to patients prior to approval of the US Food and Drug Administration; (4) Emergency Use Authorization during public health emergencies; and (5) the development of pathways for bringing generic drugs and biosimilar biologics to market. These mechanisms are being brought to bear to facilitate the defeat of infection with SARS-CoV-2.
Collapse
Affiliation(s)
- Paul Beninger
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| |
Collapse
|
17
|
Nili A, Farbod A, Neishabouri A, Mozafarihashjin M, Tavakolpour S, Mahmoudi H. Remdesivir: A beacon of hope from Ebola virus disease to COVID-19. Rev Med Virol 2020; 30:1-13. [PMID: 33210457 DOI: 10.1002/rmv.2133] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022]
Abstract
Since the emergence of coronavirus disease 2019 (Covid-19), many studies have been performed to characterize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and find the optimum way to combat this virus. After suggestions and assessments of several therapeutic options, remdesivir (GS-5734), a direct-acting antiviral drug previously tested against Ebola virus disease, was found to be moderately effective and probably safe for inhibiting SARS-CoV-2 replication. Finally, on 1 May 2020, remdesivir (GS-5734) was granted emergency use authorization as an investigational drug for the treatment of Covid-19 by the Food and Drug Administration. However, without a doubt, there are challenging days ahead. Here, we provide a review of the latest findings (based on preprints, post-prints, and news releases in scientific websites) related to remdesivir efficacy and safety for the treatment of Covid-19, along with covering remdesivir history from bench-to-bedside, as well as an overview of its mechanism of action. In addition, active clinical trials, as well as challenging issues related to the future of remdesivir in Covid-19, are covered. Up to the date of writing this review (19 May 2020), there is one finished randomized clinical trial and two completed non-randomized studies, in addition to some ongoing studies, including three observational studies, two expanded access studies, and seven active clinical trials registered on the clinicaltrials.gov and isrctn.com websites. Based on these studies, it seems that remdesivir could be an effective and probably safe treatment option for Covid-19. However, more randomized controlled studies are required.
Collapse
Affiliation(s)
- Ali Nili
- Department of Dermatology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Farbod
- Department of Dermatology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Neishabouri
- Department of Dermatology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mozafarihashjin
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada.,Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Hamidreza Mahmoudi
- Department of Dermatology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
Rhoads DD, Cherian SS, Roman K, Stempak LM, Schmotzer CL, Sadri N. Comparison of Abbott ID Now, DiaSorin Simplexa, and CDC FDA Emergency Use Authorization Methods for the Detection of SARS-CoV-2 from Nasopharyngeal and Nasal Swabs from Individuals Diagnosed with COVID-19. J Clin Microbiol 2020; 58:e00760-20. [PMID: 32303564 DOI: 10.1128/JCM.00760-20] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
19
|
Johnson WG, Marchant GE. Legislating in the time of a pandemic: window of opportunity or invitation for recklessness? J Law Biosci 2020; 7:lsaa042. [PMID: 32959005 PMCID: PMC7337772 DOI: 10.1093/jlb/lsaa042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 05/24/2023]
Affiliation(s)
- Walter G Johnson
- Sandra Day O’Connor College of Law, Arizona State University, Phoenix, AZ 85004, USA
| | - Gary E Marchant
- Sandra Day O’Connor College of Law, Arizona State University, Phoenix, AZ 85004, USA
| |
Collapse
|
20
|
Van Norman GA. Expanding Patient Access to Investigational New Drugs: Overview of Intermediate and Widespread Treatment Investigational New Drugs, and Emergency Authorization in Public Health Emergencies. JACC Basic Transl Sci 2018; 3:403-414. [PMID: 30062226 PMCID: PMC6058931 DOI: 10.1016/j.jacbts.2018.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/23/2018] [Indexed: 11/26/2022]
Abstract
Individual patients with life-threatening or severely debilitating diseases can petition the U.S. Food and Drug Administration (FDA) through their physicians to have expanded access (EA) to drugs that are in clinical trials but have not reached full FDA approval (the "single-patient" investigational new drug [IND] application). Additionally, recent state and federal laws-so-called "right to try legislation"-allow patients to approach drug companies directly for access prior to FDA approval. While these pathways provide potential access for individual patients to investigational drugs, different EA pathways permit entire groups of certain patients to access investigational drugs prior to FDA approval. This review focuses on special categories of EA INDs intended for multiple patients-the intermediate-group IND and the widespread-treatment IND-as well as emergency authorization for use of investigational drugs and biological products (e.g., vaccines) in public health emergencies.
Collapse
Affiliation(s)
- Gail A. Van Norman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
21
|
Kost GJ, Ferguson W, Truong AT, Hoe J, Prom D, Banpavichit A, Kongpila S. Molecular detection and point-of-care testing in Ebola virus disease and other threats: a new global public health framework to stop outbreaks. Expert Rev Mol Diagn 2015; 15:1245-59. [PMID: 26367243 PMCID: PMC7103715 DOI: 10.1586/14737159.2015.1079776] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ultrahigh sensitivity and specificity assays that detect Ebola virus disease or other highly contagious and deadly diseases quickly and successfully upstream in Spatial Care Paths™ can stop outbreaks from escalating into devastating epidemics ravaging communities locally and countries globally. Even had the WHO and CDC responded more quickly and not misjudged the dissemination of Ebola in West Africa and other world regions, mobile rapid diagnostics were, and still are, not readily available for immediate and definitive diagnosis, a stunning strategic flaw that needs correcting worldwide. This article strategizes point-of-care testing for diagnosis, triage, monitoring, recovery and stopping outbreaks in the USA and other countries; reviews Ebola molecular diagnostics, summarizes USA FDA emergency use authorizations and documents why they should not be stop-gaps; and reduces community risk from internal and external infectious disease threats by enabling public health at points of need.
Collapse
|