1
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Fukushima HCS, Bailone RL, Borra RC. Assessment of Risperidone Toxicity in Zebrafish ( Danio rerio) Embryos. Comp Med 2023; 73:260-266. [PMID: 37536933 PMCID: PMC10702279 DOI: 10.30802/aalas-cm-22-000123] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/26/2023] [Accepted: 03/14/2023] [Indexed: 08/05/2023]
Abstract
Risperidone is an antipsychotic medication used in the treatment of conditions like autism and schizophrenia. The goal of the current study was to examine the effects of risperidone in zebrafish embryos ( Danio rerio ) with regard to survival, development, and cardiac and neural systems. The results showed that concentrations above 100 μM were associated with deaths, teratogenic effects, and cardiotoxic and neurotoxic effects. The findings support the utility of zebrafish for toxicological screening studies.
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Affiliation(s)
| | - Ricardo Lacava Bailone
- Department of Genetics and Evolution, Federal University of São Carlos, São Carlos, Brazil; and
- Department of Federal Inspection Service, Ministry of Agriculture, Livestock and Supply of Brazil, São Carlos, Brazil
| | - Ricardo Carneiro Borra
- Department of Genetics and Evolution, Federal University of São Carlos, São Carlos, Brazil; and
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2
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Yih WK, Daley MF, Duffy J, Fireman B, McClure D, Nelson J, Qian L, Smith N, Vazquez-Benitez G, Weintraub E, Williams JTB, Xu S, Maro JC. A broad assessment of covid-19 vaccine safety using tree-based data-mining in the vaccine safety datalink. Vaccine 2023; 41:826-835. [PMID: 36535825 PMCID: PMC9755007 DOI: 10.1016/j.vaccine.2022.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 10/03/2022] [Revised: 11/18/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Except for spontaneous reporting systems, vaccine safety monitoring generally involves pre-specifying health outcomes and post-vaccination risk windows of concern. Instead, we used tree-based data-mining to look more broadly for possible adverse events after Pfizer-BioNTech, Moderna, and Janssen COVID-19 vaccination. METHODS Vaccine Safety Datalink enrollees receiving ≥1 dose of COVID-19 vaccine in 2020-2021 were followed for 70 days after Pfizer-BioNTech or Moderna and 56 days after Janssen vaccination. Incident diagnoses in inpatient or emergency department settings were analyzed for clustering within both the hierarchical ICD-10-CM code structure and the post-vaccination follow-up period. We used the self-controlled tree-temporal scan statistic and TreeScan software. Monte Carlo simulation was used to estimate p-values; p = 0.01 was the pre-specified cut-off for statistical significance of a cluster. RESULTS There were 4.1, 2.6, and 0.4 million Pfizer-BioNTech, Moderna, and Janssen vaccinees, respectively. Clusters after Pfizer-BioNTech vaccination included: (1) unspecified adverse effects, (2) common vaccine reactions, such as fever, myalgia, and headache, (3) myocarditis/pericarditis, and (4) less specific cardiac or respiratory symptoms, all with the strongest clusters generally after Dose 2; and (5) COVID-19/viral pneumonia/sepsis/respiratory failure in the first 3 weeks after Dose 1. Moderna results were similar but without a significant myocarditis/pericarditis cluster. Further investigation suggested the fifth signal group was a manifestation of mRNA vaccine effectiveness after the first 3 weeks. Janssen vaccinees had clusters of unspecified or common vaccine reactions, gait/mobility abnormalities, and muscle weakness. The latter two were deemed to have arisen from confounding related to practices at one site. CONCLUSIONS We detected post-vaccination clusters of unspecified adverse effects, common vaccine reactions, and, for the mRNA vaccines, chest pain and palpitations, as well as myocarditis/pericarditis after Pfizer-BioNTech Dose 2. Unique advantages of this data mining are its untargeted nature and its inherent adjustment for the multiplicity of diagnoses and risk intervals scanned.
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Affiliation(s)
- W Katherine Yih
- Harvard Pilgrim Health Care Institute and Department of Population Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Bruce Fireman
- Kaiser Permanente Northern California, Oakland, CA, United States
| | - David McClure
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | | | - Lei Qian
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Ning Smith
- Kaiser Permanente Northwest, Portland, OR, United States
| | | | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Stanley Xu
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Judith C Maro
- Harvard Pilgrim Health Care Institute and Department of Population Medicine, Harvard Medical School, Boston, MA, United States
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3
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Hedvat J, Lange NW, Salerno DM, DeFilippis EM, Kovac D, Corbo H, Chen JK, Choe JY, Lee JH, Anamisis A, Jennings DL, Codispodo G, Shertel T, Brown RS, Pereira MR. COVID-19 therapeutics and outcomes among solid organ transplant recipients during the Omicron BA.1 era. Am J Transplant 2022; 22:2682-2688. [PMID: 35801839 PMCID: PMC9349644 DOI: 10.1111/ajt.17140] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 04/22/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
Treatment outcomes associated with the use of novel COVID-19 therapeutics in solid organ transplant recipients (SOTR) are not well described in the literature. The objective of this analysis was to characterize 30-day hospitalization and other key secondary endpoints experienced by outpatient SOTR with mild-moderate COVID-19 treated with nirmatrelvir/ritonavir (NR), sotrovimab, or no SARS-CoV-2 specific treatment. This IRB-approved, retrospective study included 154 SOTR with a documented positive SARS-CoV-2 infection between December 16, 2021 and January 19, 2022 (a predominant Omicron BA.1 period in New York City). Patients who received NR (N = 28) or sotrovimab (N = 51) experienced a lower rate of 30-day hospitalization or death as compared to those who received no specific treatment (N = 75) (p = .009). A total of three deaths occurred, all among patients who initially received no specific treatment prior to hospitalization. These results suggest a role for SARS-CoV-2 specific agents in the treatment of SOTR with COVID-19, and that there does not appear to be any difference in effectiveness when comparing NR versus sotrovimab.
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Key Words
- aki, acute kidney injury
- arr, adjusted risk ratio
- bmi, body mass index
- ci, confidence interval
- eua, emergency use authorization
- fda, food and drug administration
- iqr, interquartile range
- mmf, mycophenolate mofetil
- nr, nirmatrelvir/ritonavir
- nyph, newyork-presbyterian hospital
- rrr, relative risk reduction
- scr, serum creatinine
- sotr, solid organ transplant recipient
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Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA,Jessica Hedvat, Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, NY, USA.
| | - Nicholas W. Lange
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - David M. Salerno
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Ersilia M. DeFilippis
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York City, New York USA
| | - Danielle Kovac
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Heather Corbo
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Justin K. Chen
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Jason Y. Choe
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Jennifer H. Lee
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Anastasia Anamisis
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Douglas L. Jennings
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Giovanna Codispodo
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Tara Shertel
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Robert S. Brown
- Department of Medicine Weill Cornell Medicine New York City, New York USA
| | - Marcus R. Pereira
- Department of Medicine Vagelos College of Physicians and Surgeons New York City, New York USA
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4
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O'Horo J, Challener DW, Anderson RJ, Arndt RF, Ausman SE, Hall ST, Heyliger A, Kennedy BD, Sweeten PW, Ganesh R, Razonable RR. Rates of Severe Outcomes After Bamlanivimab-Etesevimab and Casirivimab-Imdevimab Treatment of High-Risk Patients With Mild to Moderate Coronavirus Disease 2019. Mayo Clin Proc 2022; 97:943-950. [PMID: 35512884 PMCID: PMC8864104 DOI: 10.1016/j.mayocp.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 11/23/2022]
Abstract
Bamlanivimab-etesevimab and casirivimab-imdevimab are authorized by the US Food and Drug Administration for emergency treatment of mild to moderate coronavirus disease 2019 (COVID-19) in high-risk persons. There has been no study comparing their clinical efficacy. In this retrospective study of 681 patients with mild to moderate COVID-19 during a period dominated by severe acute respiratory syndrome coronavirus 2 wild-type and alpha variants, 25 patients (3.7%) had progression to a severe outcome requiring hospitalization and oxygen supplementation within 30 days after monoclonal antibody infusion. Severe outcome was significantly higher among the 181 patients who were treated with casirivimab-imdevimab when compared with the 500 patients who received bamlanivimab-etesevimab (21 [6.6%] vs 13 [2.6%]; P=.01). Patients treated with casirivimab-imdevimab had higher odds of severe outcomes compared with those who received bamlanivimab-etesevimab (odds ratio, 2.67; 95% CI, 1.17 to 6.06). The demographic and clinical characteristics, and the time to monoclonal antibody infusion, of the 2 treatment cohorts were not significantly different. The reason behind this significant difference in the clinical outcomes is unclear, but our observations emphasize potential efficacy differences among antispike monoclonal antibodies against COVID-19. Further clinical studies using larger cohorts of patients are needed to confirm or refute these observations.
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Affiliation(s)
- John O'Horo
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Richard F Arndt
- Department of Pharmacy, Mayo Clinic Health System, Eau Claire, WI
| | - Sara E Ausman
- Department of Pharmacy, Mayo Clinic Health System, Eau Claire, WI
| | - Scott T Hall
- Department of Pharmacy, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | | | - Brian D Kennedy
- Department of Pharmacy, Mayo Clinic Health System, Lake City, MN
| | - Perry W Sweeten
- Department of Pharmacy, Mayo Clinic Health System, Mankato, MN
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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5
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Werbel WA, Segev DL. SARS-CoV-2 antibody testing for transplant recipients: A tool to personalize protection versus COVID-19. Am J Transplant 2022; 22:1316-1320. [PMID: 35119179 PMCID: PMC9111420 DOI: 10.1111/ajt.16993] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/13/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 01/25/2023]
Abstract
Anti-spike antibody testing has emerged as a powerful tool to assess SARS-CoV-2 vaccine response in solid organ transplant (SOT) recipients, many of whom remain at risk for COVID-19 despite vaccination. Neither the US Food and Drug Administration nor major transplant societies recommend testing antibody responses after vaccination, or its general incorporation into COVID-19 risk stratification. Notably, in December 2021, the American Society of Transplantation recognized anti-spike seronegativity as a consideration for use of monoclonal antibody pre-exposure prophylaxis. In this viewpoint, we narrate the evolving rationale for anti-spike antibody testing and ultimately recommend that all SOT recipients be tested for anti-spike antibody after vaccination. This result should then be used to personalize efforts to improve protection versus COVID-19 for the most vulnerable, such as additional vaccination strategies and consideration of passive immunoprophylaxis.
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Affiliation(s)
- William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA,Correspondence Dorry Segev, Associate Vice-Chair of Research, Department of Surgery, Johns Hopkins Medical Institutions, 720 Rutland Ave, Ross 34, Baltimore, MD 21205, USA.
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6
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Akamine CM, El Sahly HM. Messenger ribonucleic acid vaccines for severe acute respiratory syndrome coronavirus-2 - a review. Transl Res 2022; 242:1-19. [PMID: 34954088 PMCID: PMC8695521 DOI: 10.1016/j.trsl.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023]
Abstract
The mRNA therapeutics have been studied since the 1970s and the currently available mRNA vaccines against COVID-19 are the culmination of decades of scientific research. The mRNA vaccines BNT162b2 and mRNA-1273 have played a key role in our global response to the COVID-19 pandemic as they have demonstrated significant advantages over conventional vaccines and have proven to be highly effective against COVID-19 associated hospitalization and severe illness in large clinical trials and studies using real-world data.
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Key Words
- covid-19, coronavirus disease of 2019
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- mrna, messenger ribonucleic acid
- lnp, liposomal nanoparticle
- sam, self-amplifying mrna
- dsrna, double-stranded rna
- ad5, adenovirus type 5
- apcs, antigen presenting cells
- rbd, receptor-binding domain
- mers-cov, middle east respiratory syndrome coronavirus
- gmt, geometric mean titer
- bmi, body mass index
- eua, emergency use authorization
- cdc, centers for disease control
- b.1.1.7, alpha variant
- b.1.351, beta variant
- covid-net, covid-19-associated hospitalization surveillance network
- voc, variants of concern
- utr, untranslated regions
- pamps, pathogen-associated molecular patterns
- mhc, major histocompatibility complex
- dcs, dendritic cells
- ace-2, angiotensin converting enzyme receptor
- cvncov, curevac
- gmc, geometric mean concentration
- fda, food and drug administration
- vaers, vaccine adverse event reporting system
- bau, binding antibody units
- dna, deoxyribonucleic acid
- trna, transfer ribonucleic acid
- prnt50, plaque reduction neutralization test
- nab, neutralizing antibodies
- bla, biologics license application
- ve, vaccine efficacy
- vsd, vaccine safety datalink
- va, department of veterans affairs
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Affiliation(s)
| | - Hana M El Sahly
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas
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7
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Pettoello-Mantovani M, Cardemil C, Cohen R, Levy C, Giardino I, Indrio F, Somekh E. Importance of Coronavirus Disease 2019 Vaccination in Children: Viewpoint and Recommendations of the Union of European National Societies of Pediatrics. J Pediatr 2022; 243:242-245. [PMID: 34973285 PMCID: PMC8716156 DOI: 10.1016/j.jpeds.2021.12.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Massimo Pettoello-Mantovani
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, ARS, Nouchatel, Switzerland; Italian Academy of Pediatrics, Milan, Italy; Department of Pediatrics, University of Foggia, "Casa Sollievo" Scientific Institute, San Giovanni Rotondo, Italy
| | - Cristina Cardemil
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Rockville, MD
| | - Robert Cohen
- Pediatric Infectious Disease Group (GPIP), Créteil, France; Association Clinique et thérapeutique Infantile du Val de Marne, Créteil, France; Paris Est University, IMRB-GRC GEMINI, Créteil, France
| | - Corinne Levy
- Pediatric Infectious Disease Group (GPIP), Créteil, France; Association Clinique et thérapeutique Infantile du Val de Marne, Créteil, France; Paris Est University, IMRB-GRC GEMINI, Créteil, France
| | - Ida Giardino
- Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Flavia Indrio
- Department of Pediatrics, University of Foggia, "Casa Sollievo" Scientific Institute, San Giovanni Rotondo, Italy
| | - Eli Somekh
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Association pour l'Activité et la Recherche Scìentifiques, ARS, Nouchatel, Switzerland; Department of Pediatrics, Mayanei Hayeshuah Medical Center, Bnei Brak, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Pediatric Society, Tel Aviv, Israel
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8
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O'Horo JC, Challener DW, Speicher L, Bosch W, Seville MT, Bierle DM, Ganesh R, Wilker CG, Arndt RF, Arndt LL, Tulledge-Scheitel SM, Hanson SN, Razonable RR. Effectiveness of Monoclonal Antibodies in Preventing Severe COVID-19 With Emergence of the Delta Variant. Mayo Clin Proc 2022; 97:327-332. [PMID: 35120695 PMCID: PMC8674496 DOI: 10.1016/j.mayocp.2021.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/03/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
Anti-spike monoclonal antibodies have proven invaluable in preventing severe outcomes from COVID-19, including hospitalization and death. The rise of the SARS-CoV-2 delta variant begs the question of whether monoclonal antibodies maintain similar efficacy now as they had when the alpha and beta variants predominated, when they were first assessed and approved. We used a retrospective cohort to compare rates of severe outcomes in an epoch in which alpha and beta were predominant compared with delta. A total of 5356 patients were infused during the alpha/beta variant-predominant (n=4874) and delta variant-predominant (n=482) era. Overall, odds of severe infection were 3.0% of patients in the alpha/beta-predominant era compared with 4.9% in the delta-predominant cohort. The unadjusted odds ratio (OR) was higher for severe disease in the delta era (OR, 1.67; 95% CI, 0.96 to 2.89), particularly when adjusted for Charlson Comorbidity Index (adjusted OR, 2.04; 95% CI, 1.30 to 3.08). The higher odds of severe infection could be due to a more virulent delta variant, although the possibility of decreased anti-spike monoclonal antibody effectiveness in the clinical setting cannot be excluded. Research into the most effective strategies for using and improving anti-spike monoclonals for the treatment of emerging variants is warranted.
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Affiliation(s)
- John C O'Horo
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
| | | | - Dennis M Bierle
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Caroline G Wilker
- Division of Primary Care Internal Medicine, Mayo Clinic Health System, La Crosse, WI
| | - Richard F Arndt
- Department of Pharmacy, Mayo Clinic Health System, Eau Claire, WI
| | - Lori L Arndt
- Division of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI
| | | | - Sara N Hanson
- Division of Family Medicine, Mayo Clinic Health System, Mankato, MN
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9
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Key Words
- aidp, acute, inflammatory demyelinating polyneuropathy
- aman, acute, motor, axonal neuropathy
- amsan, acute, motor, and sensory axonal neuropathy
- azv, astra zeneca vaccine
- cns, central nervous system
- fda, food and drug administration
- gbs, guillain barres syndrome
- ivig, ntravenous immunoglobulins
- mhra, medicine and healthcare products regulatory agency
- pcb, pharyngo-cervico-brachial
- pe, plasma exchange
- pns, pcripheral nervous system
- sc2vag, sars-cov-2 vaccination associated gbs
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Affiliation(s)
| | - Carla A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
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10
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Ison MG, Blumberg E, Halasa N, Kaul D, Theodoropoulos NM, Wolfe CR. Antibodies, boosters, and optimizing SARS-CoV-2 vaccines for transplantation: A call for more research. Am J Transplant 2022; 22:24-27. [PMID: 34241964 PMCID: PMC8441892 DOI: 10.1111/ajt.16758] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/22/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/25/2023]
Abstract
Despite emerging data suggesting reduced antibody responses among solid organ transplant recipients following SARS-CoV-2 vaccine, critical unanswered questions remain. The clinical implications of the reduced humoral response need to be assessed through prospective studies. Studies are likewise needed to inform which vaccine dosing strategies result in improved immunity and if such approaches maximize protection against severe infection in the vulnerable transplant population.
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Affiliation(s)
- Michael G. Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Correspondence Michael G. Ison, Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Emily Blumberg
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Dan Kaul
- Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole M. Theodoropoulos
- Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Cameron R. Wolfe
- Division of Infectious Diseases, Duke University, Durham North, Carolina, USA
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11
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Minocha PK, Better D, Singh RK, Hoque T. Recurrence of Acute Myocarditis Temporally Associated with Receipt of the mRNA Coronavirus Disease 2019 (COVID-19) Vaccine in a Male Adolescent. J Pediatr 2021; 238:321-323. [PMID: 34166671 PMCID: PMC8216855 DOI: 10.1016/j.jpeds.2021.06.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Prashant K Minocha
- Division of Pediatric Cardiology, Hassenfeld Children's Hospital, NYU Langone, New York, NY.
| | - Donna Better
- Division of Pediatric Cardiology, NYU Long Island School of Medicine, Mineola, NY
| | - Rakesh K Singh
- Division of Pediatric Cardiology, Hassenfeld Children's Hospital, NYU Langone, New York, NY
| | - Tasneem Hoque
- Division of Pediatric Cardiology, NYU Long Island School of Medicine, Mineola, NY
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12
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Bothun LS, Feeder SE, Poland GA. Readability of Participant Informed Consent Forms and Informational Documents: From Phase 3 COVID-19 Vaccine Clinical Trials in the United States. Mayo Clin Proc 2021; 96:2095-2101. [PMID: 34226027 PMCID: PMC8173482 DOI: 10.1016/j.mayocp.2021.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To assess the readability of the informed consent forms from the phase 3 COVID-19 vaccine trials conducted in the United States. PATIENTS AND METHODS English consent forms were used for patients in phase 3 COVID-19 vaccine clinical trials. Consent forms were obtained in October 2020. Using Microsoft Word tools, we analyzed the readability (ie, the ease of reading) of written consent forms and informational documents from phase 3 COVID-19 vaccine clinical trials in the United States from the following manufacturers: AstraZeneca, Moderna, Pfizer, Johnson & Johnson, and Novavax. RESULTS Owing to low readability and several format factors, this study determined that none of the consent forms or informational documents from the recent phase 3 COVID-19 vaccine clinical trials conducted in the United States met readability standards at the recommended 7th grade readability level for the average vaccine research volunteer in any readability category. The average English-speaking vaccine trial volunteer would have great difficulty comprehending the information provided in the consent forms and informational documents. To ensure that study subjects receive and fully comprehend information regarding a clinical study and can provide reliable consent, greater attention should be given to the development and use of simplified consent forms, multimedia formatting, personal discussion, and comprehension assessments.
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Affiliation(s)
- Luke S Bothun
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN
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13
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Khanna S, Tande A, Rubin DT, Khoruts A, Kahn SA, Pardi DS. Fecal Microbiota Transplantation for Recurrent C difficile Infection During the COVID-19 Pandemic: Experience and Recommendations. Mayo Clin Proc 2021; 96:1418-1425. [PMID: 34088413 PMCID: PMC8169126 DOI: 10.1016/j.mayocp.2021.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/23/2021] [Accepted: 04/12/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To report experience with fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) and provide recommendations for management of rCDI and donor testing during the COVID-19 pandemic. METHODS A retrospective study of patients with rCDI who underwent FMT from May 26, 2020, to September 30, 2020, with stool from well-screened donors with health and infectious screening and a newly implemented strategy for COVID-19 screening with every 2-week bookend testing with stool quarantine. Patients were followed up for development of rCDI and COVID-19. RESULTS Of the 57 patients who underwent FMT for rCDI, 29 were tested for COVID-19 via nasopharyngeal polymerase chain reaction (PCR) and 22 via serology. All results were negative, except for 1 positive serology. Donor testing every 2 weeks for COVID-19 via serology and nasopharyngeal swab PCR was negative, except for 2 donors at 1 center who were excluded. Three patients had rCDI after FMT, and 1 underwent repeat FMT. One patient developed respiratory symptoms suggestive of COVID-19 and tested negative via nasopharyngeal PCR. Eleven patients who underwent COVID-19 testing for elective procedures or hospitalizations tested negative. No SARS-CoV-2 transmission was noted. CONCLUSIONS With appropriate donor screening, FMT can be performed safely for rCDI during the COVID-19 pandemic. Development of a validated stool assay for SARS-CoV-2 will simplify this process further.
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Affiliation(s)
- Sahil Khanna
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
| | - Aaron Tande
- Infectious Diseases, Mayo Clinic, Rochester, MN
| | - David T Rubin
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL
| | - Alexander Khoruts
- Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN
| | - Stacy A Kahn
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
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14
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Razonable RR, Aloia NCE, Anderson RJ, Anil G, Arndt LL, Arndt RF, Ausman SE, Bell SJ, Bierle DM, Billings ML, Bishop RK, Cramer CH, Culbertson TL, Dababneh AS, Derr AN, Epps K, Flaker SM, Ganesh R, Gilmer MA, Urena EG, Gulden CR, Haack TL, Hanson SN, Herzog JR, Heyliger A, Hokanson LD, Hopkins LH, Horecki RJ, Krishna BH, Huskins WC, Jackson TA, Johnson RR, Jorgenson B, Kudrna C, Kennedy BD, Klingsporn MK, Kottke B, Larsen JJ, Lessard SR, Lutwick LI, Malone EJ, Matoush JA, Micallef IN, Moehnke DE, Mohamed M, Ness CN, Olson SM, Orenstein R, Palraj R, Patel J, Paulson DJ, Phelan D, Peinovich MT, Ramsey WL, Rau-Kane TJ, Reid KI, Reinschmidt KJ, Seville MT, Skold EC, Smith JM, Speicher LL, Spielman LA, Springer DJ, Sweeten PW, Tempelis JM, Tulledge-Scheitel S, Vergidis P, Whipple DC, Wilker CG, Destro Borgen MJ. A Framework for Outpatient Infusion of Antispike Monoclonal Antibodies to High-Risk Patients with Mild-to-Moderate Coronavirus Disease-19: The Mayo Clinic Model. Mayo Clin Proc 2021; 96:1250-1261. [PMID: 33958056 PMCID: PMC7942148 DOI: 10.1016/j.mayocp.2021.03.010] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The administration of spike monoclonal antibody treatment to patients with mild to moderate COVID-19 is very challenging. This article summarizes essential components and processes in establishing an effective spike monoclonal antibody infusion program. Rapid identification of a dedicated physical infrastructure was essential to circumvent the logistical challenges of caring for infectious patients while maintaining compliance with regulations and ensuring the safety of our personnel and other patients. Our partnerships and collaborations among multiple different specialties and disciplines enabled contributions from personnel with specific expertise in medicine, nursing, pharmacy, infection prevention and control, electronic health record (EHR) informatics, compliance, legal, medical ethics, engineering, administration, and other critical areas. Clear communication and a culture in which all roles are welcomed at the planning and operational tables are critical to the rapid development and refinement needed to adapt and thrive in providing this time-sensitive beneficial therapy. Our partnerships with leaders and providers outside our institutions, including those who care for underserved populations, have promoted equity in the access of monoclonal antibodies in our regions. Strong support from institutional leadership facilitated expedited action when needed, from a physical, personnel, and system infrastructure standpoint. Our ongoing real-time assessment and monitoring of our clinical program allowed us to improve and optimize our processes to ensure that the needs of our patients with COVID-19 in the outpatient setting are met.
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Key Words
- cfct, covid-19 frontline care team
- covid-19, coronavirus disease-19
- ehr, electronic health records
- eua, emergency use authorization
- fda, food and drug administration
- hics, healthcare incident command system
- idsa, infectious diseases society of america
- ipac, infection prevention and control
- itc, infusion therapy center
- matrx, monoclonal antibody treatment team
- nih, national institutes of health
- pcct, pediatric covid-19 care team
- sars-cov-2, severe acute respiratory syndrome coronavirus-2
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Affiliation(s)
| | - Nicole C E Aloia
- Administrative Operations, Mayo Clinic Health System, Eau Claire, WI
| | | | - Gokhan Anil
- Department of Obstetrics and Gynecology, Mayo Clinic Health System, Mankato, MN
| | - Lori L Arndt
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI
| | - Richard F Arndt
- Department of Pharmacy, Mayo Clinic Health System, Eau Claire, WI
| | - Sara E Ausman
- Department of Pharmacy, Mayo Clinic Health System, Eau Claire, WI
| | - Sarah J Bell
- Department of Nursing, Mayo Clinic, Rochester, MN
| | - Dennis M Bierle
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Marcie L Billings
- Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Rachel K Bishop
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Department of Nursing, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | - Carl H Cramer
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Division of Pediatric Nephrology, Mayo Clinic, Rochester, MN
| | - Tracy L Culbertson
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Department of Nursing, Mayo Clinic Health System, Mankato, MN
| | - Ala S Dababneh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | - Kevin Epps
- Department of Pharmacy, Mayo Clinic, Jacksonville, FL
| | - Susan M Flaker
- Department of Pharmacy, Mayo Clinic Health System, Red Wing, MN
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Mary A Gilmer
- Department of Pharmacy, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | - Eric Gomez Urena
- Division of Infectious Diseases, Mayo Clinic Health System, Mankato, MN
| | | | | | - Sara N Hanson
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN
| | - Jenna R Herzog
- Administrative Operations, Mayo Clinic Health System, Albert Lea, MN
| | | | | | - Laura H Hopkins
- Department of Nursing, Mayo Clinic Health System, Mankato, MN
| | - Richard J Horecki
- Division of Primary Care Internal Medicine, Mayo Clinic Health System, Eau Claire, WI
| | | | - W Charles Huskins
- Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Tammy A Jackson
- Department of Nursing, Mayo Clinic Health System, Eau Claire, WI
| | - Ryan R Johnson
- Department of Administration, Mayo Clinic Health System, Mankato, MN
| | - Betty Jorgenson
- Department of Nursing, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | - Cory Kudrna
- Information Technology, Mayo Clinic, Rochester, MN
| | - Brian D Kennedy
- Department of Pharmacy, Mayo Clinic Health System, Lake City, MN
| | - Mary K Klingsporn
- Nursing Education and Professional Development, Mayo Clinic, Rochester, MN
| | - Brian Kottke
- Department of Nursing, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | | | - Sarah R Lessard
- Department of Pharmacy, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | - Larry I Lutwick
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI
| | - Edward J Malone
- Department of Family Medicine, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | | | | | | | - Muhanad Mohamed
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI
| | | | - Shelly M Olson
- Department of Nursing, Mayo Clinic Health System, Owatonna, MN
| | - Robert Orenstein
- Division of Infectious Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Raj Palraj
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Janki Patel
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI
| | | | - David Phelan
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | - Kevin I Reid
- Department of Dental Specialties, Mayo Clinic, Rochester, MN
| | - Karen J Reinschmidt
- Department of Management Engineering and Consulting, Mayo Clinic, Rochester, MN
| | | | - Erin C Skold
- Legal Department, Mayo Clinic Health System, Eau Claire, WI
| | - Jill M Smith
- Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Leigh L Speicher
- Division of General Internal Medicine, Mayo Clinic Florida, Jacksonville, FL
| | | | | | - Perry W Sweeten
- Department of Pharmacy, Mayo Clinic Health System, Mankato, MN
| | - Jennifer M Tempelis
- Department of Pharmacy, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | | | | | - Daniel C Whipple
- Department of Management Engineering and Consulting, Mayo Clinic, Rochester, MN
| | - Caroline G Wilker
- Division of Primary Care Internal Medicine, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
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15
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Rolak S, Hayney MS, Farraye FA, Temte JL, Caldera F. What Gastroenterologists Should Know About COVID-19 Vaccines. Clin Gastroenterol Hepatol 2021; 19:657-661. [PMID: 33548200 PMCID: PMC7857702 DOI: 10.1016/j.cgh.2021.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Stacey Rolak
- Department of Medicine, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, Wisconsin
| | - Mary S Hayney
- School of Pharmacy, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, Wisconsin
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Jonathan L Temte
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, Wisconsin
| | - Freddy Caldera
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, Wisconsin.
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16
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Affiliation(s)
- Amanda Fernandes
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sonya Chaudhari
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nadia Jamil
- Alpert Medical School of Brown University, Providence, Rhode Island
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17
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Montastruc F, Thuriot S, Durrieu G. Hepatic Disorders With the Use of Remdesivir for Coronavirus 2019. Clin Gastroenterol Hepatol 2020; 18:2835-2836. [PMID: 32721580 PMCID: PMC7381904 DOI: 10.1016/j.cgh.2020.07.050] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
Remdesivir is a nucleotide analog prodrug with antiviral activity against a broad spectrum of human coronavirus in cell cultures and mouse models including severe acute respiratory syndrome-associated coronavirus 2. Recently, the Food and Drug Agency (FDA) and the European Medicines Agency (EMA) recommended remdesivir for the treatment of patients hospitalized with severe coronavirus disease 2019 (COVID-19) infection.1,2 In the remdesivir clinical development program, some cases have raised concerns regarding potential hepatobiliary disorders associated with remdesivir, including in healthy volunteers and patients with COVID-19.3 In cohort studies of patients hospitalized for severe COVID-19 who were treated with compassionate-use remdesivir, elevated hepatic enzymes were the most frequent adverse drug reaction reported.4,5 In the first randomized, double-blind, placebo-controlled clinical trial assessing the effect of intravenous remdesivir in adults admitted to hospital with severe COVID-19 (n = 237), a higher proportion of remdesivir recipients than placebo recipients had dosing prematurely stopped by the investigators because of adverse events including aminotransferase or bilirubin increases (3 versus 0).6 Although there is no signal from the available data of severe hepatotoxicity or drug-induced liver injury in clinical trials, the number of patients exposed to remdesivir was too limited. Therefore, there is an urgent need to investigate the hepatic safety profile associated with remdesivir in COVID-19 patients.
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Affiliation(s)
- François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, Toulouse, France; INSERM, UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, CIC 1426 - University Paul Sabatier Toulouse, Toulouse, France.
| | - Samuel Thuriot
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, Toulouse, France
| | - Geneviève Durrieu
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, Toulouse, France,INSERM, UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, CIC 1426 - University Paul Sabatier Toulouse, Toulouse, France
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18
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Joyner MJ, Bruno KA, Klassen SA, Kunze KL, Johnson PW, Lesser ER, Wiggins CC, Senefeld JW, Klompas AM, Hodge DO, Shepherd JRA, Rea RF, Whelan ER, Clayburn AJ, Spiegel MR, Baker SE, Larson KF, Ripoll JG, Andersen KJ, Buras MR, Vogt MNP, Herasevich V, Dennis JJ, Regimbal RJ, Bauer PR, Blair JE, van Buskirk CM, Winters JL, Stubbs JR, van Helmond N, Butterfield BP, Sexton MA, Diaz Soto JC, Paneth NS, Verdun NC, Marks P, Casadevall A, Fairweather D, Carter RE, Wright RS. Safety Update: COVID-19 Convalescent Plasma in 20,000 Hospitalized Patients. Mayo Clin Proc 2020; 95:1888-1897. [PMID: 32861333 PMCID: PMC7368917 DOI: 10.1016/j.mayocp.2020.06.028] [Citation(s) in RCA: 293] [Impact Index Per Article: 73.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide an update on key safety metrics after transfusion of convalescent plasma in hospitalized coronavirus 2019 (COVID-19) patients, having previously demonstrated safety in 5000 hospitalized patients. PATIENTS AND METHODS From April 3 to June 2, 2020, the US Food and Drug Administration Expanded Access Program for COVID-19 convalescent plasma transfused a convenience sample of 20,000 hospitalized patients with COVID-19 convalescent plasma. RESULTS The incidence of all serious adverse events was low; these included transfusion reactions (n=78; <1%), thromboembolic or thrombotic events (n=113; <1%), and cardiac events (n=677, ~3%). Notably, the vast majority of the thromboembolic or thrombotic events (n=75) and cardiac events (n=597) were judged to be unrelated to the plasma transfusion per se. The 7-day mortality rate was 13.0% (12.5%, 13.4%), and was higher among more critically ill patients relative to less ill counterparts, including patients admitted to the intensive care unit versus those not admitted (15.6 vs 9.3%), mechanically ventilated versus not ventilated (18.3% vs 9.9%), and with septic shock or multiple organ dysfunction/failure versus those without dysfunction/failure (21.7% vs 11.5%). CONCLUSION These updated data provide robust evidence that transfusion of convalescent plasma is safe in hospitalized patients with COVID-19, and support the notion that earlier administration of plasma within the clinical course of COVID-19 is more likely to reduce mortality.
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Affiliation(s)
- Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. https://twitter.com/DrMJoyner
| | - Katelyn A Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Stephen A Klassen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Katie L Kunze
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | - Patrick W Johnson
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | | | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Allan M Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - John R A Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Robert F Rea
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Emily R Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Andrew J Clayburn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew R Spiegel
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Sarah E Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Kathryn F Larson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan G Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Kylie J Andersen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew R Buras
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | - Matthew N P Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Joshua J Dennis
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Riley J Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Philippe R Bauer
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN
| | - Janis E Blair
- Department of Internal Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ
| | | | - Jeffrey L Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James R Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Brian P Butterfield
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew A Sexton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan C Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Nigel S Paneth
- Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing
| | - Nicole C Verdun
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Peter Marks
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - R Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Human Research Protection Program, Mayo Clinic, Rochester, MN
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19
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Lim S, DeBruin DA, Leider JP, Sederstrom N, Lynfield R, Baker JV, Kline S, Kesler S, Rizza S, Wu J, Sharp RR, Wolf SM. Developing an Ethics Framework for Allocating Remdesivir in the COVID-19 Pandemic. Mayo Clin Proc 2020; 95:1946-1954. [PMID: 32861338 PMCID: PMC7305893 DOI: 10.1016/j.mayocp.2020.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
On May 1, 2020, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) to allow use of the antiviral drug remdesivir to treat patients with severe coronavirus disease-2019 (COVID-19). Remdesivir is an investigational drug studied in clinical trials for COVID-19 and is available to children and pregnant women through compassionate-use access but is not yet FDA approved. In early May, the US Department of Health and Human Services began to distribute remdesivir, donated by Gilead Sciences, Inc., to hospitals and state health departments for emergency use; multiple shipments have since been distributed. This process has raised questions of how remdesivir should be allocated. The Minnesota Department of Health has collaborated with the Minnesota COVID Ethics Collaborative and multiple clinical experts to issue an Ethical Framework for May 2020 Allocation of Remdesivir in the COVID-19 Pandemic. The framework builds on extensive ethical guidance developed for public health emergencies in Minnesota before the COVID-19 crisis. The Minnesota remdesivir allocation framework specifies an ethical approach to distributing the drug to facilities across the state and then among COVID-19 patients within each facility. This article describes the process of developing the framework and adjustments in the framework over time with emergence of new data, analyzes key issues addressed, and suggests next steps. Sharing this framework and the development process can encourage transparency and may be useful to other states formulating and refining their approach to remdesivir EUA allocation.
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Key Words
- ecmo, extracorporeal membrane oxygenation
- ehr, electronic health record
- eua, emergency use authorization
- fda, food and drug administration
- hhs, department of health and human services
- mcec, minnesota covid ethics collaborative
- mdh, minnesota department of health
- niaid, national institute of allergy and infectious diseases
- sat, science advisory team
- shccc, state health care coordination center
- umn, university of minnesota
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Affiliation(s)
- Sarah Lim
- Minnesota Department of Health, St. Paul, MN
| | | | | | | | | | | | | | | | | | - Joel Wu
- University of Minnesota, Minneapolis
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20
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Narang K, Enninga EAL, Gunaratne MDSK, Ibirogba ER, Trad ATA, Elrefaei A, Theiler RN, Ruano R, Szymanski LM, Chakraborty R, Garovic VD. SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review. Mayo Clin Proc 2020; 95:1750-1765. [PMID: 32753148 PMCID: PMC7260486 DOI: 10.1016/j.mayocp.2020.05.011] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has been associated with worse outcomes in several patient populations, including the elderly and those with chronic comorbidities. Data from previous pandemics and seasonal influenza suggest that pregnant women may be at increased risk for infection-associated morbidity and mortality. Physiologic changes in normal pregnancy and metabolic and vascular changes in high-risk pregnancies may affect the pathogenesis or exacerbate the clinical presentation of COVID-19. Specifically, SARS-CoV-2 enters the cell via the angiotensin-converting enzyme 2 (ACE2) receptor, which is upregulated in normal pregnancy. Upregulation of ACE2 mediates conversion of angiotensin II (vasoconstrictor) to angiotensin-(1-7) (vasodilator) and contributes to relatively low blood pressures, despite upregulation of other components of the renin-angiotensin-aldosterone system. As a result of higher ACE2 expression, pregnant women may be at elevated risk for complications from SARS-CoV-2 infection. Upon binding to ACE2, SARS-CoV-2 causes its downregulation, thus lowering angiotensin-(1-7) levels, which can mimic/worsen the vasoconstriction, inflammation, and pro-coagulopathic effects that occur in preeclampsia. Indeed, early reports suggest that, among other adverse outcomes, preeclampsia may be more common in pregnant women with COVID-19. Medical therapy, during pregnancy and breastfeeding, relies on medications with proven safety, but safety data are often missing for medications in the early stages of clinical trials. We summarize guidelines for medical/obstetric care and outline future directions for optimization of treatment and preventive strategies for pregnant patients with COVID-19 with the understanding that relevant data are limited and rapidly changing.
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Key Words
- ace2, angiotensin-converting enzyme 2
- acog, american college of obstetricians and gynecologists
- ang, angiotensin
- ards, acute respiratory distress syndrome
- cd, cesarean delivery
- cdc, centers for disease control and prevention
- cl, cervical length
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- ct, computed tomography
- cvs, chorionic villus sampling
- f2f, face to face
- fda, food and drug administration
- f/u, follow-up
- ga, general anesthesia
- gbs, group b streptococcus
- hcq, hydroxychloroquine
- hcw, health care worker
- hiv, human immunodeficiency virus
- icu, intensive care unit
- il, interleukin
- iol, induction of labor
- isuog, international society of ultrasound in obstetrics and gynecology
- naftnet, north american fetal therapy network
- nsaid, nonsteroidal anti-inflammatory drug
- nst, nonstress test
- ppe, personal protective equipment
- qrt-pcr, quantitative reverse transcriptase polymerase chain reaction
- raas, renin-angiotensin-aldosterone system
- rcog, royal college of obstetricians and gynaecologists
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- smfm, society for maternal-fetal medicine
- tmprss2, transmembrane serine protease 2
- us, ultrasonography
- vd, vaginal delivery
- who, world health organization
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Affiliation(s)
- Kavita Narang
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Elizabeth Ann L Enninga
- Division of Research, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Madugodaralalage D S K Gunaratne
- Division of Nephrology and Hypertension, Department of Internal Medicine, and Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Eniola R Ibirogba
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Ayssa Teles A Trad
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Amro Elrefaei
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Regan N Theiler
- Obstetrics Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Rodrigo Ruano
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Linda M Szymanski
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Rana Chakraborty
- Division of Research, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN; Division of Pediatric and Adolescent Medicine, Department of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN; Department of Immunology, Mayo Clinic College of Medicine, Rochester, MN
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, and Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN.
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Razonable RR, Pennington KM, Meehan AM, Wilson JW, Froemming AT, Bennett CE, Marshall AL, Virk A, Carmona EM. A Collaborative Multidisciplinary Approach to the Management of Coronavirus Disease 2019 in the Hospital Setting. Mayo Clin Proc 2020; 95:1467-1481. [PMID: 32622450 PMCID: PMC7260518 DOI: 10.1016/j.mayocp.2020.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which presents an unprecedented challenge to medical providers worldwide. Although most SARS-CoV-2-infected individuals manifest with a self-limited mild disease that resolves with supportive care in the outpatient setting, patients with moderate to severe COVID-19 will require a multidisciplinary collaborative management approach for optimal care in the hospital setting. Laboratory and radiologic studies provide critical information on disease severity, management options, and overall prognosis. Medical management is mostly supportive with antipyretics, hydration, oxygen supplementation, and other measures as dictated by clinical need. Among its medical complications is a characteristic proinflammatory cytokine storm often associated with end-organ dysfunction, including respiratory failure, liver and renal insufficiency, cardiac injury, and coagulopathy. Specific recommendations for the management of these medical complications are discussed. Despite the issuance of emergency use authorization for remdesivir, there are still no proven effective antiviral and immunomodulatory therapies, and their use in COVID-19 management should be guided by clinical trial protocols or treatment registries. The medical care of patients with COVID-19 extends beyond their hospitalization. Postdischarge follow-up and monitoring should be performed, preferably using telemedicine, until the patients have fully recovered from their illness and are released from home quarantine protocols.
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Key Words
- agp, aerosol-generating procedure
- aki, acute kidney injury
- alt, alanine aminotransferase
- ards, acute respiratory distress syndrome
- ast, aspartate aminotransferase
- cbc, complete blood cell
- cdc, centers for disease control and prevention
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- ct, computed tomography
- ecg, electrocardiogram
- esr, erythrocyte sedimentation rate
- fda, food and drug administration
- ggo, ground-glass opacity
- hrct, high-resolution computed tomography
- icu, intensive care unit
- il, interleukin
- ldh, lactate dehydrogenase
- lft, liver function test
- pcr, polymerase chain reaction
- rsv, respiratory syncytial virus
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
| | - Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Anne M Meehan
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - John W Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Eva M Carmona
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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22
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Giudicessi JR, Noseworthy PA, Friedman PA, Ackerman MJ. Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19). Mayo Clin Proc 2020; 95:1213-1221. [PMID: 32359771 PMCID: PMC7141471 DOI: 10.1016/j.mayocp.2020.03.024] [Citation(s) in RCA: 286] [Impact Index Per Article: 71.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 02/08/2023]
Abstract
As the coronavirus disease 19 (COVID-19) global pandemic rages across the globe, the race to prevent and treat this deadly disease has led to the "off-label" repurposing of drugs such as hydroxychloroquine and lopinavir/ritonavir, which have the potential for unwanted QT-interval prolongation and a risk of drug-induced sudden cardiac death. With the possibility that a considerable proportion of the world's population soon could receive COVID-19 pharmacotherapies with torsadogenic potential for therapy or postexposure prophylaxis, this document serves to help health care professionals mitigate the risk of drug-induced ventricular arrhythmias while minimizing risk of COVID-19 exposure to personnel and conserving the limited supply of personal protective equipment.
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Affiliation(s)
- John R Giudicessi
- Department of Cardiovascular Medicine, Clinician-Investigator Training Program, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN.
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Feng Yeh C, Wang KC, Chiang LC, Shieh DE, Yen MH, San Chang J. Water extract of licorice had anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines. J Ethnopharmacol 2013; 148:466-73. [PMID: 23643542 PMCID: PMC7126896 DOI: 10.1016/j.jep.2013.04.040] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/11/2013] [Accepted: 04/18/2013] [Indexed: 05/24/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Licorice (Glycyrrhiza uralensis Fisch., Leguminosae) has been used in herbal medicine and food supplement worldwide for centuries. Licorice is a common ingredient of several prescriptions of traditional Chinese medicine which have been proved to inhibit infection of human respiratory syncytial virus (HRSV). There are two preparations of licorice, Radix Glycyrrhizae and Radix Glycyrrhizae Preparata. However, it is unknown whether licorice or which preparation of licorice is effective against HRSV, nor is its active constituent. AIM OF THE STUDY We tested the hypothesis that Radix Glycyrrhizae can effectively decrease HRSV-induced plaque formation in respiratory mucosal cell lines. We also tried to find out the active constituent. MATERIALS AND METHODS Anti-HRSV activities of hot water extracts of preparations of licorice, glycyrrhizin and 18β-glycyrrhetinic acid (18β-GA), the active constituents of licorice, were examined by plaque reduction assay in both human upper (HEp-2) and low (A549) respiratory tract cell lines. Abilities of crude licorice to inhibit viral replication and to stimulate IFN-β were evaluated by reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS Radix Glycyrrhizae and Radix Glycyrrhizae Preparata dose-dependently inhibited HRSV-induced plaque formation in both HEp-2 and A549 cell lines (p<0.0001). The effect of Radix Glycyrrhizae was better than that of Radix Glycyrrhizae Preparata on HEp-2 cells. However, there was no difference of their anti-HRSV effects on A549 cells. Besides, glycyrrhizin was ineffective at all. Nevertheless, 18β-GA showed a potent anti-HRSV activity. Radix Glycyrrhizae was more effective when given before viral inoculation (p<0.0001) which may be due to its inhibition of viral attachment on (p<0.0001) and penetration (p<0.0001) into the host cells. The anti-HRSV activity of Radix Glycyrrhizae was further confirmed by RT-PCR and qRT-PCR. 300 μg/ml Radix Glycyrrhizae markedly decreased the viral amounts within the cells and in the suspension. Radix Glycyrrhizae might further stimulate mucosal cells to secrete IFN-β to counteract viral infection. CONCLUSIONS Both Radix Glycyrrhizae and Radix Glycyrrhizae Preparata are effective against HRSV infection on airway epithelial cells. Radix Glycyrrhizae inhibited HRSV mainly by preventing viral attachment, internalization, and by stimulating IFN secretion. 18β-GA may be one of its active constituents.
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Key Words
- 18β-ga, 18β-glycyrrhetinic acid
- a549, human lung carcinoma cell
- atcc, the american type culture collection
- cc50, 50% cytotoxic concentration
- elisa, enzyme-linked immunosorbent assay
- fcs, fetal calf serum
- fda, food and drug administration
- hep-2, human larynx epidermoid carcinoma cell
- ic50, minimal concentration required to inhibit 50% cytopathic effect
- ifn, interferon
- dmem, dulbecco’s modified eagle’s medium
- pbs, phosphate-buffered saline
- pfu, plaque forming unit
- hrsv, human respiratory syncytial virus
- glycyrrhiza uralensis
- respiratory tract infection
- rsv
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Affiliation(s)
- Chia Feng Yeh
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
Clostridium difficile was first described as a cause of diarrhea in 1978 and is now among the leading 3 hospital-acquired infections in the United States, along with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. In the past 2 decades, there has been an increase in the incidence, severity, and recurrence rates of C difficile infection, all of which are associated with poor outcomes. In addition, several novel risk factors and newer treatment methods are emerging, including fidaxomicin therapy, treatment using monoclonal antibodies, and fecal microbiota transplantation, that have shown promise for the treatment of C difficile infection. This review focuses on the changing epidemiology, risk factors, and newer methods for treatment of C difficile infection.
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Affiliation(s)
| | - Darrell S. Pardi
- Correspondence: Address to Darrell S. Pardi, MD, MS, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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25
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Rochet NM, Dronca RS, Kottschade LA, Chavan RN, Gorman B, Gilbertson JR, Markovic SN. Melanoma brain metastases and vemurafenib: need for further investigation. Mayo Clin Proc 2012; 87:976-81. [PMID: 23036672 PMCID: PMC3538399 DOI: 10.1016/j.mayocp.2012.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 06/19/2012] [Accepted: 07/16/2012] [Indexed: 11/25/2022]
Abstract
Brain metastases are a major cause of morbidity and mortality in patients with advanced melanoma. With the development of targeted agents for the treatment of metastatic melanoma, a great deal of interest has focused on whether selective BRAF inhibitors may play a role in the treatment of brain metastases in lieu of or in addition to surgery and/or radiation therapy. However, relatively little is known about the intracranial effectiveness of vemurafenib, the only US Food and Drug Administration-approved selective BRAF V600E inhibitor, because patients with brain metastases have historically been excluded from vemurafenib clinical trials. We describe 3 patients with BRAF V600E mutation metastatic melanoma in whom treatment with vemurafenib resulted in prompt extracranial disease response but progression of metastatic disease in the brain. Further, we discuss possible mechanisms responsible for the suboptimal central nervous system response observed in these patients and alternative therapies for patients with melanoma metastatic to the brain.
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Affiliation(s)
| | - Roxana S. Dronca
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
- Correspondence: Address to Roxana S. Dronca, MD, Department of Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | | | | | - Brian Gorman
- Department of Radiology, Mayo Clinic, Rochester, MN
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Abstract
The term off-label drug use (OLDU) is used extensively in the medical literature, continuing medical education exercises, and the media. Yet, we propose that many health care professionals have an underappreciation of its definition, prevalence, and implications. This article introduces and answers 10 questions regarding OLDU in an effort to clarify the practice's meaning, breadth of application, acceptance, and liabilities. Off-label drug use involves prescribing medications for indications, or using a dosage or dosage form, that have not been approved by the US Food and Drug Administration. Since the Food and Drug Administration does not regulate the practice of medicine, OLDU has become common. It occurs in every specialty of medicine, but it may be more common in areas of medicine in which the patient population is less likely to be included in clinical trials (eg, pediatric, pregnant, or psychiatric patients). Pharmaceutical companies are not allowed to promote their medications for an off-label use, which has lead to several large settlements for illegal marketing. To limit liability, physicians should prescribe medications only for indications that they believe are in the best interest of the patient. In addition, health care professionals should educate themselves about OLDU to weigh the risks and benefits and provide the best possible care for their patients.
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Affiliation(s)
- Christopher M Wittich
- Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
There are now 24 antiepileptic drugs (AEDs) approved for use in epilepsy in the United States by the Food and Drug Administration. A literature search was conducted using PubMed, MEDLINE, and Google for all English-language articles that discuss newly approved AEDs and the use of AEDs in epilepsy in the United States from January 1, 2008, through December 31, 2011. Five new agents were identified that have come onto the market within the past 2 years. Moreover, 3 trends involving AEDs have become clinically important and must be considered by all who treat patients with epilepsy. These trends include issues of generic substitution of AEDs, pharmacogenomics predicting serious adverse events in certain ethnic populations, and the issue of the suicide risk involving the entire class of AEDs. This article discusses the most recent AEDs approved for use in the United States and the 3 important trends shaping the modern medical management of epilepsy.
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Affiliation(s)
- Joseph I Sirven
- Department of Neurology, Division of Epilepsy, Mayo Clinic, Phoenix, AZ 85054, USA.
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28
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Humphries RM, Kelesidis T, Dien Bard J, Ward KW, Bhattacharya D, Lewinski MA. Successful treatment of pan-resistant Klebsiella pneumoniae pneumonia and bacteraemia with a combination of high-dose tigecycline and colistin. J Med Microbiol 2010; 59:1383-1386. [PMID: 20688947 PMCID: PMC8482875 DOI: 10.1099/jmm.0.023010-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [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: 06/08/2010] [Accepted: 08/04/2010] [Indexed: 11/18/2022] Open
Abstract
The spread of antimicrobial resistance among members of the Enterobacteriaceae is a significant clinical threat. We report the treatment of pan-resistant Klebsiella pneumoniae bacteraemia with combination tigecycline and colistin in a 49-year-old male and review available therapeutic options. Despite a poor prognosis, the patient recovered, but remains colonized with the pan-resistant isolate.
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Affiliation(s)
- Romney M. Humphries
- UCLA David Geffen School of Medicine, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer Dien Bard
- UCLA David Geffen School of Medicine, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA
| | | | - Debika Bhattacharya
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael A. Lewinski
- UCLA David Geffen School of Medicine, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA
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Piedra PA, Gaglani MJ, Riggs M, Herschler G, Fewlass C, Watts M, Kozinetz C, Hessel C, Glezen WP. Live attenuated influenza vaccine, trivalent, is safe in healthy children 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in a community-based, nonrandomized, open-label trial. Pediatrics 2005; 116:e397-407. [PMID: 16140685 PMCID: PMC1361119 DOI: 10.1542/peds.2004-2258] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Influenza-associated deaths in healthy children that were reported during the 2003-2004 influenza season heightened the public awareness of the seriousness of influenza in children. In 1996-1998, a pivotal phase III trial was conducted in children who were 15 to 71 months of age. Live attenuated influenza vaccine, trivalent (LAIV-T), was shown to be safe and efficacious. In a subsequent randomized, double-blind, placebo-controlled LAIV-T trial in children who were 1 to 17 years of age, a statistically significant increase in asthma encounters was observed for children who were younger than 59 months. LAIV-T was not licensed to children who were younger than 5 years because of the concern for asthma. We report on the largest safety study to date of the recently licensed LAIV-T in children 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in a 4-year (1998-2002) community-based trial that was conducted at Scott & White Memorial Hospital and Clinic (Temple, TX). METHODS An open-label, nonrandomized, community-based trial of LAIV-T was conducted before its licensure. Medical records of all children were surveyed for serious adverse events (SAEs) 6 weeks after vaccination. Health care utilization was evaluated by determining the relative risk (RR) of medically attended acute respiratory illness (MAARI) and asthma rates at 0 to 14 and 15 to 42 days after vaccination compared with the rates before vaccination. Medical charts of all visits coded as asthma were reviewed for appropriate classification of events: acute asthma or other. We evaluated the risk for MAARI (health care utilization for acute respiratory illness) 0 to 14 and 15 to 42 days after LAIV-T by a method similar to the postlicensure safety analysis conducted on measles, mumps, and rubella and on diphtheria, tetanus, and whole-cell pertussis vaccines. RESULTS All children regardless of age were administered a single intranasal dose of LAIV-T in each vaccine year. In the 4 years of the study, we administered 18780 doses of LAIV-T to 11096 children. A total of 4529, 7036, and 7215 doses of LAIV-T were administered to children who were 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age, respectively. In vaccination years 1, 2, 3, and 4, we identified 10, 15, 11, and 6 SAEs, respectively. None of the SAEs was attributed to LAIV-T. In vaccination years 1, 2, 3, and 4, we identified 3, 2, 1, and 0 pregnancies, respectively, among adolescents. All delivered healthy infants. The RR for MAARI from 0 to 14 and 15 to 42 days after LAIV-T was assessed in vaccinees during the 4 vaccine years. Compared with the prevaccination period, there was no significant increase in risk in health care utilization attributed to MAARI from 0 to 14 and 15 to 42 days after vaccination in children who were 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in the 4 vaccine years. In children who were 18 months to 4 years of age, there was no significant increase in the risk in health care utilization for MAARI, MAARI subcategories (otitis media/sinusitis, upper respiratory tract illness, and lower respiratory tract illness), and asthma during the 0 to 14 days after vaccination compared with the prevaccination period. No significant increase in the risk in health care utilization for MAARI, MAARI subcategories, and asthma was detected when the risk period was extended to 15 to 42 days after vaccination, except for asthma events in vaccine year 1. A RR of 2.85 (95% confidence interval [CI]: 1.01-8.03) for asthma events was detected in children who were 18 months to 4 years of age but was not significantly increased for the other 3 vaccine years (vaccine year 2, RR: 1.42 [95% CI: 0.59-3.42]; vaccine year 3, RR: 0.47 [95% CI: 0.12-1.83]; vaccine year 4, RR: 0.20 [95% CI: 0.03-1.54]). No significant increase in the risk in health care utilization for MAARI or asthma was observed in children who were 18 months to 18 years of age and received 1, 2, 3, or 4 annual sequential doses of LAIV-T. Children who were 18 months to 4 years of age and received 1, 2, 3, or 4 annual doses of LAIV-T did not experience a significant increase in the RR for MAARI 0 to 14 days after vaccination; this was also true for children who were 5 to 9 and 10 to 18 years of age. CONCLUSIONS We observed no increased risk for asthma events 0 to 14 days after vaccination in children who were 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age, In vaccine year 1, children who were 18 months to 4 years of age did have a significantly higher RR (2.85; 95% CI: 1.01-8.03) for asthma events 15 to 42 days after vaccination. In vaccine year 2, the formulation of LAIV-T was identical to the vaccine formulation used in vaccine year 1; however, in children who were 18 months to 4 years of age, no statistically significant increased risk was detected for asthma events 15 to 42 days after vaccination. Similarly, in vaccine years 3 and 4, children who were 18 months to 4 years of age did not have a statistically significant increased risk for asthma events 15 to 42 days after vaccination. Also, LAIV-T did not increase the risk for asthma in children who received 1, 2, 3, or 4 annual doses of LAIV-T. Although the possibility for a true increased risk for asthma was observed in 1 of 4 years in children who were 18 months to 4 years at 15 to 42 days after vaccination, it is more likely that the association is a chance effect because of the 190 comparisons made without adjustment for multiple comparisons. We conclude that LAIV-T is safe in children who are 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age. The hypothesis that LAIV-T is associated with an increase in asthma events in children who are younger than 5 years is not supported by our data. Reassessment of the lower age limit for use of LAIV-T in children is indicated.
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Key Words
- asthma exacerbation
- children and adolescents
- health service utilization
- influenza vaccine
- outcome assessment
- rsv, respiratory syncytial virus
- laiv-t, live attenuated influenza vaccine, trivalent
- maari, medically attended acute respiratory illness
- fda, food and drug administration
- sae, serious adverse event
- swhp, scott & white health plan
- rr, relative risk
- icd-9, international classification of diseases, ninth revision
- ci, confidence interval
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Affiliation(s)
- Pedro A Piedra
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas 77030, USA.
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30
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Affiliation(s)
- Charles R Woods
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Abstract
On February 2, 2004, the Food and Drug Administration organized a joint meeting of the Neuro-Psychopharmacologic Advisory Committee and Pediatric Subcommittee of the Anti-Infective Drugs Advisory Committee to examine the occurrence of suicidality in clinical trials that investigate the use of the newer antidepressant drugs in pediatric patients. Committee members reconvened on September 13-14, 2004, and concluded that there was a causal link between the newer antidepressants and pediatric suicidality. This article provides a summary of the Food and Drug Administration deliberations for the pediatric clinician. We also provide research, regulation, education, and practice implications for care for children and adolescents who may be eligible for treatment with these medications.
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Key Words
- depression
- pediatrics
- children
- adolescents
- antidepressants
- suicide
- regulation
- mental health
- fda
- fda, food and drug administration
- mdd, major depressive disorder
- dd, dysthymic disorder
- bpd, bipolar disorder
- cbt, cognitive behavioral therapy
- ssri, selective serotonin reuptake inhibitor
- fdama, food and drug administration modernization act
- bpca, best pharmaceuticals for children act
- mhra, medicines and healthcare products regulatory agency
- tads, treatment for adolescents with depression study
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Affiliation(s)
- Laurel K Leslie
- Children's Hospital, Child and Adolescent Services Research Center, San Diego, California 92123, USA.
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Van Rompay AR, Johansson M, Karlsson A. Substrate specificity and phosphorylation of antiviral and anticancer nucleoside analogues by human deoxyribonucleoside kinases and ribonucleoside kinases. Pharmacol Ther 2003; 100:119-39. [PMID: 14609716 PMCID: PMC7126524 DOI: 10.1016/j.pharmthera.2003.07.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [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: 11/20/2022]
Abstract
Structural analogues of nucleosides, nucleoside analogues (NA), are used in the treatment of cancer and viral infections. Antiviral NAs inhibit replication of the viral genome, whereas anticancer NAs inhibit cellular DNA replication and repair. NAs are inactive prodrugs that are dependent on intracellular phosphorylation to their pharmacologically active triphosphate form. The deoxyribonucleoside kinases (dNK) and ribonucleoside kinases (rNK) catalyze the first phosphorylation step, converting deoxyribonucleosides and ribonucleosides to their corresponding monophosphate form. The dNKs have been studied intensively, whereas the rNKs have not been as thoroughly investigated. This overview is focused on the substrate specificity, tissue distribution, and subcellular location of the mammalian dNKs and rNKs and their role in the activation of NAs.
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Key Words
- antiviral therapy
- anticancer therapy
- chemotherapy
- nucleoside analogue
- deoxyribonucleoside kinase
- ribonucleoside kinase
- adk, adenosine kinase
- aids, aquired immunodeficiency syndrome
- arac, 1-β-d-arabinofuranosylcytosine (cytarabine)
- arag, 9-β-d-arabinofuranosylguanine (nelarabine)
- azt, 3′-azido-2′,3′-dideoxythymidine (zidovudine)
- cafda, 2-chloro-2′-fluoro-9-β-d-arabinofuranosyladenine (clofarabine)
- cda, 2-chloro-2′-deoxyadenosine (cladribine)
- dck, deoxycytidine kinase
- ddc, 2′,3′-dideoxycytidine (zalcitabine)
- ddi, 2′,3′-dideoxyinosine (didanosine)
- dgk, deoxyguanosine kinase
- dfdc, 2′,2′-difluorodeoxycytidine (gemcitabine)
- dnk, deoxyribonucleoside kinase
- d4t, 2′,3′-didehydro-3′-deoxythymidine (stavudine)
- f-araa, 2-fluoro-9-β-d-arabinofuranosyladenine (fludarabine)
- fda, food and drug administration
- fiau, 1-(2′-deoxy-2′-fluoro-β-d-arabinofuranosyl)-5-iodouracil (fialuridine)
- hbv, hepatitis b virus
- mtdna, mitochondrial dna
- hiv, human immunodeficiency virus
- na, nucleoside analogue
- ndpk, nucleoside diphosphate kinase
- nmpk, nucleoside monophosphate kinase
- 5′-nt, 5′-nucleotidase
- rnk, ribonucleoside kinase
- rr, ribonucleotide reductase
- rt, reverse transcriptase
- tk1, thymidine kinase 1
- tk2, thymidine kinase 2
- uck1, uridine-cytidine kinase 1
- uck2, uridine-cytidine kinase 2
- 3tc, 2′-deoxy-3′-thiacytidine (lamivudine)
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Affiliation(s)
- An R Van Rompay
- Department of Nephrology-Hypertension, University of Antwerp, 2610 Antwerp, Belgium
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