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Affiliation(s)
- Hallie C Prescott
- Department of Medicine, University of Michigan, Ann Arbor
- VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Todd W Rice
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
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52
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Cunniffe NG, Gunter SJ, Brown M, Burge SW, Coyle C, De Soyza A, Dymond T, Esmail H, Francis DP, Galloway J, Galloway JB, Gkrania-Klotsas E, Greenaway J, Katritsis G, Kanagaratnam P, Knolle MD, Leonard K, McIntyre ZC, Prudon B, Rampling T, Torok ME, Warne B, Yates M, Matheson NJ, Su L, Villar S, Stewart GD, Toshner M. How achievable are COVID-19 clinical trial recruitment targets? A UK observational cohort study and trials registry analysis. BMJ Open 2020; 10:e044566. [PMID: 33020111 PMCID: PMC7536634 DOI: 10.1136/bmjopen-2020-044566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To analyse enrolment to interventional trials during the first wave of the COVID-19 pandemic in England and describe the barriers to successful recruitment in the circumstance of a further wave or future pandemics. DESIGN We analysed registered interventional COVID-19 trial data and concurrently did a prospective observational study of hospitalised patients with COVID-19 who were being assessed for eligibility to one of the RECOVERY, C19-ACS or SIMPLE trials. SETTING Interventional COVID-19 trial data were analysed from the clinicaltrials.gov and International Standard Randomized Controlled Trial Number databases on 12 July 2020. The patient cohort was taken from five centres in a respiratory National Institute for Health Research network. Population and modelling data were taken from published reports from the UK government and Medical Research Council Biostatistics Unit. PARTICIPANTS 2082 consecutive admitted patients with laboratory-confirmed SARS-CoV-2 infection from 27 March 2020 were included. MAIN OUTCOME MEASURES Proportions enrolled, and reasons for exclusion from the aforementioned trials. Comparisons of trial recruitment targets with estimated feasible recruitment numbers. RESULTS Analysis of trial registration data for COVID-19 treatment studies enrolling in England showed that by 12 July 2020, 29 142 participants were needed. In the observational study, 430 (20.7%) proceeded to randomisation. 82 (3.9%) declined participation, 699 (33.6%) were excluded on clinical grounds, 363 (17.4%) were medically fit for discharge and 153 (7.3%) were receiving palliative care. With 111 037 people hospitalised with COVID-19 in England by 12 July 2020, we determine that 22 985 people were potentially suitable for trial enrolment. We estimate a UK hospitalisation rate of 2.38%, and that another 1.25 million infections would be required to meet recruitment targets of ongoing trials. CONCLUSIONS Feasible recruitment rates, study design and proliferation of trials can limit the number, and size, that will successfully complete recruitment. We consider that fewer, more appropriately designed trials, prioritising cooperation between centres would maximise productivity in a further wave.
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Affiliation(s)
- Nick G Cunniffe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Simon J Gunter
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Michael Brown
- Division of Infection, University College London Hospital NHS Trust, London, UK
| | - Sarah W Burge
- Cancer Research UK Urological Malignancies Programme, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Clare Coyle
- Department of Cardiology, Hammersmith Hospitals NHS Trust, London, UK
| | | | - Tom Dymond
- Department of Infection and Inflammation Research, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hanif Esmail
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
- MRC Clinical Trials Unit, University College London, London, UK
- Institute for Global Health, University College London, London, United Kingdom
| | - Darrel P Francis
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Jacqui Galloway
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Jane Greenaway
- Research and Development, North Tees Hospital, Stockton-on-Tees, UK
| | - George Katritsis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Prapa Kanagaratnam
- Department of Cardiology, St Marys Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Martin D Knolle
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kelly Leonard
- Cambridge Urology Translational Research and Clinical Trials Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zoe C McIntyre
- School of Clinical Medicine, Office for Translational Research, University of Cambridge, Cambridge, UK
| | - Ben Prudon
- Department of Respiratory Medicine, North Tees Hospital, Stockton-on-Tees, UK
| | - Tommy Rampling
- Division of Pathology, University College London Hospital NHS Trust, London, United Kingdom
| | | | - Ben Warne
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - Mark Yates
- Centre for Rheumatic Diseases, Kings College London, London, UK
| | - Nicholas J Matheson
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Li Su
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - Sofia Villar
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - Grant D Stewart
- Cancer Research UK Urological Malignancies Programme, Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mark Toshner
- Department of Medicine, University of Cambridge, Cambridge, UK
- NIHR Respiratory Translational Research Collaboration, Cambridge, UK
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53
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Janiaud P, Axfors C, van't Hooft J, Saccilotto R, Agarwal A, Appenzeller-Herzog C, Contopoulos-Ioannidis DG, Danchev V, Dirnagl U, Ewald H, Gartlehner G, Goodman SN, Haber NA, Ioannidis AD, Ioannidis JPA, Lythgoe MP, Ma W, Macleod M, Malički M, Meerpohl JJ, Min Y, Moher D, Nagavci B, Naudet F, Pauli-Magnus C, O'Sullivan JW, Riedel N, Roth JA, Sauermann M, Schandelmaier S, Schmitt AM, Speich B, Williamson PR, Hemkens LG. The worldwide clinical trial research response to the COVID-19 pandemic - the first 100 days. F1000Res 2020; 9:1193. [PMID: 33082937 PMCID: PMC7539080 DOI: 10.12688/f1000research.26707.2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Never before have clinical trials drawn as much public attention as those testing interventions for COVID-19. We aimed to describe the worldwide COVID-19 clinical research response and its evolution over the first 100 days of the pandemic. Methods: Descriptive analysis of planned, ongoing or completed trials by April 9, 2020 testing any intervention to treat or prevent COVID-19, systematically identified in trial registries, preprint servers, and literature databases. A survey was conducted of all trials to assess their recruitment status up to July 6, 2020. Results: Most of the 689 trials (overall target sample size 396,366) were small (median sample size 120; interquartile range [IQR] 60-300) but randomized (75.8%; n=522) and were often conducted in China (51.1%; n=352) or the USA (11%; n=76). 525 trials (76.2%) planned to include 155,571 hospitalized patients, and 25 (3.6%) planned to include 96,821 health-care workers. Treatments were evaluated in 607 trials (88.1%), frequently antivirals (n=144) or antimalarials (n=112); 78 trials (11.3%) focused on prevention, including 14 vaccine trials. No trial investigated social distancing. Interventions tested in 11 trials with >5,000 participants were also tested in 169 smaller trials (median sample size 273; IQR 90-700). Hydroxychloroquine alone was investigated in 110 trials. While 414 trials (60.0%) expected completion in 2020, only 35 trials (4.1%; 3,071 participants) were completed by July 6. Of 112 trials with detailed recruitment information, 55 had recruited <20% of the targeted sample; 27 between 20-50%; and 30 over 50% (median 14.8% [IQR 2.0-62.0%]). Conclusions: The size and speed of the COVID-19 clinical trials agenda is unprecedented. However, most trials were small investigating a small fraction of treatment options. The feasibility of this research agenda is questionable, and many trials may end in futility, wasting research resources. Much better coordination is needed to respond to global health threats.
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Affiliation(s)
- Perrine Janiaud
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department for Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Janneke van't Hooft
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, The Netherlands
| | - Ramon Saccilotto
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Valentin Danchev
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine,, Stanford University School of Medicine, Stanford, California, USA
| | - Ulrich Dirnagl
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park Laboratories, Raleigh, North Carolina, USA
| | - Steven N. Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Noah A. Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Angeliki Diotima Ioannidis
- Molecular Toxicology Interdepartmental Program, University of California, Los Angeles, Los Angeles, California, USA
| | - John P. A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine,, Stanford University School of Medicine, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Mark P. Lythgoe
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Wenyan Ma
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Malcolm Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mario Malički
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Yan Min
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Naudet
- CHU Rennes, Inserm, CIC 1414 [(Centre d’Investigation Clinique de Rennes)],, University of Rennes 1, Rennes, France
| | | | - Jack W. O'Sullivan
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nico Riedel
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Jan A. Roth
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Mandy Sauermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schandelmaier
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andreas M. Schmitt
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Deparment of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Benjamin Speich
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paula R. Williamson
- MRC/NIHR Trials Methodology Research Partnership, University of Liverpool, Liverpool, UK
| | - Lars G. Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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54
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Janiaud P, Axfors C, van't Hooft J, Saccilotto R, Agarwal A, Appenzeller-Herzog C, Contopoulos-Ioannidis DG, Danchev V, Dirnagl U, Ewald H, Gartlehner G, Goodman SN, Haber NA, Ioannidis AD, Ioannidis JPA, Lythgoe MP, Ma W, Macleod M, Malički M, Meerpohl JJ, Min Y, Moher D, Nagavci B, Naudet F, Pauli-Magnus C, O'Sullivan JW, Riedel N, Roth JA, Sauermann M, Schandelmaier S, Schmitt AM, Speich B, Williamson PR, Hemkens LG. The worldwide clinical trial research response to the COVID-19 pandemic - the first 100 days. F1000Res 2020; 9:1193. [PMID: 33082937 PMCID: PMC7539080 DOI: 10.12688/f1000research.26707.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Never before have clinical trials drawn as much public attention as those testing interventions for COVID-19. We aimed to describe the worldwide COVID-19 clinical research response and its evolution over the first 100 days of the pandemic. Methods: Descriptive analysis of planned, ongoing or completed trials by April 9, 2020 testing any intervention to treat or prevent COVID-19, systematically identified in trial registries, preprint servers, and literature databases. A survey was conducted of all trials to assess their recruitment status up to July 6, 2020. Results: Most of the 689 trials (overall target sample size 396,366) were small (median sample size 120; interquartile range [IQR] 60-300) but randomized (75.8%; n=522) and were often conducted in China (51.1%; n=352) or the USA (11%; n=76). 525 trials (76.2%) planned to include 155,571 hospitalized patients, and 25 (3.6%) planned to include 96,821 health-care workers. Treatments were evaluated in 607 trials (88.1%), frequently antivirals (n=144) or antimalarials (n=112); 78 trials (11.3%) focused on prevention, including 14 vaccine trials. No trial investigated social distancing. Interventions tested in 11 trials with >5,000 participants were also tested in 169 smaller trials (median sample size 273; IQR 90-700). Hydroxychloroquine alone was investigated in 110 trials. While 414 trials (60.0%) expected completion in 2020, only 35 trials (4.1%; 3,071 participants) were completed by July 6. Of 112 trials with detailed recruitment information, 55 had recruited <20% of the targeted sample; 27 between 20-50%; and 30 over 50% (median 14.8% [IQR 2.0-62.0%]). Conclusions: The size and speed of the COVID-19 clinical trials agenda is unprecedented. However, most trials were small investigating a small fraction of treatment options. The feasibility of this research agenda is questionable, and many trials may end in futility, wasting research resources. Much better coordination is needed to respond to global health threats.
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Affiliation(s)
- Perrine Janiaud
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department for Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Janneke van't Hooft
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, The Netherlands
| | - Ramon Saccilotto
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Valentin Danchev
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine,, Stanford University School of Medicine, Stanford, California, USA
| | - Ulrich Dirnagl
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park Laboratories, Raleigh, North Carolina, USA
| | - Steven N. Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Noah A. Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Angeliki Diotima Ioannidis
- Molecular Toxicology Interdepartmental Program, University of California, Los Angeles, Los Angeles, California, USA
| | - John P. A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine,, Stanford University School of Medicine, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Mark P. Lythgoe
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Wenyan Ma
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Malcolm Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mario Malički
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Yan Min
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Naudet
- CHU Rennes, Inserm, CIC 1414 [(Centre d’Investigation Clinique de Rennes)],, University of Rennes 1, Rennes, France
| | | | - Jack W. O'Sullivan
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nico Riedel
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Jan A. Roth
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Mandy Sauermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schandelmaier
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andreas M. Schmitt
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Deparment of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Benjamin Speich
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paula R. Williamson
- MRC/NIHR Trials Methodology Research Partnership, University of Liverpool, Liverpool, UK
| | - Lars G. Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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Entrenas Castillo M, Entrenas Costa LM, Vaquero Barrios JM, Alcalá Díaz JF, López Miranda J, Bouillon R, Quesada Gomez JM. "Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study". J Steroid Biochem Mol Biol 2020; 203:105751. [PMID: 32871238 PMCID: PMC7456194 DOI: 10.1016/j.jsbmb.2020.105751] [Citation(s) in RCA: 442] [Impact Index Per Article: 110.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The vitamin D endocrine system may have a variety of actions on cells and tissues involved in COVID-19 progression especially by decreasing the Acute Respiratory Distress Syndrome. Calcifediol can rapidly increase serum 25OHD concentration. We therefore evaluated the effect of calcifediol treatment, on Intensive Care Unit Admission and Mortality rate among Spanish patients hospitalized for COVID-19. DESIGN Parallel pilot randomized open label, double-masked clinical trial. SETTING University hospital setting (Reina Sofia University Hospital, Córdoba Spain.) PARTICIPANTS: 76 consecutive patients hospitalized with COVID-19 infection, clinical picture of acute respiratory infection, confirmed by a radiographic pattern of viral pneumonia and by a positive SARS-CoV-2 PCR with CURB65 severity scale (recommending hospital admission in case of total score > 1). PROCEDURES All hospitalized patients received as best available therapy the same standard care, (per hospital protocol), of a combination of hydroxychloroquine (400 mg every 12 h on the first day, and 200 mg every 12 h for the following 5 days), azithromycin (500 mg orally for 5 days. Eligible patients were allocated at a 2 calcifediol:1 no calcifediol ratio through electronic randomization on the day of admission to take oral calcifediol (0.532 mg), or not. Patients in the calcifediol treatment group continued with oral calcifediol (0.266 mg) on day 3 and 7, and then weekly until discharge or ICU admission. Outcomes of effectiveness included rate of ICU admission and deaths. RESULTS Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50 %) p value X2 Fischer test p < 0.001. Univariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment versus without Calcifediol treatment: 0.02 (95 %CI 0.002-0.17). Multivariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment vs Without Calcifediol treatment ICU (adjusting by Hypertension and T2DM): 0.03 (95 %CI: 0.003-0.25). Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged. CONCLUSION Our pilot study demonstrated that administration of a high dose of Calcifediol or 25-hydroxyvitamin D, a main metabolite of vitamin D endocrine system, significantly reduced the need for ICU treatment of patients requiring hospitalization due to proven COVID-19. Calcifediol seems to be able to reduce severity of the disease, but larger trials with groups properly matched will be required to show a definitive answer.
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Affiliation(s)
- Marta Entrenas Castillo
- UGC de Neumología, Instituto Maimónides de Investigación Biomédica de Córdoba 9 (IMIBIC). Hospital Universitario Reina Sofía, Universidad de Córdoba, Avda. Menéndez 10 Pidal s/n, 14004 11, Córdoba, Spain
| | - Luis Manuel Entrenas Costa
- UGC de Neumología, Instituto Maimónides de Investigación Biomédica de Córdoba 9 (IMIBIC). Hospital Universitario Reina Sofía, Universidad de Córdoba, Avda. Menéndez 10 Pidal s/n, 14004 11, Córdoba, Spain.
| | - José Manuel Vaquero Barrios
- UGC de Neumología, Instituto Maimónides de Investigación Biomédica de Córdoba 9 (IMIBIC). Hospital Universitario Reina Sofía, Universidad de Córdoba, Avda. Menéndez 10 Pidal s/n, 14004 11, Córdoba, Spain
| | - Juan Francisco Alcalá Díaz
- Departamento de Medicina Interna. IMIBIC, CIBER de Fisiopatología de la Obesidad y la Nutrición. Hospital Universitario Reina Sofía, Universidad de Córdoba, Fundación Progreso y Salud. Avda. Menéndez Pidal s/n, 14004 14, Córdoba, Spain
| | - José López Miranda
- Departamento de Medicina Interna. IMIBIC, CIBER de Fisiopatología de la Obesidad y la Nutrición. Hospital Universitario Reina Sofía, Universidad de Córdoba, Fundación Progreso y Salud. Avda. Menéndez Pidal s/n, 14004 14, Córdoba, Spain
| | - Roger Bouillon
- Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Herestraat, ON1/902, 3000, Leuven, Belgium
| | - José Manuel Quesada Gomez
- IMIBIC. CIBER de Fragilidad y Envejecimiento Saludable. Hospital Universitario Reina Sofía, Universidad de Córdoba, Fundación Progreso y Salud. Avda. Menéndez Pidal s/n, 18 14004, Córdoba, Spain
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56
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Salazar JW, McWilliams JM, Wang TY. Setting Expectations for Clinical Research During the COVID-19 Pandemic. JAMA Intern Med 2020; 180:1400-1401. [PMID: 32716474 DOI: 10.1001/jamainternmed.2020.2882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- James W Salazar
- Department of Medicine, University of California, San Francisco
| | - J Michael McWilliams
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Associate Editor, JAMA Internal Medicine
| | - Tracy Y Wang
- Associate Editor, JAMA Internal Medicine.,Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina
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57
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Dal-Ré R. Ongoing non-industry-sponsored COVID-19 clinical trials in the first trimester of the pandemic: significant differences between the European and the USA approaches. Expert Rev Clin Pharmacol 2020; 13:1067-1072. [DOI: 10.1080/17512433.2020.1810562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Rafael Dal-Ré
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma De Madrid, Madrid, Spain
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Ma LL, Yin X, Li BH, Yang JY, Jin YH, Huang D, Deng T, Wang YY, Ren XQ, Ji J, Zeng XT. Coronavirus Disease 2019 Related Clinical Studies: A Cross-Sectional Analysis. Front Pharmacol 2020; 11:540187. [PMID: 32982751 PMCID: PMC7492524 DOI: 10.3389/fphar.2020.540187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The quality and rationality of many recently registered clinical studies related to coronavirus disease 2019 (COVID-19) needs to be assessed. Hence, this study aims to evaluate the current status of COVID-19 related registered clinical trial. METHODS We did an electronic search of COVID-19 related clinical studies registered between December 1, 2019 and February 21, 2020 (updated to May 28, 2020) from the ClinicalTrials.gov, and collected registration information, study details, recruitment status, characteristics of the subjects, and relevant information about the trial implementation process. RESULTS A total of 1,706 studies were included 10.0% of which (n=171) were from France, 943 (55.3%) used an interventional design, and 600 (35.2%) used an observational design. Most of studies (73.6%) aimed to recruit fewer than 500 people. Interferon was the main prevention program, and antiviral drugs were the main treatment program. Hydroxychloroquine and chloroquine (230/943, 24.4%) were widely studied. Some registered clinical trials are incomplete in content, and 37.4% of the 1,706 studies may have had insufficient sample size. CONCLUSION The quality of COVID-19 related studies needs to be improved by strengthening the registration process and improving the quality of clinical study protocols so that these clinical studies can provide high-quality clinical evidence related to COVID-19.
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Affiliation(s)
- Lin-Lu Ma
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuan Yin
- Department of Rehabilitation, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institutes of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Jia-Yu Yang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Administrative Office of Hospital Director, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tong Deng
- Institutes of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xue-Qun Ren
- Institutes of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Jianguang Ji
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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Abstract
The number of people infected with SARS-CoV-2, and sadly dying from COVID-19, has exploded, and so the amount of literature on the novel coronavirus and the disease it causes has increased proportionately. The case numbers in some countries are beyond the epidemic peak, but the uncertainty about a second wave keeps politicians and societies under pressure. Appropriate decision-making and winning support from the population depends on precise scientific information rather than leaving the field to scaremongers of all proveniences. This mini-review is an update of earlier reports (Brüssow, Microb Biotechnol 2020a;13:607; Brüssow, Microb Biotechnol 2020b; https://doi.org/10.1111/1751-7915.13592).
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Affiliation(s)
- Harald Brüssow
- Department of BiosystemsLaboratory of Gene TechnologyKU LeuvenLeuvenBelgium
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Karlsen APH, Wiberg S, Laigaard J, Pedersen C, Rokamp KZ, Mathiesen O. A systematic review of trial registry entries for randomized clinical trials investigating COVID-19 medical prevention and treatment. PLoS One 2020; 15:e0237903. [PMID: 32817689 PMCID: PMC7444584 DOI: 10.1371/journal.pone.0237903] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/05/2020] [Indexed: 01/17/2023] Open
Abstract
AIM To identify investigated interventions for COVID-19 prevention or treatment via trial registry entries on planned or ongoing randomised clinical trials. To assess these registry entries for recruitment status, planned trial size, blinding and reporting of mortality. METHODS We identified trial registry entries systematically via the WHO International Clinical Trials Registry Platform and 33 trial registries up to June 23, 2020. We included relevant trial registry entries for randomized clinical trials investigating medical preventive, adjunct or supportive therapies and therapeutics for treatment of COVID-19. Studies with non-random and single-arm design were excluded. Trial registry entries were screened by two authors independently and data were systematically extracted. RESULTS We included 1303 trial registry entries from 71 countries investigating 381 different single interventions. Blinding was planned in 47% of trials. Sample size was >200 participants in 40% of trials and a total of 611,364 participants were planned for inclusion. Mortality was listed as an outcome in 57% of trials. Recruitment was ongoing in 54% of trials and completed in 8%. Thirty-five percent were multicenter trials. The five most frequent investigational categories were immune modulating drugs (266 trials (20%)), unconventional medicine (167 trials (13%)), antimalarial drugs (118 trials (9%)), antiviral drugs (100 trials (8%)) and respiratory adjuncts (78 trials (6%)). The five most frequently tested uni-modal interventions were: chloroquine/hydroxychloroquine (113 trials with 199,841 participants); convalescent plasma (64 trials with 11,840 participants); stem cells (51 trials with 3,370 participants); tocilizumab (19 trials with 4,139 participants) and favipiravir (19 trials with 3,210 participants). CONCLUSION An extraordinary number of randomized clinical trials investigating COVID-19 management have been initiated with a multitude of medical preventive, adjunctive and treatment modalities. Blinding will be used in only 47% of trials, which may have influence on future reported treatment effects. Fifty-seven percent of all trials will assess mortality as an outcome facilitating future meta-analyses.
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Affiliation(s)
- Anders Peder Højer Karlsen
- Center for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - Sebastian Wiberg
- Center for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - Jens Laigaard
- Center for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - Casper Pedersen
- Center for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - Kim Zillo Rokamp
- Center for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - Ole Mathiesen
- Center for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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61
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Affiliation(s)
- Eva Petkova
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Elliott M Antman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea B Troxel
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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62
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Abstract
PURPOSE OF REVIEW Assimilating and disseminating information during the novel coronavirus disease 2019 (COVID-19) has been challenging. The purpose of this review is to identify specific threats to the validity of the COVID-19 literature and to recommend resources for practicing rheumatologists and their patients. RECENT FINDINGS The COVID-19 literature has rapidly expanded and includes 17 998 publications through May of 2020, 1543 of which also address rheumatic disease-related topics. Specific obstacles to acquiring high-quality information have arisen, including 'pandemic research exceptionalism' and a 'parallel pandemic' of misinformation. Unique challenges to rheumatologists include specific interest in antirheumatic disease therapies and a paucity of rheumatology-specific information. Patients with rheumatic diseases have faced shortages of critical medications and a lack of information tailored to their health conditions and medications. SUMMARY We recommend rheumatologists develop a system to acquire high-quality information and offer guiding principles for triaging specific resources, which include relevance, accessibility, credibility, timeliness, and trustworthiness. The same principles can be applied to selecting patient oriented resources. Specific trustworthy resources are recommended.
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Azoulay E, de Waele J, Ferrer R, Staudinger T, Borkowska M, Povoa P, Iliopoulou K, Artigas A, Schaller SJ, Shankar-Hari M, Pellegrini M, Darmon M, Kesecioglu J, Cecconi M. International variation in the management of severe COVID-19 patients. Crit Care 2020; 24:486. [PMID: 32758266 PMCID: PMC7403819 DOI: 10.1186/s13054-020-03194-w] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/20/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is little evidence to support the management of severe COVID-19 patients. METHODS To document this variation in practices, we performed an online survey (April 30-May 25, 2020) on behalf of the European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection. RESULTS A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient's management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated. CONCLUSIONS There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.
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Affiliation(s)
- Elie Azoulay
- Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France.
| | - Jan de Waele
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, Netherlands
| | - Ricard Ferrer
- Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Instituto de Investigación de Vall d'Hebron, Barcelona, Spain
- Departmento de Medicina Intensiva, Hospital Universitario de Vall d́Hebron, Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Barcelona, Spain
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Marta Borkowska
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, Netherlands
| | - Pedro Povoa
- NOVA Medical School, CHRC, New University of Lisbon, Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, CHLO, Estrada Do Forte Do Alto Do Duque, 1449-005, Lisbon, Portugal
| | | | - Antonio Artigas
- Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes, Barcelona, Spain
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany
| | - Manu Shankar-Hari
- School of Immunology and Microbial Science, Kings College London. Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, UK
| | - Mariangela Pellegrini
- Department of Surgical Sciences and Central Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesia, Operation, and Intensive Care; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Darmon
- Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
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64
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Stallard N, Hampson L, Benda N, Brannath W, Burnett T, Friede T, Kimani PK, Koenig F, Krisam J, Mozgunov P, Posch M, Wason J, Wassmer G, Whitehead J, Williamson SF, Zohar S, Jaki T. Efficient Adaptive Designs for Clinical Trials of Interventions for COVID-19. Stat Biopharm Res 2020; 12:483-497. [PMID: 34191981 PMCID: PMC8011600 DOI: 10.1080/19466315.2020.1790415] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has led to an unprecedented response in terms of clinical research activity. An important part of this research has been focused on randomized controlled clinical trials to evaluate potential therapies for COVID-19. The results from this research need to be obtained as rapidly as possible. This presents a number of challenges associated with considerable uncertainty over the natural history of the disease and the number and characteristics of patients affected, and the emergence of new potential therapies. These challenges make adaptive designs for clinical trials a particularly attractive option. Such designs allow a trial to be modified on the basis of interim analysis data or stopped as soon as sufficiently strong evidence has been observed to answer the research question, without compromising the trial's scientific validity or integrity. In this article, we describe some of the adaptive design approaches that are available and discuss particular issues and challenges associated with their use in the pandemic setting. Our discussion is illustrated by details of four ongoing COVID-19 trials that have used adaptive designs.
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Affiliation(s)
- Nigel Stallard
- Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lisa Hampson
- Advanced Methodology and Data Science, Novartis Pharma AG, Basel, Switzerland
| | - Norbert Benda
- The Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Werner Brannath
- Institute for Statistics, University of Bremen, Bremen, Germany
| | - Thomas Burnett
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Peter K. Kimani
- Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Franz Koenig
- Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Vienna, Austria
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Pavel Mozgunov
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Martin Posch
- Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Vienna, Austria
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | - John Whitehead
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - S. Faye Williamson
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Sarah Zohar
- INSERM, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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Hsiehchen D, Espinoza M, Hsieh A. Deficiencies in the Designs and Interventions of COVID-19 Clinical Trials. MED 2020; 1:103-104. [PMID: 32838360 PMCID: PMC7334919 DOI: 10.1016/j.medj.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- David Hsiehchen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Magdalena Espinoza
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Antony Hsieh
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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66
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Maggioni AP, Andreotti F, Gervasoni C, Di Pasquale G. COVID-19 trials in Italy: A call for simplicity, top standards and global pooling. Int J Cardiol 2020; 318:160-164. [PMID: 32610153 PMCID: PMC7321654 DOI: 10.1016/j.ijcard.2020.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/23/2022]
Abstract
The novel coronavirus disease, affecting ~9 million people in the past five months and causing >460,000 deaths worldwide, is completely new to mankind. More than 2,000 research projects registered at ClinTrials.gov are aiming at finding effective treatments for rapid transfer to clinical practice. Unfortunately, just few studies have a sufficiently valid design to provide reliable information for clinical practice.
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Affiliation(s)
| | - Felicita Andreotti
- Physician Scientist, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases Physician, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
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Murphy M, Estcourt L, Grant-Casey J, Dzik S. International Survey of Trials of Convalescent Plasma to Treat COVID-19 Infection. Transfus Med Rev 2020; 34:151-157. [PMID: 32703664 PMCID: PMC7320682 DOI: 10.1016/j.tmrv.2020.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022]
Abstract
The collection and clinical use of COVID-19 convalescent plasma (CCP) as a therapy for COVID-19 infection is under development and early use in many centers worldwide. We conducted an international survey of centers undertaking studies of CCP to provide understanding of the common themes and differences between them. Sixty-four studies in 22 countries were identified from clinical trial registries and personal contacts of the authors. Twenty of the 64 centers (31%) from 12 of 22 countries (55%) responded to the survey. Of the 20 studies, 11 were randomized controlled trials (RCTs), and 9 were case series. Only 4 of the RCTs plan to recruit 400 patients or more, and only 3 RCTs were blinded. The majority of studies will study the effect of CCP on sick patients requiring hospitalization and those requiring critical care, and none is examining the role of CCP in non-infected at-risk individuals. A wide variety of primary and secondary outcomes are being used. The donor eligibility criteria among the studies are very similar, and the use of plasmapheresis for the collection of CCP is almost universal. The planned dose of CCP ranges from as little as 200 mL to well over 1 L, but is 400 to 800 mL or 4 mL/kg or greater in all the RCTs. There is considerable variability in donor antibody testing with no consistency regarding the cut-off for antibody titer for acceptance as CCP or the use of pathogen-inactivation. Our survey provides an understanding of the similarities and differences among the studies of CCP, and that by virtue of their design some studies may be more informative than others. Twenty of the 64 centers (31%) from 12 of 22 countries (55%) responded to a survey about studies of COVID-19 convalescent plasma (CCP); 11 were randomized controlled trials (RCTs), and 9 were case series. The majority of studies are studying the effect of CCP on sick patients requiring hospitalization and those requiring critical care. A wide variety of primary and secondary outcomes are being used. The donor eligibility criteria among the studies are very similar, and the use of plasmapheresis for the collection of CCP is almost universal. Our survey provides an understanding of the similarities and differences among the studies of CCP, and that by virtue of their design some studies may be more informative than others.
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Affiliation(s)
- Michael Murphy
- NHS Blood & Transplant, UK; Oxford University Hospitals, Oxford, UK; University of Oxford, Oxford, UK.
| | - Lise Estcourt
- NHS Blood & Transplant, UK; University of Oxford, Oxford, UK
| | | | - Sunny Dzik
- Massachusetts General Hospital, Boston, USA
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Mendelian randomization in COVID-19: Applications for cardiovascular comorbidities and beyond. EBioMedicine 2020; 57:102847. [PMID: 32574960 PMCID: PMC7305723 DOI: 10.1016/j.ebiom.2020.102847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 01/22/2023] Open
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Ehrenreich H, Weissenborn K, Begemann M, Busch M, Vieta E, Miskowiak KW. Erythropoietin as candidate for supportive treatment of severe COVID-19. Mol Med 2020; 26:58. [PMID: 32546125 PMCID: PMC7297268 DOI: 10.1186/s10020-020-00186-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
In light of the present therapeutic situation in COVID-19, any measure to improve course and outcome of seriously affected individuals is of utmost importance. We recap here evidence that supports the use of human recombinant erythropoietin (EPO) for ameliorating course and outcome of seriously ill COVID-19 patients. This brief expert review grounds on available subject-relevant literature searched until May 14, 2020, including Medline, Google Scholar, and preprint servers. We delineate in brief sections, each introduced by a summary of respective COVID-19 references, how EPO may target a number of the gravest sequelae of these patients. EPO is expected to: (1) improve respiration at several levels including lung, brainstem, spinal cord and respiratory muscles; (2) counteract overshooting inflammation caused by cytokine storm/ inflammasome; (3) act neuroprotective and neuroregenerative in brain and peripheral nervous system. Based on this accumulating experimental and clinical evidence, we finally provide the research design for a double-blind placebo-controlled randomized clinical trial including severely affected patients, which is planned to start shortly.
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Affiliation(s)
- Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany.
| | | | - Martin Begemann
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
- Department of Psychiatry & Psychotherapy, University Medical Center, Göttingen, Germany
| | - Markus Busch
- Center of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Eduard Vieta
- Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Kamilla W Miskowiak
- Psychiatric Centre Copenhagen, University Hospital, Rigshospitalet, Copenhagen, Denmark.
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70
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Current Status of Treatment Options, Clinical Trials, and Vaccine Development for SARS-CoV-2 Infection. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.spl1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The severe acute respiratory syndrome virus (SARS-CoV-2), a novel coronavirus first discovered in Wuhan, China in December 2019 causes the Coronavirus Disease 19 (COVID-19), which presents with a wide range of clinical symptoms from mild or moderate to severe and critical illnesses. With the continuing transmission of the virus worldwide and the rapidly evolving situation globally, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic in March. Currently, there is no proven specific treatment for this potentially deadly disease beyond supportive care. However, a massive effort has been put globally into the investigation of medications and other interventional measures to fight COVID-19. Convalescent plasma therapy from recovered patients has recently drawn considerable interest. Several alternative medical treatments, although evidence of their efficacy still lacking, have also gained popularity, especially in countries with such traditions such as India and China. Rapid repurposing of drugs for COVID-19 has revealed a few promising candidate antiviral agents, but further research, especially high quality randomized controlled trials, will be needed to prove their efficacy and safety in the clinical use to treat COVID-19. Vaccine development has been the imperative task in the battle against SARS-CoV-2. While clinical trials have been launched for several candidate vaccines, research on COVID-19 vaccines is still at an early stage. So far, optimized supportive care remains the best practice against COVID-19.
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71
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Müller T. Therapien gegen COVID-19 — ein Update. MMW Fortschr Med 2020; 162:20-23. [PMID: 32447695 PMCID: PMC7245183 DOI: 10.1007/s15006-020-0505-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In mehr als 600 Interventionsstudien prüfen Ärzte derzeit Therapien gegen COVID-19. Bislang konnte noch kein Ansatz in kontrollierten Studien überzeugen, für einige Medikamente finden sich aber Hinweise auf einen Nutzen.
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NADANOVSKY P, SANTOS APPD. Strategies to deal with the COVID-19 pandemic. Braz Oral Res 2020; 34:e068. [DOI: 10.1590/1807-3107bor-2020.vol34.0068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
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