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Deng J, Moskalyk M, Zuo QK, Garcia C, Abbas U, Ramaraju HB, Rayner D, Park YJ, Heybati K, Zhou F, Lohit S. Evaluating fluvoxamine for the outpatient treatment of COVID-19: A systematic review and meta-analysis. Rev Med Virol 2024; 34:e2501. [PMID: 38148036 DOI: 10.1002/rmv.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to evaluate the efficacy, safety, and tolerability of fluvoxamine for the outpatient management of COVID-19. We conducted this review in accordance with the PRISMA 2020 guidelines. Literature searches were conducted in MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, Web of Science, and CENTRAL up to 14 September 2023. Outcomes included incidence of hospitalisation, healthcare utilization (emergency room visits and/or hospitalisation), mortality, supplemental oxygen and mechanical ventilation requirements, serious adverse events (SAEs) and non-adherence. Fluvoxamine 100 mg twice a day was associated with reductions in the risk of hospitalisation (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58-0.97; I 2 = 0%) and reductions in the risk of healthcare utilization (RR 0.68, 95% CI 0.53-0.86; I 2 = 0%). While no increased SAEs were observed, fluvoxamine 100 mg twice a day was associated with higher treatment non-adherence compared to placebo (RR 1.61, 95% CI 1.22-2.14; I 2 = 53%). In subgroup analyses, fluvoxamine reduced healthcare utilization in outpatients with BMI ≥30 kg/m2 , but not in those with lower BMIs. While fluvoxamine offers potential benefits in reducing healthcare utilization, its efficacy may be most pronounced in high-risk patient populations. The observed non-adherence rates highlight the need for better patient education and counselling. Future investigations should reassess trial endpoints to include outcomes relating to post-COVID sequelaes. Registration: This review was prospectively registered on PROSPERO (CRD42023463829).
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Affiliation(s)
- Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Myron Moskalyk
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Qi Kang Zuo
- UBC Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cristian Garcia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Umaima Abbas
- Schulich School of Medicine & Dentistry (Windsor), Western University, Windsor, Ontario, Canada
| | | | - Daniel Rayner
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ye-Jean Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine (Jacksonville), Mayo Clinic, Jacksonville, Florida, USA
| | - Fangwen Zhou
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Simran Lohit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Stewart TG, Rebolledo PA, Mourad A, Lindsell CJ, Boulware DR, McCarthy MW, Thicklin F, Garcia del Sol IT, Bramante CT, Lenert LA, Lim S, Williamson JC, Cardona OQ, Scott J, Schwasinger-Schmidt T, Ginde AA, Castro M, Jayaweera D, Sulkowski M, Gentile N, McTigue K, Felker GM, DeLong A, Wilder R, Rothman RL, Collins S, Dunsmore SE, Adam SJ, Hanna GJ, Shenkman E, Hernandez AF, Naggie S. Higher-Dose Fluvoxamine and Time to Sustained Recovery in Outpatients With COVID-19: The ACTIV-6 Randomized Clinical Trial. JAMA 2023; 330:2354-2363. [PMID: 37976072 PMCID: PMC10656670 DOI: 10.1001/jama.2023.23363] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
Importance The effect of higher-dose fluvoxamine in reducing symptom duration among outpatients with mild to moderate COVID-19 remains uncertain. Objective To assess the effectiveness of fluvoxamine, 100 mg twice daily, compared with placebo, for treating mild to moderate COVID-19. Design, Setting, and Participants The ACTIV-6 platform randomized clinical trial aims to evaluate repurposed medications for mild to moderate COVID-19. Between August 25, 2022, and January 20, 2023, a total of 1175 participants were enrolled at 103 US sites for evaluating fluvoxamine; participants were 30 years or older with confirmed SARS-CoV-2 infection and at least 2 acute COVID-19 symptoms for 7 days or less. Interventions Participants were randomized to receive fluvoxamine, 50 mg twice daily on day 1 followed by 100 mg twice daily for 12 additional days (n = 601), or placebo (n = 607). Main Outcomes and Measures The primary outcome was time to sustained recovery (defined as at least 3 consecutive days without symptoms). Secondary outcomes included time to death; time to hospitalization or death; a composite of hospitalization, urgent care visit, emergency department visit, or death; COVID-19 clinical progression scale score; and difference in mean time unwell. Follow-up occurred through day 28. Results Among 1208 participants who were randomized and received the study drug, the median (IQR) age was 50 (40-60) years, 65.8% were women, 45.5% identified as Hispanic/Latino, and 76.8% reported receiving at least 2 doses of a SARS-CoV-2 vaccine. Among 589 participants who received fluvoxamine and 586 who received placebo included in the primary analysis, differences in time to sustained recovery were not observed (adjusted hazard ratio [HR], 0.99 [95% credible interval, 0.89-1.09]; P for efficacy = .40]). Additionally, unadjusted median time to sustained recovery was 10 (95% CI, 10-11) days in both the intervention and placebo groups. No deaths were reported. Thirty-five participants reported health care use events (a priori defined as death, hospitalization, or emergency department/urgent care visit): 14 in the fluvoxamine group compared with 21 in the placebo group (HR, 0.69 [95% credible interval, 0.27-1.21]; P for efficacy = .86) There were 7 serious adverse events in 6 participants (2 with fluvoxamine and 4 with placebo) but no deaths. Conclusions and Relevance Among outpatients with mild to moderate COVID-19, treatment with fluvoxamine does not reduce duration of COVID-19 symptoms. Trial Registration ClinicalTrials.gov Identifier: NCT04885530.
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Affiliation(s)
| | - Paulina A. Rebolledo
- Department of Medicine and Global Health, Division of Infectious Diseases, Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia
| | - Ahmad Mourad
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - David R. Boulware
- University of Minnesota Medical School, General Internal Medicine, Minneapolis
| | | | | | | | - Carolyn T. Bramante
- University of Minnesota Medical School, General Internal Medicine, Minneapolis
| | | | - Stephen Lim
- Louisiana State University Health Sciences Center New Orleans, University Medical Center New Orleans, New Orleans
| | - John C. Williamson
- Wake Forest University School of Medicine, Department of Internal Medicine, Section on Infectious Diseases, Winston-Salem, North Carolina
| | - Orlando Quintero Cardona
- Stanford University School of Medicine, Department of Medicine, Infectious Diseases and Geographic Medicine Division, Stanford, California
| | - Jake Scott
- Stanford University School of Medicine, Department of Medicine, Infectious Diseases and Geographic Medicine Division, Stanford, California
| | | | | | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Missouri-Kansas City School of Medicine, Kansas City
| | - Dushyantha Jayaweera
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mark Sulkowski
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Nina Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Kathleen McTigue
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - G. Michael Felker
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Allison DeLong
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Rhonda Wilder
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Sean Collins
- Vanderbilt University Medical Center, Nashville, Tennessee
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville
| | - Sarah E. Dunsmore
- National Center for Advancing Translational Sciences, Bethesda, Maryland
| | - Stacey J. Adam
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - George J. Hanna
- Biomedical Advanced Research and Development Authority, Washington, DC
| | - Elizabeth Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | - Adrian F. Hernandez
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Susanna Naggie
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Lan Q, Yan Y, Zhang G, Xia S, Zhou J, Lu L, Jiang S. Clinical development of antivirals against SARS-CoV-2 and its variants. CURRENT RESEARCH IN MICROBIAL SCIENCES 2023; 6:100208. [PMID: 38149085 PMCID: PMC10750039 DOI: 10.1016/j.crmicr.2023.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
The unceasing global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) calls for the development of novel therapeutics. Although many newly developed antivirals and repurposed antivirals have been applied to the treatment of coronavirus disease 2019 (COVID-19), antivirals showing satisfactory clinical efficacy are few in number. In addition, the loss of sensitivity to variants of concern (VOCs) and lack of oral bioavailability have also limited the clinical application of some antivirals. These facts remind us to develop more potent and broad-spectrum antivirals with better pharmacokinetic/pharmacodynamic properties to fight against infections from SARS-CoV-2, its variants, and other human coronaviruses (HCoVs). In this review, we summarize the latest advancements in the clinical development of antivirals against infections by SARS-CoV-2 and its variants.
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Affiliation(s)
- Qiaoshuai Lan
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
- Centre for Virology, Vaccinology and Therapeutics, Hong Kong Science and Technology Park, Hong Kong, China
| | - Yan Yan
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Guangxu Zhang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Shuai Xia
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Jie Zhou
- Centre for Virology, Vaccinology and Therapeutics, Hong Kong Science and Technology Park, Hong Kong, China
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China
| | - Lu Lu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Shibo Jiang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
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54
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Sullivan DJ, Focosi D, Hanley DF, Cruciani M, Franchini M, Ou J, Casadevall A, Paneth N. Outpatient randomized controlled trials to reduce COVID-19 hospitalization: Systematic review and meta-analysis. J Med Virol 2023; 95:e29310. [PMID: 38105461 PMCID: PMC10754263 DOI: 10.1002/jmv.29310] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
This COVID-19 outpatient randomized controlled trials (RCTs) systematic review compares hospitalization outcomes amongst four treatment classes over pandemic period, geography, variants, and vaccine status. Outpatient RCTs with hospitalization endpoint were identified in Pubmed searches through May 2023, excluding RCTs <30 participants (PROSPERO-CRD42022369181). Risk of bias was extracted from COVID-19-NMA, with odds ratio utilized for pooled comparison. Searches identified 281 studies with 61 published RCTs for 33 diverse interventions analyzed. RCTs were largely unvaccinated cohorts with at least one COVID-19 hospitalization risk factor. Grouping by class, monoclonal antibodies (mAbs) (OR = 0.31 [95% CI = 0.24-0.40]) had highest hospital reduction efficacy, followed by COVID-19 convalescent plasma (CCP) (OR = 0.69 [95% CI = 0.53-0.90]), small molecule antivirals (OR = 0.78 [95% CI = 0.48-1.33]), and repurposed drugs (OR = 0.82 [95% CI: 0.72-0.93]). Earlier in disease onset interventions performed better than later. This meta-analysis allows approximate head-to-head comparisons of diverse outpatient interventions. Omicron sublineages (XBB and BQ.1.1) are resistant to mAbs Despite trial heterogeneity, this pooled comparison by intervention class indicated oral antivirals are the preferred outpatient treatment where available, but intravenous interventions from convalescent plasma to remdesivir are also effective and necessary in constrained medical resource settings or for acute and chronic COVID-19 in the immunocompromised.
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Affiliation(s)
- David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Daniel F Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mario Cruciani
- Division of Hematology, Carlo Poma Hospital, Mantua, Italy
| | | | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nigel Paneth
- Departments of Epidemiology & Biostatistics and Pediatrics & Human Development, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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Lightner AL, Sengupta V, Qian S, Ransom JT, Suzuki S, Park DJ, Melson TI, Williams BP, Walsh JJ, Awili M. Bone Marrow Mesenchymal Stem Cell-Derived Extracellular Vesicle Infusion for the Treatment of Respiratory Failure From COVID-19: A Randomized, Placebo-Controlled Dosing Clinical Trial. Chest 2023; 164:1444-1453. [PMID: 37356708 PMCID: PMC10289818 DOI: 10.1016/j.chest.2023.06.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Bone marrow mesenchymal stem cell (BM-MSC)-derived extracellular vesicles (ExoFlo) convey the immunomodulatory and regenerative properties of intact BM-MSCs. This study aimed to determine the safety and efficacy of ExoFlo as treatment for moderate to severe ARDS in patients with severe COVID-19. RESEARCH QUESTION Do two doses of ExoFlo safely reduce mortality in COVID-19-associated moderate to severe ARDS compared with placebo? STUDY DESIGN AND METHODS A prospective phase 2 multicenter double-anonymized randomized placebo-controlled dosing trial was conducted at five sites across the United States with infusions of placebo, 10 mL of ExoFlo, or 15 mL of ExoFlo on days 1 and 4. Patients (N = 102) with COVID-19-associated moderate to severe ARDS were enrolled and randomized to treatment. Adverse events were documented throughout the study. The primary outcome measure was all-cause 60-day mortality rate. Secondary outcomes included time to death (overall mortality); the incidence of treatment-emergent serious adverse events; proportion of discharged patients at 7, 30, and 60 days; time to hospital discharge; and ventilation-free days. RESULTS No treatment-related adverse events were reported. Mortality (60-day) in the intention-to-treat population was reduced with 15 mL ExoFlo mixed with 85 mL normal saline (ExoFlo-15) compared with placebo (not significant, χ2, P = .1343). For the post hoc subgroup analyses, 60-day mortality was decreased with ExoFlo-15 compared with placebo (relative risk, 0.385; 95% CI, 0.159-0.931; P = .0340; n = 50). With ExoFlo-15, a relative risk of 0.423 (95% CI, 0.173-1.032; P = .0588; n = 24) was determined for participants aged 18 to 65 years with moderate to severe ARDS. Ventilation-free days improved with ExoFlo-15 (P = .0455; n = 50) for all participants aged 18 to 65 years. INTERPRETATION The 15 mL dose of ExoFlo was found to be safe in patients with severe or critical COVID-19-associated respiratory failure. In participants aged 18 to 65 years, the risk reduction in 60-day mortality was further improved from subjects of all ages in the intention-to-treat population after two doses of 15 mL of ExoFlo compared with placebo. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT04493242; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
| | | | | | | | | | - David J Park
- Providence St Jude Medical Center/Providence Medical Foundation, Fullerton, CA
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Kirenga BJ, Mugenyi L, Sánchez-Rico M, Kyobe H, Muttamba W, Mugume R, Mwesigwa E, Kalimo E, Nyombi V, Segawa I, Namakula LO, Sekibira R, Kabweru W, Byanyima R, Aanyu H, Byakika-Kibwika P, Mwebesa HG, Hoertel N, Bazeyo W. Association of fluvoxamine with mortality and symptom resolution among inpatients with COVID-19 in Uganda: a prospective interventional open-label cohort study. Mol Psychiatry 2023; 28:5411-5418. [PMID: 36869228 PMCID: PMC9982784 DOI: 10.1038/s41380-023-02004-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
Prior research suggests that fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) used for the treatment of obsessive-compulsive disorder and major depressive disorder, could be repurposed against COVID-19. We undertook a prospective interventional open-label cohort study to evaluate the efficacy and tolerability of fluvoxamine among inpatients with laboratory-confirmed COVID-19 in Uganda. The main outcome was all-cause mortality. Secondary outcomes were hospital discharge and complete symptom resolution. We included 316 patients, of whom 94 received fluvoxamine in addition to standard care [median age, 60 years (IQR = 37.0); women, 52.2%]. Fluvoxamine use was significantly associated with reduced mortality [AHR = 0.32; 95% CI = 0.19-0.53; p < 0.001, NNT = 4.46] and with increased complete symptom resolution [AOR = 2.56; 95% CI = 1.53-5.51; p < 0.001, NNT = 4.44]. Sensitivity analyses yielded similar results. These effects did not significantly differ by clinical characteristic, including vaccination status. Among the 161 survivors, fluvoxamine was not significantly associated with time to hospital discharge [AHR 0.81, 95% CI (0.54-1.23), p = 0.32]. There was a trend toward greater side effects with fluvoxamine (7.45% versus 3.15%; SMD = 0.21; χ2 = 3.46, p = 0.06), most of which were light or mild in severity and none of which were serious. One hundred mg of fluvoxamine prescribed twice daily for 10 days was well tolerated and significantly associated with reduced mortality and with increased complete symptom resolution, without a significant increase in time to hospital discharge, among inpatients with COVID-19. Large-scale randomized trials are urgently needed to confirm these findings, especially for low- and middle-income countries, where access to vaccines and approved treatments against COVID-19 is limited.
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Affiliation(s)
- Bruce J Kirenga
- Department of Internal Medicine, Makerere University, Kampala, Uganda.
- Makerere University Lung Institute, Kampala, Uganda.
| | - Levicatus Mugenyi
- Makerere University Lung Institute, Kampala, Uganda
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Entebbe Unit, Entebbe, Uganda
| | - Marina Sánchez-Rico
- Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, F-92130, Issy-les-Moulineaux, France
| | | | - Winters Muttamba
- Makerere University Lung Institute, Kampala, Uganda
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Eliya Mwesigwa
- Makerere University Lung Institute, Kampala, Uganda
- Mulago National Referral Hospital, Kampala, Uganda
| | - Ezra Kalimo
- Mulago National Referral Hospital, Kampala, Uganda
| | - Vicky Nyombi
- Mulago National Referral Hospital, Kampala, Uganda
| | - Ivan Segawa
- Makerere University Lung Institute, Kampala, Uganda
| | - Loryndah Olive Namakula
- Makerere University Lung Institute, Kampala, Uganda
- Mulago National Referral Hospital, Kampala, Uganda
| | | | | | | | - Hellen Aanyu
- Mulago National Referral Hospital, Kampala, Uganda
| | | | | | - Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, F-92130, Issy-les-Moulineaux, France
- Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, Paris, France
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57
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Vatvani AD, Kurniawan A, Hariyanto TI. Efficacy and Safety of Fluvoxamine as Outpatient Treatment for Patients With Covid-19: A Systematic Review and Meta-analysis of Clinical Trials. Ann Pharmacother 2023; 57:1389-1397. [PMID: 37002592 PMCID: PMC10067701 DOI: 10.1177/10600280231162243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Fluvoxamine may be beneficial for the management of coronavirus disease 2019 (Covid-19) because of its effect on the sigma-1 receptor. Available evidence from randomized clinical trials (RCTs) has shown conflicting results. OBJECTIVE This study sought to analyze the efficacy and safety of fluvoxamine as an outpatient treatment for Covid-19. METHODS Using specific keywords, we comprehensively go through the potential articles on PubMed, Scopus, Europe PMC, and ClinicalTrials.gov sources until February 1, 2023. We collected all published clinical trials on fluvoxamine and Covid-19. We were using Review Manager 5.4 to conduct statistical analysis. RESULTS We include a total of 6 trials. Our pooled analysis revealed that fluvoxamine did not offer any significant benefit when compared with placebo in reducing the risk of clinical deterioration (risk ratio [RR] = 0.83; 95% CI: 0.65-1.06, P = 0.14, I2 = 29%), and hospitalization (RR = 0.80; 95% CI: 0.62-1.04, P = 0.09, I2 = 0%) of Covid-19 outpatients. The serious adverse events did not differ significantly between the 2 groups. CONCLUSIONS AND RELEVANCE This study indicates that although safe, fluvoxamine was not effective for outpatient treatment of Covid-19. Until more evidence can be obtained from larger RCTs, our study did not encourage the use of fluvoxamine as routine management for patients with Covid-19.
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Affiliation(s)
| | - Andree Kurniawan
- Department of Internal Medicine,
Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
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58
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Avula N, Kakach D, Tignanelli CJ, Liebovitz DM, Nicklas JM, Cohen K, Puskarich MA, Belani HK, Buse JB, Klatt NR, Anderson B, Karger AB, Hartman KM, Patel B, Fenno SL, Reddy NV, Erickson SM, Boulware DR, Murray TA, Bramante CT. Strategies used for the COVID-OUT decentralized trial of outpatient treatment of SARS-CoV-2. J Clin Transl Sci 2023; 7:e242. [PMID: 38033705 PMCID: PMC10685265 DOI: 10.1017/cts.2023.668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/20/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
The COVID-19 pandemic accelerated the development of decentralized clinical trials (DCT). DCT's are an important and pragmatic method for assessing health outcomes yet comprise only a minority of clinical trials, and few published methodologies exist. In this report, we detail the operational components of COVID-OUT, a decentralized, multicenter, quadruple-blinded, randomized trial that rapidly delivered study drugs nation-wide. The trial examined three medications (metformin, ivermectin, and fluvoxamine) as outpatient treatment of SARS-CoV-2 for their effectiveness in preventing severe or long COVID-19. Decentralized strategies included HIPAA-compliant electronic screening and consenting, prepacking investigational product to accelerate delivery after randomization, and remotely confirming participant-reported outcomes. Of the 1417 individuals with the intention-to-treat sample, the remote nature of the study caused an additional 94 participants to not take any doses of study drug. Therefore, 1323 participants were in the modified intention-to-treat sample, which was the a priori primary study sample. Only 1.4% of participants were lost to follow-up. Decentralized strategies facilitated the successful completion of the COVID-OUT trial without any in-person contact by expediting intervention delivery, expanding trial access geographically, limiting contagion exposure, and making it easy for participants to complete follow-up visits. Remotely completed consent and follow-up facilitated enrollment.
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Affiliation(s)
- Nandini Avula
- Department of Medicine, Medical School, University of
Minnesota, Minneapolis, MN,
USA
| | - Dustin Kakach
- Investigational Drug Service, Fairview Health Services,
University of Minnesota Medical Center,
Minneapolis, MN, USA
| | | | - David M. Liebovitz
- Department of Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL,
USA
| | - Jacinda M. Nicklas
- Department of Medicine, School of Medicine, University of
Colorado-Anschutz Medical Campus, Aurora, CO,
USA
| | - Kenneth Cohen
- UnitedHealth Group, Optum Health, Minnetonka,
MN, USA
| | - Michael A. Puskarich
- Department of Emergency Medicine, School of Medicine,
University of Minnesota, Minneapolis,
MN, USA
- Department of Emergency Medicine, Hennepin County Medical
Center, Minneapolis, MN, USA
| | - Hrishikesh K. Belani
- Department of Medicine, Olive View - University of
California, Los Angeles, CA,
USA
| | - John B. Buse
- Department of Medicine, School of Medicine, University of
North Carolina, Chapel Hill, NC,
USA
| | - Nichole R. Klatt
- Department of Surgery, Medical School, University of
Minnesota, Minneapolis, MN,
USA
| | - Blake Anderson
- Atlanta Veterans Affairs Medical Center and the Department of Medicine,
Emory University School of Medicine, Atlanta,
GA, USA
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, Medical School,
University of Minnesota, Minneapolis,
MN, USA
| | - Katrina M. Hartman
- Department of Medicine, Medical School, University of
Minnesota, Minneapolis, MN,
USA
| | - Barkha Patel
- Department of Medicine, Medical School, University of
Minnesota, Minneapolis, MN,
USA
| | - Sarah L. Fenno
- Department of Medicine, Medical School, University of
Minnesota, Minneapolis, MN,
USA
| | - Neha V. Reddy
- Department of Medicine, Medical School, University of
Minnesota, Minneapolis, MN,
USA
| | - Spencer M. Erickson
- Department of Medicine, Medical School, University of
Minnesota, Minneapolis, MN,
USA
| | - David R. Boulware
- Department of Medicine, Medical School, University of
Minnesota, Minneapolis, MN,
USA
| | - Thomas A. Murray
- Division of Biostatistics, School of Public Health,
University of Minnesota, Minneapolis,
MN, USA
| | - Carolyn T. Bramante
- Department of Medicine, Medical School, University of
Minnesota, Minneapolis, MN,
USA
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59
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Zhang S, Liu Q, Yang F, Zhang J, Fu Y, Zhu Z, Guo J, Li X, Yang L. Associations between COVID-19 infection experiences and mental health problems among Chinese adults: A large cross-section study. J Affect Disord 2023; 340:719-727. [PMID: 37597780 DOI: 10.1016/j.jad.2023.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES This study aimed to: 1) estimate the prevalence of the coronavirus disease 2019 (COVID-19) infection and mental health problems in Chinese adults, after the relaxation of the dynamic zero-COVID-19 policy; 2) examine the relationship between multi-dimensional variables related to COVID-19 infection and mental health symptoms; 3) explore the differences in the above relationship between healthcare workers (HCWs) and general populations. METHOD A large cross-sectional survey of residents in Beijing was conducted from January 13th to February 9th, 2023. A total of 53,762 adults were included in our analyses. RESULTS The infection rate of COVID-19 was 83.6 % in our study sample. The prevalence of depressive and post-traumatic stress symptoms (PTSS) was 20.0 % and 19.2 % in full sample, respectively. People with COVID-19 infection experience developed more mental health problems, especially for those still having physical symptoms. However, participants recovered from infection had lesser PTSS. Multi-dimensional variables related to COVID-19, i.e., infection status, frequency of infection, time from firstly tested positive, number, duration, severity of physical symptoms and the lowest SpO2, were all significantly associated with mental health symptoms. Occupational types were found to moderate the above relationships, and healthcare workers had less mental health symptoms though they had more infection exposure. LIMITATION This was a cross-sectional study, limiting the causal inference. CONCLUSIONS Multi-dimensional indicators related to COVID-19 infection are associated with mental health symptoms. The findings call for that more personalized mental health service should be delivered to the general populations with COVID-19 infection experience.
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Affiliation(s)
- Shan Zhang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Qing Liu
- General Practice Department, Second Outpatient Section, Peking University Third Hospital, Beijing, China
| | - Fan Yang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jiawei Zhang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yaqun Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zheng Zhu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Xiaoguang Li
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China.
| | - Li Yang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
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Martin DE, Cadar AN, Bartley JM. Old drug, new tricks: the utility of metformin in infection and vaccination responses to influenza and SARS-CoV-2 in older adults. FRONTIERS IN AGING 2023; 4:1272336. [PMID: 37886013 PMCID: PMC10598609 DOI: 10.3389/fragi.2023.1272336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
In the face of global pathogens such as influenza (flu) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), strategies beyond standard vaccines and virus-specific treatments are critically needed for older populations who are more susceptible to severe disease and death from these infections due to age-related immune dysregulation. Thus, complimentary therapeutics are needed to address the increased risk of complications and death in older adults. Metformin, an FDA approved diabetes drug, is an attractive therapeutic candidate to improve immune defenses and resilience in older adults facing viral challenge. Metformin is already a candidate anti-aging drug, but its benefits have potential to span beyond this and improve specific immune responses. Metformin can target multiple aging hallmarks as well as directly impact innate and adaptive immune cell subsets. Both retrospective and prospective studies have demonstrated metformin's efficacy in improving outcomes after SARS-CoV-2 or flu infections. Moreover, evidence from clinical trials has also suggested that metformin treatment can improve vaccination responses. In totality, these findings suggest that metformin can improve age-related declines in immunological resilience. Strategies to improve outcomes after infection or improve vaccine-induced protection are invaluable for older adults. Moreover, the ability to repurpose an already FDA approved drug has significant advantages in terms of necessary time and resources. Thus, metformin has great potential as a therapeutic to improve age-related immune dysregulation during flu and SARS-CoV-2 infections and should be further explored to confirm its ability to improve overall immunological resilience in older adults.
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Zeng B, Zhou J, Peng D, Dong C, Qin Q. The prevention and treatment of COVID-19 in patients treated with hemodialysis. Eur J Med Res 2023; 28:410. [PMID: 37814329 PMCID: PMC10563282 DOI: 10.1186/s40001-023-01389-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
Patients treated with hemodialysis are often immunocompromised due to concomitant disease. As a result, this population is at high risk of infection and mortality from COVID-19. In addition to symptomatic treatment, a series of antiviral drugs targeting COVID-19 are now emerging. However, these antivirals are used mainly in mild or moderate patients with high-risk factors for progression to severe disease and are not available as pre- or post-exposure prophylaxis for COVID-19. There is a lack of clinical data on the use of anti-COVID-19 drugs, especially in patients treated with hemodialysis, therefore, vaccination remains the main measure to prevent SARS-CoV-2 infection in these patients. Here, we review the clinical features and prognosis of patients on hemodialysis infected with SARS-CoV-2, the main anti-COVID-19 drugs currently available for clinical use, and the safety and efficacy of anti-COVID-19 drugs or COVID-19 vaccination in patients treated with hemodialysis. This information will provide a reference for the treatment and vaccination of COVID-19 in patients treated with hemodialysis and maximize the health benefits of these patients during the outbreak.
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Affiliation(s)
- Binyu Zeng
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- International Science and Technology Innovation Cooperation Base for Early Clinical Trials of Biological Agents in Hunan Province, Changsha, China
| | - Jia Zhou
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- International Science and Technology Innovation Cooperation Base for Early Clinical Trials of Biological Agents in Hunan Province, Changsha, China
| | - Daizhuang Peng
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- International Science and Technology Innovation Cooperation Base for Early Clinical Trials of Biological Agents in Hunan Province, Changsha, China
| | - Chengmei Dong
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- International Science and Technology Innovation Cooperation Base for Early Clinical Trials of Biological Agents in Hunan Province, Changsha, China
| | - Qun Qin
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
- International Science and Technology Innovation Cooperation Base for Early Clinical Trials of Biological Agents in Hunan Province, Changsha, China.
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Matz AJ, Zhou B. A wonder drug? New discoveries potentiate new therapeutic potentials of metformin. OBESITY MEDICINE 2023; 43:100514. [DOI: 10.1016/j.obmed.2023.100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2024]
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63
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Bramante CT, Buse JB, Liebovitz DM, Nicklas JM, Puskarich MA, Cohen K, Belani HK, Anderson BJ, Huling JD, Tignanelli CJ, Thompson JL, Pullen M, Wirtz EL, Siegel LK, Proper JL, Odde DJ, Klatt NR, Sherwood NE, Lindberg SM, Karger AB, Beckman KB, Erickson SM, Fenno SL, Hartman KM, Rose MR, Mehta T, Patel B, Griffiths G, Bhat NS, Murray TA, Boulware DR. Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:1119-1129. [PMID: 37302406 PMCID: PMC11259948 DOI: 10.1016/s1473-3099(23)00299-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/30/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Post-COVID-19 condition (also known as long COVID) is an emerging chronic illness potentially affecting millions of people. We aimed to evaluate whether outpatient COVID-19 treatment with metformin, ivermectin, or fluvoxamine soon after SARS-CoV-2 infection could reduce the risk of long COVID. METHODS We conducted a decentralised, randomised, quadruple-blind, parallel-group, phase 3 trial (COVID-OUT) at six sites in the USA. We included adults aged 30-85 years with overweight or obesity who had COVID-19 symptoms for fewer than 7 days and a documented SARS-CoV-2 positive PCR or antigen test within 3 days before enrolment. Participants were randomly assigned via 2 × 3 parallel factorial randomisation (1:1:1:1:1:1) to receive metformin plus ivermectin, metformin plus fluvoxamine, metformin plus placebo, ivermectin plus placebo, fluvoxamine plus placebo, or placebo plus placebo. Participants, investigators, care providers, and outcomes assessors were masked to study group assignment. The primary outcome was severe COVID-19 by day 14, and those data have been published previously. Because the trial was delivered remotely nationwide, the a priori primary sample was a modified intention-to-treat sample, meaning that participants who did not receive any dose of study treatment were excluded. Long COVID diagnosis by a medical provider was a prespecified, long-term secondary outcome. This trial is complete and is registered with ClinicalTrials.gov, NCT04510194. FINDINGS Between Dec 30, 2020, and Jan 28, 2022, 6602 people were assessed for eligibility and 1431 were enrolled and randomly assigned. Of 1323 participants who received a dose of study treatment and were included in the modified intention-to-treat population, 1126 consented for long-term follow-up and completed at least one survey after the assessment for long COVID at day 180 (564 received metformin and 562 received matched placebo; a subset of participants in the metformin vs placebo trial were also randomly assigned to receive ivermectin or fluvoxamine). 1074 (95%) of 1126 participants completed at least 9 months of follow-up. 632 (56·1%) of 1126 participants were female and 494 (43·9%) were male; 44 (7·0%) of 632 women were pregnant. The median age was 45 years (IQR 37-54) and median BMI was 29·8 kg/m2 (IQR 27·0-34·2). Overall, 93 (8·3%) of 1126 participants reported receipt of a long COVID diagnosis by day 300. The cumulative incidence of long COVID by day 300 was 6·3% (95% CI 4·2-8·2) in participants who received metformin and 10·4% (7·8-12·9) in those who received identical metformin placebo (hazard ratio [HR] 0·59, 95% CI 0·39-0·89; p=0·012). The metformin beneficial effect was consistent across prespecified subgroups. When metformin was started within 3 days of symptom onset, the HR was 0·37 (95% CI 0·15-0·95). There was no effect on cumulative incidence of long COVID with ivermectin (HR 0·99, 95% CI 0·59-1·64) or fluvoxamine (1·36, 0·78-2·34) compared with placebo. INTERPRETATION Outpatient treatment with metformin reduced long COVID incidence by about 41%, with an absolute reduction of 4·1%, compared with placebo. Metformin has clinical benefits when used as outpatient treatment for COVID-19 and is globally available, low-cost, and safe. FUNDING Parsemus Foundation; Rainwater Charitable Foundation; Fast Grants; UnitedHealth Group Foundation; National Institute of Diabetes, Digestive and Kidney Diseases; National Institutes of Health; and National Center for Advancing Translational Sciences.
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Affiliation(s)
- Carolyn T Bramante
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - John B Buse
- Endocrinology, University of North Carolina, Chapel Hill, NC, USA
| | - David M Liebovitz
- General Internal Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Ken Cohen
- UnitedHealth Group, Optum Labs, Minnetonka, MN, USA
| | - Hrishikesh K Belani
- Department of Medicine, Olive View, University of California, Los Angeles, CA, USA
| | - Blake J Anderson
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA; Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jared D Huling
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Jennifer L Thompson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Pullen
- Division of Infectious Diseases and International Medicine, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Esteban Lemus Wirtz
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lianne K Siegel
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer L Proper
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - David J Odde
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Nichole R Klatt
- Department of Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Sarah M Lindberg
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | | | - Spencer M Erickson
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sarah L Fenno
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Katrina M Hartman
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael R Rose
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tanvi Mehta
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Barkha Patel
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gwendolyn Griffiths
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Neeta S Bhat
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Thomas A Murray
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
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Kashfi K, Anbardar N, Asadipooya A, Asadipooya K. Type 1 Diabetes and COVID-19: A Literature Review and Possible Management. Int J Endocrinol Metab 2023; 21:e139768. [PMID: 38666042 PMCID: PMC11041820 DOI: 10.5812/ijem-139768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 04/28/2024] Open
Abstract
Context Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection normally damages the respiratory system but might likewise impair endocrine organs' function. Thyroid dysfunction and hyperglycemia are common endocrine complications of SARS-CoV-2 infection. The onset of type 1 diabetes (T1D) and associated complications, including diabetic ketoacidosis (DKA), hospitalization, and death, are thought to have increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to review the available data about the incidence rate of T1D and accompanying complications since the beginning of the COVID-19 pandemic. Evidence Acquisition A literature review was conducted using the electronic databases PubMed and Google Scholar. The keywords "T1D, T1DM, Type 1 DM or Type 1 Diabetes", "Coronavirus, SARS-CoV-2 or COVID-19" were used to search these databases. Titles and abstracts were screened for selection, and then relevant studies were reviewed in full text. Results A total of 25 manuscripts out of 304 identified studies were selected. There were 15 (60%) multicenter or nationwide studies. The data about the incidence rate of T1D, hospitalization, and death are not consistent across countries; however, DKA incidence and severity seem to be higher during the COVID-19 pandemic. The present study's data collection demonstrated that COVID-19 might or might not increase the incidence of T1D. Nevertheless, it is associated with the higher incidence and severity of DKA in T1D patients. This finding might indicate that antivirals are not fully protective against the endocrine complications of SARS-CoV-2 infection, which promotes the application of an alternative approach. Conclusions Combining medications that reduce SARS-CoV-2 entry into the cells and modulate the immune response to infection is an alternative practical approach to treating COVID-19.
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Affiliation(s)
- Kebria Kashfi
- Department of Clinical Medicine, Florida International University AUACOM, Florida, USA
| | - Narges Anbardar
- Department of Clinical Medicine, SMUSOM, Cleveland Clinic Lerner College of Medicine, Ohio, USA
| | - Artin Asadipooya
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Kamyar Asadipooya
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, Kentucky, USA
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Li M, Wang M, Wen Y, Zhang H, Zhao G, Gao Q. Signaling pathways in macrophages: molecular mechanisms and therapeutic targets. MedComm (Beijing) 2023; 4:e349. [PMID: 37706196 PMCID: PMC10495745 DOI: 10.1002/mco2.349] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023] Open
Abstract
Macrophages play diverse roles in development, homeostasis, and immunity. Accordingly, the dysfunction of macrophages is involved in the occurrence and progression of various diseases, such as coronavirus disease 2019 and atherosclerosis. The protective or pathogenic effect that macrophages exert in different conditions largely depends on their functional plasticity, which is regulated via signal transduction such as Janus kinase-signal transducer and activator of transcription, Wnt and Notch pathways, stimulated by environmental cues. Over the past few decades, the molecular mechanisms of signaling pathways in macrophages have been gradually elucidated, providing more alternative therapeutic targets for diseases treatment. Here, we provide an overview of the basic physiology of macrophages and expound the regulatory pathways within them. We also address the crucial role macrophages play in the pathogenesis of diseases, including autoimmune, neurodegenerative, metabolic, infectious diseases, and cancer, with a focus on advances in macrophage-targeted strategies exploring modulation of components and regulators of signaling pathways. Last, we discuss the challenges and possible solutions of macrophage-targeted therapy in clinical applications. We hope that this comprehensive review will provide directions for further research on therapeutic strategies targeting macrophage signaling pathways, which are promising to improve the efficacy of disease treatment.
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Affiliation(s)
- Ming Li
- Department of Gynecological OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- National Clinical Research Center for Obstetrics and GynecologyCancer Biology Research Center (Key Laboratory of the Ministry of Education)Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Mengjie Wang
- Department of Gynecological OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- National Clinical Research Center for Obstetrics and GynecologyCancer Biology Research Center (Key Laboratory of the Ministry of Education)Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yuanjia Wen
- Department of Gynecological OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- National Clinical Research Center for Obstetrics and GynecologyCancer Biology Research Center (Key Laboratory of the Ministry of Education)Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hongfei Zhang
- Department of Gynecological OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- National Clinical Research Center for Obstetrics and GynecologyCancer Biology Research Center (Key Laboratory of the Ministry of Education)Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Guang‐Nian Zhao
- Department of Gynecological OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- National Clinical Research Center for Obstetrics and GynecologyCancer Biology Research Center (Key Laboratory of the Ministry of Education)Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Qinglei Gao
- Department of Gynecological OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- National Clinical Research Center for Obstetrics and GynecologyCancer Biology Research Center (Key Laboratory of the Ministry of Education)Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Kim C, Chen B, Mohandas S, Rehman J, Sherif ZA, Coombs K. The importance of patient-partnered research in addressing long COVID: Takeaways for biomedical research study design from the RECOVER Initiative's Mechanistic Pathways taskforce. eLife 2023; 12:e86043. [PMID: 37737716 PMCID: PMC10516599 DOI: 10.7554/elife.86043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
The NIH-funded RECOVER study is collecting clinical data on patients who experience a SARS-CoV-2 infection. As patient representatives of the RECOVER Initiative's Mechanistic Pathways task force, we offer our perspectives on patient motivations for partnering with researchers to obtain results from mechanistic studies. We emphasize the challenges of balancing urgency with scientific rigor. We recognize the importance of such partnerships in addressing post-acute sequelae of SARS-CoV-2 infection (PASC), which includes 'long COVID,' through contrasting objective and subjective narratives. Long COVID's prevalence served as a call to action for patients like us to become actively involved in efforts to understand our condition. Patient-centered and patient-partnered research informs the balance between urgency and robust mechanistic research. Results from collaborating on protocol design, diverse patient inclusion, and awareness of community concerns establish a new precedent in biomedical research study design. With a public health matter as pressing as the long-term complications that can emerge after SARS-CoV-2 infection, considerate and equitable stakeholder involvement is essential to guiding seminal research. Discussions in the RECOVER Mechanistic Pathways task force gave rise to this commentary as well as other review articles on the current scientific understanding of PASC mechanisms.
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Affiliation(s)
- C Kim
- Department of Population Health, NYU Grossman School of MedicineNew YorkUnited States
| | - Benjamin Chen
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Sindhu Mohandas
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern CaliforniaLos AngelesUnited States
| | - Jalees Rehman
- Department of Biochemistry and Molecular Genetics, University of Illinois, College of MedicineChicagoUnited States
| | - Zaki A Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of MedicineWashingtonUnited States
| | - K Coombs
- Department of Pandemic Equity, Vermont Center for Independent LivingMontpelierUnited States
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Boulware DR, Lindsell CJ, Stewart TG, Hernandez AF, Collins S, McCarthy MW, Jayaweera D, Gentile N, Castro M, Sulkowski M, McTigue K, Felker GM, Ginde AA, Dunsmore SE, Adam SJ, DeLong A, Hanna G, Remaly A, Thicklin F, Wilder R, Wilson S, Shenkman E, Naggie S. Inhaled Fluticasone Furoate for Outpatient Treatment of Covid-19. N Engl J Med 2023; 389:1085-1095. [PMID: 37733308 PMCID: PMC10597427 DOI: 10.1056/nejmoa2209421] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND The effectiveness of inhaled glucocorticoids in shortening the time to symptom resolution or preventing hospitalization or death among outpatients with mild-to-moderate coronavirus disease 2019 (Covid-19) is unclear. METHODS We conducted a decentralized, double-blind, randomized, placebo-controlled platform trial in the United States to assess the use of repurposed medications in outpatients with confirmed coronavirus disease 2019 (Covid-19). Nonhospitalized adults 30 years of age or older who had at least two symptoms of acute infection that had been present for no more than 7 days before enrollment were randomly assigned to receive inhaled fluticasone furoate at a dose of 200 μg once daily for 14 days or placebo. The primary outcome was the time to sustained recovery, defined as the third of 3 consecutive days without symptoms. Key secondary outcomes included hospitalization or death by day 28 and a composite outcome of the need for an urgent-care or emergency department visit or hospitalization or death through day 28. RESULTS Of the 1407 enrolled participants who underwent randomization, 715 were assigned to receive inhaled fluticasone furoate and 692 to receive placebo, and 656 and 621, respectively, were included in the analysis. There was no evidence that the use of fluticasone furoate resulted in a shorter time to recovery than placebo (hazard ratio, 1.01; 95% credible interval, 0.91 to 1.12; posterior probability of benefit [defined as a hazard ratio >1], 0.56). A total of 24 participants (3.7%) in the fluticasone furoate group had urgent-care or emergency department visits or were hospitalized, as compared with 13 participants (2.1%) in the placebo group (hazard ratio, 1.9; 95% credible interval, 0.8 to 3.5). Three participants in each group were hospitalized, and no deaths occurred. Adverse events were uncommon in both groups. CONCLUSIONS Treatment with inhaled fluticasone furoate for 14 days did not result in a shorter time to recovery than placebo among outpatients with Covid-19 in the United States. (Funded by the National Center for Advancing Translational Sciences and others; ACTIV-6 ClinicalTrials.gov number, NCT04885530.).
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Affiliation(s)
- David R Boulware
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Christopher J Lindsell
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Thomas G Stewart
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Adrian F Hernandez
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Sean Collins
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Matthew William McCarthy
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Dushyantha Jayaweera
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Nina Gentile
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Mario Castro
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Mark Sulkowski
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Kathleen McTigue
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - G Michael Felker
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Adit A Ginde
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Sarah E Dunsmore
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Stacey J Adam
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Allison DeLong
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - George Hanna
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - April Remaly
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Florence Thicklin
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Rhonda Wilder
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Sybil Wilson
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Elizabeth Shenkman
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
| | - Susanna Naggie
- From the University of Minnesota, Minneapolis (D.R.B.); Vanderbilt University Medical Center, Nashville (C.J.L., S.C.); the University of Virginia, Charlottesville (T.G.S.); the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., G.M.F., A.D., A.R., R.W., S.W., S.N.); Weill Cornell Medicine, New York (M.W.M.); the University of Miami, Miami (D.J.), and the University of Florida, Gainesville (E.S.); the Lewis Katz School of Medicine at Temple University, Philadelphia (N.G.); the University of Kansas Medical Center, Kansas City (M.C.); Johns Hopkins University, Baltimore (M.S.), and the National Center for Advancing Translational Sciences (S.E.D.) and the Foundation for the National Institutes of Health (S.J.A.), Bethesda - all in Maryland; the University of Pittsburgh Medical Center (K.M.) and the ACTIV-6 Stakeholder Advisory Committee, University of Pittsburgh (F.T.) - both in Pittsburgh; the University of Colorado Denver-Anschutz, Denver (A.A.G.); and the Biomedical Advanced Research and Development Authority, Washington, DC (G.H.)
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Naggie S. Effect of Higher-Dose Fluvoxamine vs Placebo on Time to Sustained Recovery in Outpatients with Mild to Moderate COVID-19: A Randomized Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.12.23295424. [PMID: 37745371 PMCID: PMC10516082 DOI: 10.1101/2023.09.12.23295424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background The impact of fluvoxamine in reducing symptom duration among outpatients with mild to moderate coronavirus disease 2019 (COVID-19) remains uncertain. Our objective was to assess the effectiveness of fluvoxamine 100 mg twice daily, compared with placebo, for treating mild to moderate COVID-19. Methods The ACTIV-6 platform randomized clinical trial aims to evaluate repurposed medications for mild to moderate COVID-19. Between August 25, 2022, and January 20, 2023, 1175 participants were enrolled at 103 US sites for evaluating fluvoxamine; participants were age ≥30 years with confirmed SARS-CoV-2 infection and ≥2 acute COVID-19 symptoms for ≤7 days. Participants were randomized to receive fluvoxamine 50 mg twice daily on day 1 followed by 100 mg twice daily for 12 additional days or to placebo. The primary outcome was time to sustained recovery (defined as at least 3 consecutive days without symptoms). Secondary outcomes included time to death; time to hospitalization or death; a composite of hospitalization, urgent care visit, emergency department visit, or death; COVID clinical progression scale; and difference in mean time unwell. Results Among participants who were randomized and received study drug, the median age was 50 years (IQR 40-60), 66% were female, 45% identified as Hispanic/Latino, and 77% reported ≥2 doses of a SARS-CoV-2 vaccine. Among 589 participants who received fluvoxamine and 586 who received placebo, differences in time to sustained recovery were not observed (adjusted hazard ratio [HR], 0.99 [95% credible interval, 0.89-1.09; P(efficacy) = 0.4]). Additionally, unadjusted, median time to sustained recovery was 10 days (95% CI 10-11) in both the intervention and placebo group. No deaths were reported. Thirty-five participants reported healthcare utilization events ( a priori defined as death, hospitalization, emergency department/urgent care visit); 14 in the fluvoxamine group compared with 21 in the placebo group (HR 0.69; 95% CrI 0.27-1.21; P(efficacy)=0.86) There were 7 serious adverse events in 6 participants (2 with fluvoxamine and 4 with placebo). Conclusions Among outpatients with mild to moderate COVID-19, treatment with fluvoxamine does not reduce duration of COVID-19 symptoms. Trial Registration ClinicalTrials.gov ( NCT04885530 ).
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Wang Z, Pan Q, Ma L, Zhao J, McIntosh F, Liu Z, Ding S, Lin R, Cen S, Finzi A, Liang C. Anthracyclines inhibit SARS-CoV-2 infection. Virus Res 2023; 334:199164. [PMID: 37379907 PMCID: PMC10305762 DOI: 10.1016/j.virusres.2023.199164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/13/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023]
Abstract
Vaccines and drugs are two effective medical interventions to mitigate SARS-CoV-2 infection. Three SARS-CoV-2 inhibitors, remdesivir, paxlovid, and molnupiravir, have been approved for treating COVID-19 patients, but more are needed, because each drug has its limitation of usage and SARS-CoV-2 constantly develops drug resistance mutations. In addition, SARS-CoV-2 drugs have the potential to be repurposed to inhibit new human coronaviruses, thus help to prepare for future coronavirus outbreaks. We have screened a library of microbial metabolites to discover new SARS-CoV-2 inhibitors. To facilitate this screening effort, we generated a recombinant SARS-CoV-2 Delta variant carrying the nano luciferase as a reporter for measuring viral infection. Six compounds were found to inhibit SARS-CoV-2 at the half maximal inhibitory concentration (IC50) below 1 μM, including the anthracycline drug aclarubicin that markedly reduced viral RNA-dependent RNA polymerase (RdRp)-mediated gene expression, whereas other anthracyclines inhibited SARS-CoV-2 by activating the expression of interferon and antiviral genes. As the most commonly prescribed anti-cancer drugs, anthracyclines hold the promise of becoming new SARS-CoV-2 inhibitors.
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Affiliation(s)
- Zhen Wang
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Qinghua Pan
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ling Ma
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Jianyuan Zhao
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Fiona McIntosh
- Research Institute of the McGill University Health Centre, McGill International TB Centre, Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
| | - Zhenlong Liu
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Shilei Ding
- Centre de Recherche du CHUM, Montreal, Quebec, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Rongtuan Lin
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Shan Cen
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Andrés Finzi
- Centre de Recherche du CHUM, Montreal, Quebec, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Chen Liang
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada.
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Osores PI, Vivacqua MN, Vazquez C, Marciano S, Giunta DH, Faccioli JL. Association Between Selective Serotonin Reuptake Inhibitors Prevalent Use and COVID-19-Related Mortality: A Retrospective Cohort Study. J Clin Psychopharmacol 2023; 43:411-416. [PMID: 37683229 DOI: 10.1097/jcp.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
PURPOSE/BACKGROUND Since the emergence of the coronavirus disease 2019 (COVID-19), many efforts have been made to prevent and to treat the disease. In this line, the anti-inflammatory effect of selective serotonin reuptake inhibitors (SSRI) as alternatives for treating chronic inflammatory diseases has been studied. There is previous evidence of the usefulness of these drugs for reducing COVID-19 impact. METHODS/PROCEDURES We conducted a retrospective single-center cohort study of adult patients with a positive reverse transcriptase-polymerase chain reaction for COVID-19, evaluating the association between SSRI use and in-hospital mortality. FINDINGS/RESULTS Of 1689 included patients, 182 (10.8%) were exposed to SSRI. A total of 291 patients died during the hospitalization, representing an in-hospital mortality of 17.2% (95% confidence interval [CI], 15.4%-19.0%): 44 (24.2%) of the exposed to SSRIs versus 247 (16.4%) of those not exposed to SSRIs (crude odds ratio [OR], 1.62; 95% CI, 1.12-2.34; P = 0.009). No independent effect of SSRIs on in-hospital mortality was found when applying either the inverse probability of treatment weighting (OR, 1.15; 95% CI, 0.71-1.89; P = 0.56) or with conventional multivariable analysis 0.81 (95 % CI: 0.28-2.31, P = 0.69). IMPLICATIONS/CONCLUSIONS In the present retrospective study of patients hospitalized for COVID-19, prior use of SSRIs did not reduce mortality.
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Affiliation(s)
| | | | | | - Sebastián Marciano
- Department or Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Hernán Giunta
- Department or Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Şimşek-Yavuz S. COVID-19: An Update on Epidemiology, Prevention and Treatment, September-2023. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:165-187. [PMID: 38633552 PMCID: PMC10986731 DOI: 10.36519/idcm.2023.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 04/19/2024]
Abstract
After a downward trend for more than 12 months, the incidence of COVID-19 has increased in the last months. Although COVID-19 is not as frequent as in the first years of the pandemic, case numbers are still very high, and it causes a significant number of deaths. COVID-19 is not seen with a predictable frequency, at least two times more deadly than the flu, continues as an epidemic, and has not reached the endemic level yet. Currently, the Omicron strains EG.5 and XBB.1.16 are dominant worldwide. Although BA.2.86 and FLip variants, including FL.1.5.1 are not widespread at the moment, both were shown to be highly immune-evasive and require close monitoring. Prevention of COVID-19 relies on vaccinations, surveillance, proper ventilation of enclosed spaces, isolation of patients, and mask usage. Currently, monovalent COVID-19 vaccines, including XBB.1.5 Omicron SARS-CoV-2, are recommended for both primary and booster vaccinations against COVID-19. Monovalent vaccines, including only original SARS-CoV-2 strain, and bivalent vaccines, including original virus plus BA4/5 variant, are no longer recommended against COVID-19. Booster vaccination with XBB.1.5 containing vaccine should be prioritized for patients at high risk for severe COVID-19. Bacillus Calmette-Guérin (BCG) vaccination does not seem to be effective in preventing COVID-19. At the current phase of the pandemic, nirmatrelvir/ritonavir, remdesivir, molnupiravir, sotrovimab (for patients from XBB.1.5 variant dominant settings), and convalescent plasma can be considered for the treatment of high-risk early-stage outpatients with COVID-19, while hospitalized patients with more severe disease can be treated with dexamethasone, anti cytokines including tocilizumab, sarilumab, baricitinib, and tofacitinib and antithrombotic agents including enoxaparin. Remdesivir oral analogues and ensitrelvir fumarate are promising agents for treating acute COVID-19, which are in phase trials now; however, ivermectin, fluvoxamine, and metformin were shown to be ineffective.
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Affiliation(s)
- Serap Şimşek-Yavuz
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University School of Medicine, İstanbul, Türkiye
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Perakakis N, Harb H, Hale BG, Varga Z, Steenblock C, Kanczkowski W, Alexaki VI, Ludwig B, Mirtschink P, Solimena M, Toepfner N, Zeissig S, Gado M, Abela IA, Beuschlein F, Spinas GA, Cavelti-Weder C, Gerber PA, Huber M, Trkola A, Puhan MA, Wong WWL, Linkermann A, Mohan V, Lehnert H, Nawroth P, Chavakis T, Mingrone G, Wolfrum C, Zinkernagel AS, Bornstein SR. Mechanisms and clinical relevance of the bidirectional relationship of viral infections with metabolic diseases. Lancet Diabetes Endocrinol 2023; 11:675-693. [PMID: 37524103 DOI: 10.1016/s2213-8587(23)00154-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 08/02/2023]
Abstract
Viruses have been present during all evolutionary steps on earth and have had a major effect on human history. Viral infections are still among the leading causes of death. Another public health concern is the increase of non-communicable metabolic diseases in the last four decades. In this Review, we revisit the scientific evidence supporting the presence of a strong bidirectional feedback loop between several viral infections and metabolic diseases. We discuss how viruses might lead to the development or progression of metabolic diseases and conversely, how metabolic diseases might increase the severity of a viral infection. Furthermore, we discuss the clinical relevance of the current evidence on the relationship between viral infections and metabolic disease and the present and future challenges that should be addressed by the scientific community and health authorities.
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Affiliation(s)
- Nikolaos Perakakis
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany; Paul Langerhans Institute Dresden, Helmholtz Munich, Technische Universität Dresden, Dresden 01307, Germany; German Center for Diabetes Research, Neuherberg, Germany.
| | - Hani Harb
- Medical Microbiology and Virology, Technische Universität Dresden, Dresden 01307, Germany
| | - Benjamin G Hale
- Institute of Medical Virology, University of Zürich, Zürich, Switzerland
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University of Zürich, Zürich, Switzerland
| | - Charlotte Steenblock
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany
| | - Waldemar Kanczkowski
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany
| | - Vasileia Ismini Alexaki
- Institute for Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden 01307, Germany
| | - Barbara Ludwig
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany; Paul Langerhans Institute Dresden, Helmholtz Munich, Technische Universität Dresden, Dresden 01307, Germany; Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden 01307, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Peter Mirtschink
- Institute for Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden 01307, Germany
| | - Michele Solimena
- Paul Langerhans Institute Dresden, Helmholtz Munich, Technische Universität Dresden, Dresden 01307, Germany; Department of Molecular Diabetology, Technische Universität Dresden, Dresden 01307, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Technische Universität Dresden, Dresden 01307, Germany
| | - Sebastian Zeissig
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden 01307, Germany; Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany
| | - Manuel Gado
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany; Paul Langerhans Institute Dresden, Helmholtz Munich, Technische Universität Dresden, Dresden 01307, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Irene Alma Abela
- Institute of Medical Virology, University of Zürich, Zürich, Switzerland; Department of Infectious Diseases and Hospital Epidemiology, University of Zürich, Zürich, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zürich, University of Zürich, Zürich, Switzerland; Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Giatgen A Spinas
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Claudia Cavelti-Weder
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Philipp A Gerber
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zürich, Zürich, Switzerland
| | - Alexandra Trkola
- Institute of Medical Virology, University of Zürich, Zürich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Wendy Wei-Lynn Wong
- and Department of Molecular Life Science, University of Zürich, Zürich, Switzerland
| | - Andreas Linkermann
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany; Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| | - Hendrik Lehnert
- Presidential Office, Paris Lodron Universität Salzburg, Salzburg, Austria
| | - Peter Nawroth
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany
| | - Triantafyllos Chavakis
- Paul Langerhans Institute Dresden, Helmholtz Munich, Technische Universität Dresden, Dresden 01307, Germany; Institute for Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden 01307, Germany; German Center for Diabetes Research, Neuherberg, Germany; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Geltrude Mingrone
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Division of Diabetes and Nutritional Sciences, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christian Wolfrum
- Laboratory of Translational Nutrition Biology, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Schwerzenbach, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University of Zürich, Zürich, Switzerland
| | - Stefan R Bornstein
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany; Paul Langerhans Institute Dresden, Helmholtz Munich, Technische Universität Dresden, Dresden 01307, Germany; German Center for Diabetes Research, Neuherberg, Germany; Division of Diabetes and Nutritional Sciences, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Taheri R, Shahrokhi SZ, Amjadi Z, Kazerouni F. Investigating the impact of metformin on severity of COVID-19 in patients with Type 2 diabetes mellitus: Focusing on laboratory findings. Endocrinol Diabetes Metab 2023; 6:e441. [PMID: 37431844 PMCID: PMC10495547 DOI: 10.1002/edm2.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND In the terrifying pandemic caused by SARS-CoV-2, diabetic patients exhibiting more severe outcomes and mortality rate is high among them. Based on recent studies, metformin as the most prescribed drug for T2DM treatment may improve severe outcomes in diabetic patients infected with SARS-CoV-2. On the other hand, abnormal laboratory findings can help to differentiate between the severe and non-severe form of COVID-19. According to the mentioned issues, the effect of metformin on severity of COVID-19 was examined in T2DM patients with SARS-CoV-2 infection. METHODS The study included 187 individuals diagnosed with COVID-19, 104 patients were diabetic and divided into two groups according to their anti-diabetic drugs: patients who were treated only with metformin and patients who were treated with other anti-diabetic drugs. The other participants were non-diabetic and diagnosed with COVID-19. Biochemical parameters were measured by routine laboratory methods before, during and after SARS-CoV-2 infection. RESULTS During infection, FBS, creatinine, ALT, AST, Ferritin and LDH were significantly lower in metformin users than non-users (p-value: .02, .01, .03, .04, .0009 and .01, respectively). Also, after recovery, there were statistically significant differences between metformin users and non-users with respect to most of the study parameters, except FBS, BUN and ALP (p-value: .51, .28 and .35, respectively). CONCLUSION Our result suggested that metformin might be associated with better outcomes in diabetic patients infected with SARS-CoV-2.
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Affiliation(s)
- Rana Taheri
- Department of Clinical Biochemistry, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
- Division of BiochemistryFardis Central LabAlborzIran
| | | | - Zahra Amjadi
- Division of BiochemistryFardis Central LabAlborzIran
- Department of Biology and Biochemistry, Science Faculty, Shahr‐e‐Qods BranchIslamic Azad UniversityTehranIran
| | - Faranak Kazerouni
- Department of Medical lab. Sciences, School of Allied Medical SciencesShahid Beheshti University of Medical SciencesTehranIran
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Siripongboonsitti T, Ungtrakul T, Tawinprai K, Nimmol T, Buttakosa M, Sornsamdang G, Jarrusrojwuttikul T, Silapant P, Mahanonda N. Efficacy of combination therapy of fluvoxamine and favipiravir vs favipiravir monotherapy to prevent severe COVID-19 among mild to moderate COVID-19 patients: Open-label randomized controlled trial (EFFaCo study). Int J Infect Dis 2023; 134:211-219. [PMID: 37393041 DOI: 10.1016/j.ijid.2023.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/05/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVES Fluvoxamine (FVX) is an antidepressant proposed to its immunomodulatory effects in preventing deterioration in mild and moderate COVID-19. METHODS An open-label, 1:1 randomized controlled trial was assigned either combination therapy 50 mg twice daily of FVX for 10 days and favipiravir (FPV) or FPV alone to assess the efficacy in preventing disease progression in mild to moderate COVID-19 on the 5th day. RESULTS In total, 134 patients with mild COVID-19 received FPV and 132 received FVX/FPV, 31 patients with moderate COVID-19 received FPV/dexamethasone (FPV/Dex), and 30 received FVX/FPV/Dex. The intention-to-treat (ITT) analysis showed no difference of no clinical deterioration on the 5th day in both mild COVID-19 (100% in FPV vs 97% in FVX/FPV) and moderate COVID-19 (83.9% in FPV/Dex vs 86.7% in FVX/FPV/Dex). However, there was a low rate of oxygen supplemental, hospitalization, or intensive care in both groups and zero death in all groups. No significant difference in oxygen supplemental, hospitalization, radiological, virological, or biochemical outcomes, and the immunomodulatory effect was observed between the group. CONCLUSION The combined fluvoxamine treatment did not add benefit in preventing deterioration in patients with mild to moderate COVID-19 without the immunomodulatory effect observed, although it demonstrated low hospitalization rates, oxygen supplemental, intensive care needed, and zero mortality. TRIAL REGISTRATION Thai clinical trials registry (TCTR) no. 20210615002.
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Affiliation(s)
- Taweegrit Siripongboonsitti
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand; Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Teerapat Ungtrakul
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kriangkrai Tawinprai
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Tararin Nimmol
- Pharmacy Department, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Mullika Buttakosa
- Nursing Department, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Gaidganok Sornsamdang
- Central Laboratory Center, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Tanadul Jarrusrojwuttikul
- Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Radiology, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
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Bostanghadiri N, Ziaeefar P, Mofrad MG, Yousefzadeh P, Hashemi A, Darban-Sarokhalil D. COVID-19: An Overview of SARS-CoV-2 Variants-The Current Vaccines and Drug Development. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1879554. [PMID: 37674935 PMCID: PMC10480030 DOI: 10.1155/2023/1879554] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/07/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
The world is presently in crisis facing an outbreak of a health-threatening microorganism known as COVID-19, responsible for causing uncommon viral pneumonia in humans. The virus was first reported in Wuhan, China, in early December 2019, and it quickly became a global concern due to the pandemic. Challenges in this regard have been compounded by the emergence of several variants such as B.1.1.7, B.1.351, P1, and B.1.617, which show an increase in transmission power and resistance to therapies and vaccines. Ongoing researches are focused on developing and manufacturing standard treatment strategies and effective vaccines to control the pandemic. Despite developing several vaccines such as Pfizer/BioNTech and Moderna approved by the U.S. Food and Drug Administration (FDA) and other vaccines in phase 4 clinical trials, preventive measures are mandatory to control the COVID-19 pandemic. In this review, based on the latest findings, we will discuss different types of drugs as therapeutic options and confirmed or developing vaccine candidates against SARS-CoV-2. We also discuss in detail the challenges posed by the variants and their effect on therapeutic and preventive interventions.
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Affiliation(s)
- Narjess Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morvarid Golrokh Mofrad
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Parsa Yousefzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Guo Z, Gao Y, Xie E, Ye Z, Li Y, Zhao X, Shen N, Zheng J. Effects of Metformin on COVID-19 Patients with Type 2 Diabetes: A Retrospective Study. Diabetes Metab Syndr Obes 2023; 16:2573-2582. [PMID: 37645237 PMCID: PMC10461736 DOI: 10.2147/dmso.s417925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose The pandemic of coronavirus disease 2019 (COVID-19) has highlighted the intricate relationship between underlying conditions and death. We designed this study to determine whether metformin therapy for type 2 diabetes mellitus (T2D) is associated with low in-hospital mortality in patients hospitalized for COVID-19. Materials and Methods This was a retrospective study including patients with COVID-19 and T2D in Wuhan, from February 4th to April 11th, 2020. Patients were divided into two groups according to metformin exposure. The hazard ratio (HR) of COVID-19-related mortality and invasive mechanical ventilation was estimated using Cox regression. Results There were 571 T2D patients among the 4330 confirmed COVID-19 patients. Of those patients, 241 received metformin therapy. The in-hospital mortality and invasive mechanical ventilation of metformin group was lower than non-metformin group. In the multivariate model, metformin use was linked to a decreased in-hospital mortality and invasive mechanical ventilation when compared with that of the control group (HR: 0.376 [95% CI 0.154-0.922]; P = 0.033). Conclusion Our study indicated that metformin therapy was associated with decreased death risk in COVID-19 patients with T2D.
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Affiliation(s)
- Ziyu Guo
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Yanxiang Gao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Enmin Xie
- Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zixiang Ye
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Yike Li
- Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xuecheng Zhao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Nan Shen
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Jingang Zheng
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
- Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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Tsiakalos A, Ziakas PD, Polyzou E, Schinas G, Akinosoglou K. Early Fluvoxamine Reduces the Risk for Clinical Deterioration in Symptomatic Outpatients with COVID-19: A Real-World, Retrospective, before-after Analysis. Microorganisms 2023; 11:2073. [PMID: 37630633 PMCID: PMC10459506 DOI: 10.3390/microorganisms11082073] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Fluvoxamine, a selective serotonin reuptake inhibitor with anti-inflammatory properties, has gained attention as a repurposed drug to treat COVID-19. We aimed to explore the potential benefit of fluvoxamine on outpatients with early SARS-CoV-2 infection. We performed a retrospective study of fluvoxamine adult outpatients with symptomatic COVID-19 disease of early onset (<5 days), in the context of an infectious diseases private practice, between September-December 2021, in Greece. Patients with disease duration ≥5 days, dyspnea and/or hypoxemia with oxygen saturation <94% in room air and pregnancy were excluded from the analysis. In total, 103 patients, 54 males/49 females with a median age of 47 years (39-56), were included in this study. Patient characteristics were balanced before and after the introduction of fluvoxamine. Two patients in the fluvoxamine arm (3.8%; 95% CI 0.4-13) had clinical deterioration compared to 8 patients in the standard of care group (16%; 95% CI 7.2-29.1, p < 0.04). After controlling for age, sex, body mass index > 30 and vaccination status, fluvoxamine was independently associated with a lower risk of clinical deterioration (adj. OR 0.12; 95% CI 0.02-0.70, p < 0.02). Adding on fluvoxamine to treatment for early symptomatic COVID-19 patients may protect them from clinical deterioration and hospitalization, and it is an appealing low-cost, low-toxicity option in the community setting and warrants further investigation.
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Affiliation(s)
| | | | - Eleni Polyzou
- Dept of Internal Medicine and Infectious Diseases, Medical School, University General Hospital of Patras, University of Patras, 26504 Rio, Greece; (E.P.); (G.S.); (K.A.)
| | - Georgios Schinas
- Dept of Internal Medicine and Infectious Diseases, Medical School, University General Hospital of Patras, University of Patras, 26504 Rio, Greece; (E.P.); (G.S.); (K.A.)
| | - Karolina Akinosoglou
- Dept of Internal Medicine and Infectious Diseases, Medical School, University General Hospital of Patras, University of Patras, 26504 Rio, Greece; (E.P.); (G.S.); (K.A.)
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Foretz M, Guigas B, Viollet B. Metformin: update on mechanisms of action and repurposing potential. Nat Rev Endocrinol 2023; 19:460-476. [PMID: 37130947 PMCID: PMC10153049 DOI: 10.1038/s41574-023-00833-4] [Citation(s) in RCA: 142] [Impact Index Per Article: 142.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/04/2023]
Abstract
Currently, metformin is the first-line medication to treat type 2 diabetes mellitus (T2DM) in most guidelines and is used daily by >200 million patients. Surprisingly, the mechanisms underlying its therapeutic action are complex and are still not fully understood. Early evidence highlighted the liver as the major organ involved in the effect of metformin on reducing blood levels of glucose. However, increasing evidence points towards other sites of action that might also have an important role, including the gastrointestinal tract, the gut microbial communities and the tissue-resident immune cells. At the molecular level, it seems that the mechanisms of action vary depending on the dose of metformin used and duration of treatment. Initial studies have shown that metformin targets hepatic mitochondria; however, the identification of a novel target at low concentrations of metformin at the lysosome surface might reveal a new mechanism of action. Based on the efficacy and safety records in T2DM, attention has been given to the repurposing of metformin as part of adjunct therapy for the treatment of cancer, age-related diseases, inflammatory diseases and COVID-19. In this Review, we highlight the latest advances in our understanding of the mechanisms of action of metformin and discuss potential emerging novel therapeutic uses.
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Affiliation(s)
- Marc Foretz
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France
| | - Bruno Guigas
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Benoit Viollet
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France.
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Reiersen AM, Mattar C, Bender Ignacio RA, Boulware DR, Lee TC, Hess R, Lankowski AJ, McDonald EG, Miller JP, Powderly WG, Pullen MF, Rado JT, Rich MW, Schiffer JT, Schweiger J, Spivak AM, Stevens A, Vigod SN, Agarwal P, Yang L, Yingling M, Gettinger TR, Zorumski CF, Lenze EJ. The STOP COVID 2 Study: Fluvoxamine vs Placebo for Outpatients With Symptomatic COVID-19, a Fully Remote Randomized Controlled Trial. Open Forum Infect Dis 2023; 10:ofad419. [PMID: 37622035 PMCID: PMC10445518 DOI: 10.1093/ofid/ofad419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023] Open
Abstract
Background Prior randomized clinical trials have reported benefit of fluvoxamine ≥200 mg/d vs placebo for patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods This randomized, double-blind, placebo-controlled, fully remote multisite clinical trial evaluated whether fluvoxamine prevents clinical deterioration in higher-risk outpatients with acute coronavirus disease 2019 (COVID-19). Between December 2020 and May 2021, nonhospitalized US and Canadian participants with confirmed symptomatic infection received fluvoxamine (50 mg on day 1, 100 mg twice daily thereafter) or placebo for 15 days. The primary modified intent-to-treat (mITT) population included participants who started the intervention within 7 days of symptom onset with a baseline oxygen saturation ≥92%. The primary outcome was clinical deterioration within 15 days of randomization, defined as having both (1) shortness of breath (severity ≥4 on a 0-10 scale or requiring hospitalization) and (2) oxygen saturation <92% on room air or need for supplemental oxygen. Results A total of 547 participants were randomized and met mITT criteria (n = 272 fluvoxamine, n = 275 placebo). The Data Safety Monitoring Board recommended stopping early for futility related to lower-than-predicted event rates and declining accrual concurrent with vaccine availability in the United States and Canada. Clinical deterioration occurred in 13 (4.8%) participants in the fluvoxamine group and 15 (5.5%) participants in the placebo group (absolute difference at day 15, 0.68%; 95% CI, -3.0% to 4.4%; log-rank P = .91). Conclusions This trial did not find fluvoxamine efficacious in preventing clinical deterioration in unvaccinated outpatients with symptomatic COVID-19. It was stopped early and underpowered due to low primary outcome rates. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT04668950.
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Affiliation(s)
- Angela M Reiersen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Caline Mattar
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel A Bender Ignacio
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Allergy & Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
- Department of Medicine, Clinical Practice Assessment Unit, McGill University Health Centre, Montréal, Québec, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Rachel Hess
- Division of Health System Innovation and Research, University of Utah, Salt Lake City, Utah, USA
- Division of General Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alexander J Lankowski
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Emily G McDonald
- Department of Medicine, Clinical Practice Assessment Unit, McGill University Health Centre, Montréal, Québec, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - J Philip Miller
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - William G Powderly
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew F Pullen
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeffrey T Rado
- Departments of Psychiatry & Behavioral Sciences and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael W Rich
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joshua T Schiffer
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Allergy & Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Julie Schweiger
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Adam M Spivak
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Angela Stevens
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | - Payal Agarwal
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | - Lei Yang
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael Yingling
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Torie R Gettinger
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles F Zorumski
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Chamie JJ, Hibberd JA, Scheim DE. COVID-19 Excess Deaths in Peru's 25 States in 2020: Nationwide Trends, Confounding Factors, and Correlations With the Extent of Ivermectin Treatment by State. Cureus 2023; 15:e43168. [PMID: 37692571 PMCID: PMC10484241 DOI: 10.7759/cureus.43168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction In 2020, nations hastened to contain an emerging COVID-19 pandemic by deploying diverse public health approaches, but conclusive appraisals of the efficacy of these approaches are elusive in most cases. One of the medicines deployed, ivermectin (IVM), a macrocyclic lactone having biochemical activity against SARS-CoV-2 through competitive binding to its spike protein, has yielded mixed results in randomized clinical trials (RCTs) for COVID-19 treatments. In Peru, an opportunity to track the efficacy of IVM with a close consideration of confounding factors was provided through data for excess deaths as correlated with IVM use in 2020, under semi-autonomous policies in its 25 states. Methods To evaluate possible IVM treatment effects, excess deaths as determined from Peruvian national health data were analyzed by state for ages ≥60 in Peru's 25 states. These data were compared with monthly summary data for excess deaths in Peru for the period 2020-2021 as published by the WHO in 2022. To identify potential confounding factors, Google mobility data, population densities, SARS-CoV-2 genetic variations, and seropositivity rates were also examined. Results Reductions in excess deaths over a period of 30 days after peak deaths averaged 74% in the 10 states with the most intensive IVM use. As determined across all 25 states, these reductions in excess deaths correlated closely with the extent of IVM use (p<0.002). During four months of IVM use in 2020, before a new president of Peru restricted its use, there was a 14-fold reduction in nationwide excess deaths and then a 13-fold increase in the two months following the restriction of IVM use. Notably, these trends in nationwide excess deaths align with WHO summary data for the same period in Peru. Conclusions The natural experiment that was put into motion with the authorization of IVM use for COVID-19 in Peru in May 2020, as analyzed using data on excess deaths by locality and by state from Peruvian national health sources, resulted in strong evidence for the drug's effectiveness. Several potential confounding factors, including effects of a social isolation mandate imposed in May 2020, variations in the genetic makeup of the SARS-CoV-2 virus, and differences in seropositivity rates and population densities across the 25 states, were considered but did not appear to have significantly influenced these outcomes.
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Affiliation(s)
- Juan J Chamie
- Data Analysis, Independent Data Analyst, Cambridge, USA
| | | | - David E Scheim
- Commissioned Corps, Inactive Reserve, United States Public Health Service, Blacksburg, USA
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Anesi GL, Degnan K, Dutcher L, Saw S, Maguire C, Binkley A, Patel S, Athans V, Barton TD, Binkley S, Candeloro CL, Herman DJ, Kasbekar N, Kennedy L, Millstein JH, Meyer NJ, Talati NJ, Patel H, Pegues DA, Sayre PJ, Tebas P, Terico AT, Murphy KM, O’Donnell JA, White M, Hamilton KW. The Penn Medicine COVID-19 Therapeutics Committee-Reflections on a Model for Rapid Evidence Review and Dynamic Practice Recommendations During a Public Health Emergency. Open Forum Infect Dis 2023; 10:ofad428. [PMID: 37663091 PMCID: PMC10468749 DOI: 10.1093/ofid/ofad428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
The Penn Medicine COVID-19 Therapeutics Committee-an interspecialty, clinician-pharmacist, and specialist-front line primary care collaboration-has served as a forum for rapid evidence review and the production of dynamic practice recommendations during the 3-year coronavirus disease 2019 public health emergency. We describe the process by which the committee went about its work and how it navigated specific challenging scenarios. Our target audiences are clinicians, hospital leaders, public health officials, and researchers invested in preparedness for inevitable future threats. Our objectives are to discuss the logistics and challenges of forming an effective committee, undertaking a rapid evidence review process, aligning evidence-based guidelines with operational realities, and iteratively revising recommendations in response to changing pandemic data. We specifically discuss the arc of evidence for corticosteroids; the noble beginnings and dangerous misinformation end of hydroxychloroquine and ivermectin; monoclonal antibodies and emerging viral variants; and patient screening and safety processes for tocilizumab, baricitinib, and nirmatrelvir-ritonavir.
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Affiliation(s)
- George L Anesi
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kathleen Degnan
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lauren Dutcher
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephen Saw
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christina Maguire
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Amanda Binkley
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Sonal Patel
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Vasilios Athans
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Todd D Barton
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Shawn Binkley
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christina L Candeloro
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - David J Herman
- Division of Infectious Diseases, Penn Medicine Princeton Medical Center, University of Pennsylvania Health System, Princeton, New Jersey, USA
| | - Nishaminy Kasbekar
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Leigh Kennedy
- Division of Infectious Diseases, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jeffrey H Millstein
- Regional Physician Practices of Penn Medicine, Woodbury Heights, New Jersey, USA
| | - Nuala J Meyer
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Naasha J Talati
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hinal Patel
- Department of Pharmacy, Penn Medicine Princeton Medical Center, University of Pennsylvania Health System, Princeton, New Jersey, USA
| | - David A Pegues
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Patrick J Sayre
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pablo Tebas
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adrienne T Terico
- Department of Pharmacy, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kathleen M Murphy
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Judith A O’Donnell
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Melissa White
- Department of Pharmacy, Penn Medicine Lancaster General Health, University of Pennsylvania Health System, Lancaster, Pennsylvania, USA
| | - Keith W Hamilton
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Cousins HC, Kline AS, Wang C, Qu Y, Zengel J, Carette J, Wang M, Altman RB, Luo Y, Cong L. Integrative analysis of functional genomic screening and clinical data identifies a protective role for spironolactone in severe COVID-19. CELL REPORTS METHODS 2023; 3:100503. [PMID: 37529368 PMCID: PMC10243122 DOI: 10.1016/j.crmeth.2023.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/01/2023] [Accepted: 05/23/2023] [Indexed: 08/03/2023]
Abstract
We demonstrate that integrative analysis of CRISPR screening datasets enables network-based prioritization of prescription drugs modulating viral entry in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by developing a network-based approach called Rapid proXimity Guidance for Repurposing Investigational Drugs (RxGRID). We use our results to guide a propensity-score-matched, retrospective cohort study of 64,349 COVID-19 patients, showing that a top candidate drug, spironolactone, is associated with improved clinical prognosis, measured by intensive care unit (ICU) admission and mechanical ventilation rates. Finally, we show that spironolactone exerts a dose-dependent inhibitory effect on viral entry in human lung epithelial cells. Our RxGRID method presents a computational framework, implemented as an open-source software package, enabling genomics researchers to identify drugs likely to modulate a molecular phenotype of interest based on high-throughput screening data. Our results, derived from this method and supported by experimental and clinical analysis, add additional supporting evidence for a potential protective role of the potassium-sparing diuretic spironolactone in severe COVID-19.
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Affiliation(s)
- Henry C. Cousins
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA
- Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Adrienne Sarah Kline
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Chengkun Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yuanhao Qu
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - James Zengel
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jan Carette
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Mengdi Wang
- Department of Electronic Engineering, Princeton University, Princeton, NJ 08544, USA
| | - Russ B. Altman
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Le Cong
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
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Erickson SM, Fenno SL, Barzilai N, Kuchel G, Bartley JM, Justice JN, Buse JB, Bramante CT. Metformin for Treatment of Acute COVID-19: Systematic Review of Clinical Trial Data Against SARS-CoV-2. Diabetes Care 2023; 46:1432-1442. [PMID: 37339345 PMCID: PMC10300519 DOI: 10.2337/dc22-2539] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/10/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Observational and preclinical data suggest metformin may prevent severe coronavirus disease 2019 (COVID-19) outcomes. PURPOSE We conducted a systematic review of randomized, placebo-controlled clinical trials of metformin treatment for COVID-19 to determine whether metformin affects clinical or laboratory outcomes in individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and present a structured summary of preclinical data. STUDY SELECTION Two independent reviewers searched PubMed, Scopus, Cochrane COVID-19 Study Register, and ClinicalTrials.gov on 1 February 2023 with no date restrictions for trials where investigators randomized adults with COVID-19 to metformin versus control and assessed clinical and/or laboratory outcomes of interest. The Cochrane Risk of Bias 2 tool was used to assess bias. DATA EXTRACTION Two reviewers extracted data pertaining to prespecified outcomes of each interest from each included trial. DATA SYNTHESIS The synthesis plan was developed a priori and was guided by Synthesis Without Meta-analysis (SWiM) guidelines. Summary tables and narrative synthesis were used (PROSPERO, 2022, CRD42022349896). Three randomized trials met inclusion criteria. In two of the trials investigators found that metformin improved clinical outcomes (prevented need for oxygen and prevented need for acute health care use), and in the third trial a larger portion of adults with diabetes were enrolled but results did show a direction of benefit similar to that of the other trials in the per-protocol group. In the largest trial, subjects were enrolled during the delta and omicron waves and vaccinated individuals were included. The certainty of evidence that metformin prevents health care use due to COVID-19 was moderate per Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Many preclinical studies have shown metformin to be effective against SARS-CoV-2. LIMITATIONS Limitations include inclusion of only three trials and heterogeneity between trials. CONCLUSIONS Future trials will help define the role of metformin in COVID-19 treatment guidelines.
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Affiliation(s)
| | | | - Nir Barzilai
- Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY
| | - George Kuchel
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT
| | - Jenna M. Bartley
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT
| | - Jamie Nicole Justice
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - John B. Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Carolyn T. Bramante
- Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
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Yong SJ, Halim A, Halim M, Ming LC, Goh KW, Alfaresi M, AlShehail BM, Al Fares MA, Alissa M, Sulaiman T, Alsalem Z, Alwashmi ASS, Khamis F, Al Kaabi NA, Albayat H, Alsheheri A, Garout M, Alsalman J, Alfaraj AH, Alhajri M, Dhama K, Alburaiky LM, Alsanad AH, AlShurbaji AT, Rabaan AA. Experimental drugs in randomized controlled trials for long-COVID: what's in the pipeline? A systematic and critical review. Expert Opin Investig Drugs 2023; 32:655-667. [PMID: 37534972 DOI: 10.1080/13543784.2023.2242773] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Over three years have passed since the emergence of coronavirus disease 2019 (COVID-19), and yet the treatment for long-COVID, a post-COVID-19 syndrome, remains long overdue. Currently, there is no standardized treatment available for long-COVID, primarily due to the lack of funding for post-acute infection syndromes (PAIS). Nevertheless, the past few years have seen a renewed interest in long-COVID research, with billions of dollars allocated for this purpose. As a result, multiple randomized controlled trials (RCTs) have been funded in the quest to find an effective treatment for long-COVID. AREAS COVERED This systematic review identified and evaluated the potential of current drug treatments for long-COVID, examining both completed and ongoing RCTs. EXPERT OPINION We identified four completed and 22 ongoing RCTs, investigating 22 unique drugs. However, most drugs were deemed to not have high potential for treating long-COVID, according to three pre-specified domains, a testament to the ordeal of treating long-COVID. Given that long-COVID is highly multifaceted with several proposed subtypes, treatments likely need to be tailored accordingly. Currently, rintatolimod appears to have modest to high potential for treating the myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) subtype, LTY-100 and Treamid for pulmonary fibrosis subtype, and metformin for general long-COVID prevention.
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Affiliation(s)
- Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Malaysia
| | - Alice Halim
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Michael Halim
- Department of Biomedical Science, School of Science, Engineering and Environment, University of Salford, Greater Manchester, UK
| | - Long Chiau Ming
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Malaysia
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
| | - Mubarak Alfaresi
- Department of Pathology and Laboratory Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
- Department of Pathology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Bashayer M AlShehail
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mona A Al Fares
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohammed Alissa
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Tarek Sulaiman
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Zainab Alsalem
- Department of Epidemic Diseases Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ameen S S Alwashmi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Faryal Khamis
- Infection Diseases Unit, Department of Internal Medicine, Royal Hospital, Muscat, Oman
| | - Nawal A Al Kaabi
- College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alsheheri
- Infectious Disease Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jameela Alsalman
- Infection Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama, Bahrain
| | - Amal H Alfaraj
- Pediatric Department, Abqaiq General Hospital, First Eastern Health Cluster, Abqaiq, Saudi Arabia
| | - Mashael Alhajri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute (IVRI), Bareilly, India
| | - Lamees M Alburaiky
- Pediatric Department, Safwa General Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Ahlam H Alsanad
- Neonatal Intensive Care Unit, Pediatrics Department, Maternity and Children Hospital, Dammam, Saudi Arabia
| | | | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
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Abstract
Convergence of the two pandemics: metabolic syndrome and COVID-19 over last two years has posed unprecedented challenges to individuals as well as healthcare systems. Epidemiological data suggest a close association between metabolic syndrome and COVID-19 while variety of possible pathogenic connections have been proposed while some have been proven. Despite the evidence of high risk for adverse COVID-19 outcomes in people with metabolic syndrome, little is known about the differences in efficacy and safety among people with metabolic syndrome and without. It is important to recognize that among people with metabolic syndrome This review summarizes the current knowledge and epidemiological evidence on the association between metabolic syndrome and adverse COVID-19 outcomes, pathogenic interrelationships, management considerations for acute COVID-19 and post-COVID sequalae and sustaining care of people living with metabolic syndrome with appraisal of evidence and gaps in knowledge.
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Affiliation(s)
- Harsha Dissanayake
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka; Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
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Glebov OO, Mueller C, Stewart R, Aarsland D, Perera G. Antidepressant drug prescription and incidence of COVID-19 in mental health outpatients: a retrospective cohort study. BMC Med 2023; 21:209. [PMID: 37340474 PMCID: PMC10283271 DOI: 10.1186/s12916-023-02877-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/20/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Currently, the main pharmaceutical intervention for COVID-19 is vaccination. While antidepressant (AD) drugs have shown some efficacy in treatment of symptomatic COVID-19, their preventative potential remains largely unexplored. Analysis of association between prescription of ADs and COVID-19 incidence in the population would be beneficial for assessing the utility of ADs in COVID-19 prevention. METHODS Retrospective study of association between AD prescription and COVID-19 diagnosis was performed in a cohort of community-dwelling adult mental health outpatients during the 1st wave of COVID-19 pandemic in the UK. Clinical record interactive search (CRIS) was performed for mentions of ADs within 3 months preceding admission to inpatient care of the South London and Maudsley (SLaM) NHS Foundation Trust. Incidence of positive COVID-19 tests upon admission and during inpatient treatment was the primary outcome measure. RESULTS AD mention was associated with approximately 40% lower incidence of positive COVID-19 test results when adjusted for socioeconomic parameters and physical health. This association was also observed for prescription of ADs of the selective serotonin reuptake inhibitor (SSRI) class. CONCLUSIONS This preliminary study suggests that ADs, and SSRIs in particular, may be of benefit for preventing COVID-19 infection spread in the community. The key limitations of the study are its retrospective nature and the focus on a mental health patient cohort. A more definitive assessment of AD and SSRI preventative potential warrants prospective studies in the wider demographic.
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Affiliation(s)
- Oleg O Glebov
- Institute of Neuroregeneration and Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Shandong, China.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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87
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Dechtman ID, Ankory R, Sokolinsky K, Krasner E, Weiss L, Gal Y. Clinically Evaluated COVID-19 Drugs with Therapeutic Potential for Biological Warfare Agents. Microorganisms 2023; 11:1577. [PMID: 37375079 PMCID: PMC10304720 DOI: 10.3390/microorganisms11061577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak resulted in hundreds of millions of coronavirus cases, as well as millions of deaths worldwide. Coronavirus Disease 2019 (COVID-19), the disease resulting from exposure to this pathogen, is characterized, among other features, by a pulmonary pathology, which can progress to "cytokine storm", acute respiratory distress syndrome (ARDS), respiratory failure and death. Vaccines are the unsurpassed strategy for prevention and protection against the SARS-CoV-2 infection. However, there is still an extremely high number of severely ill people from at-risk populations. This may be attributed to waning immune response, variant-induced breakthrough infections, unvaccinated population, etc. It is therefore of high importance to utilize pharmacological-based treatments, despite the progression of the global vaccination campaign. Until the approval of Paxlovid, an efficient and highly selective anti-SARS-CoV-2 drug, and the broad-spectrum antiviral agent Lagevrio, many pharmacological-based countermeasures were, and still are, being evaluated in clinical trials. Some of these are host-directed therapies (HDTs), which modulate the endogenic response against the virus, and therefore may confer efficient protection against a wide array of pathogens. These could potentially include Biological Warfare Agents (BWAs), exposure to which may lead to mass casualties due to disease severity and a possible lack of efficient treatment. In this review, we assessed the recent literature on drugs under advanced clinical evaluation for COVID-19 with broad spectrum activity, including antiviral agents and HDTs, which may be relevant for future coping with BWAs, as well as with other agents, in particular respiratory infections.
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Affiliation(s)
- Ido-David Dechtman
- Pulmonology Department, Edith Wolfson Medical Center, 62 Halochamim Street, Holon 5822012, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ran Ankory
- The Israel Defense Force Medical Corps, Tel Hashomer, Ramat Gan, Military Post 02149, Israel;
| | - Keren Sokolinsky
- Chemical, Biological, Radiological and Nuclear Defense Division, Ministry of Defense, HaKirya, Tel Aviv 61909, Israel; (K.S.); (E.K.)
| | - Esther Krasner
- Chemical, Biological, Radiological and Nuclear Defense Division, Ministry of Defense, HaKirya, Tel Aviv 61909, Israel; (K.S.); (E.K.)
| | - Libby Weiss
- Chemical, Biological, Radiological and Nuclear Defense Division, Ministry of Defense, HaKirya, Tel Aviv 61909, Israel; (K.S.); (E.K.)
| | - Yoav Gal
- Chemical, Biological, Radiological and Nuclear Defense Division, Ministry of Defense, HaKirya, Tel Aviv 61909, Israel; (K.S.); (E.K.)
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona 74100, Israel
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88
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Bramante CT, Beckman KB, Mehta T, Karger AB, Odde DJ, Tignanelli CJ, Buse JB, Johnson DM, Watson RHB, Daniel JJ, Liebovitz DM, Nicklas JM, Cohen K, Puskarich MA, Belani HK, Siegel LK, Klatt NR, Anderson B, Hartman KM, Rao V, Hagen AA, Patel B, Fenno SL, Avula N, Reddy NV, Erickson SM, Fricton RD, Lee S, Griffiths G, Pullen MF, Thompson JL, Sherwood N, Murray TA, Rose MR, Boulware DR, Huling JD. Metformin reduces SARS-CoV-2 in a Phase 3 Randomized Placebo Controlled Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.06.23290989. [PMID: 37333243 PMCID: PMC10275003 DOI: 10.1101/2023.06.06.23290989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Current antiviral treatment options for SARS-CoV-2 infections are not available globally, cannot be used with many medications, and are limited to virus-specific targets.1-3 Biophysical modeling of SARS-CoV-2 replication predicted that protein translation is an especially attractive target for antiviral therapy.4 Literature review identified metformin, widely known as a treatment for diabetes, as a potential suppressor of protein translation via targeting of the host mTor pathway.5 In vitro, metformin has antiviral activity against RNA viruses including SARS-CoV-2.6,7 In the COVID-OUT phase 3, randomized, placebo-controlled trial of outpatient treatment of COVID-19, metformin had a 42% reduction in ER visits/hospitalizations/death through 14 days; a 58% reduction in hospitalizations/death through 28 days, and a 42% reduction in Long COVID through 10 months.8,9 Here we show viral load analysis of specimens collected in the COVID-OUT trial that the mean SARS-CoV-2 viral load was reduced 3.6-fold with metformin relative to placebo (-0.56 log10 copies/mL; 95%CI, -1.05 to -0.06, p=0.027) while there was no virologic effect for ivermectin or fluvoxamine vs placebo. The metformin effect was consistent across subgroups and with emerging data.10,11 Our results demonstrate, consistent with model predictions, that a safe, widely available,12 well-tolerated, and inexpensive oral medication, metformin, can be repurposed to significantly reduce SARS-CoV-2 viral load.
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Affiliation(s)
| | | | - Tanvi Mehta
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN
| | - David J Odde
- Department of Biomedical Engineering University of Minnesota, Minneapolis, MN
| | | | - John B Buse
- Endocrinology, University of North Carolina, Chapel Hill, NC
| | | | - Ray H B Watson
- Genomics Center, University of Minnesota, Minneapolis, MN
| | - Jerry J Daniel
- Genomics Center, University of Minnesota, Minneapolis, MN
| | | | | | | | | | - Hrishikesh K Belani
- Department of Medicine, Olive View - University of California, Los Angeles, CA
| | - Lianne K Siegel
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Nichole R Klatt
- Department of Surgery, Medical School, University of Minnesota, Minneapolis, MN
| | - Blake Anderson
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Via Rao
- General Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Aubrey A Hagen
- General Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Barkha Patel
- General Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Sarah L Fenno
- General Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Nandini Avula
- General Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Neha V Reddy
- General Internal Medicine, University of Minnesota, Minneapolis, MN
| | | | | | - Samuel Lee
- General Internal Medicine, Northwestern University, Chicago, IL
| | | | - Matthew F Pullen
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN
| | - Jennifer L Thompson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Nancy Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Thomas A Murray
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michael R Rose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN
| | - Jared D Huling
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
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89
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Scheim DE, Aldous C, Osimani B, Fordham EJ, Hoy WE. When Characteristics of Clinical Trials Require Per-Protocol as Well as Intention-to-Treat Outcomes to Draw Reliable Conclusions: Three Examples. J Clin Med 2023; 12:jcm12113625. [PMID: 37297820 DOI: 10.3390/jcm12113625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Under exceptional circumstances, including high rates of protocol non-compliance, per-protocol (PP) analysis can better indicate the real-world benefits of a medical intervention than intention-to-treat (ITT) analysis. Exemplifying this, the first randomized clinical trial (RCT) considered found that colonoscopy screenings were marginally beneficial, based upon ITT analysis, with only 42% of the intervention group actually undergoing the procedure. However, the study authors themselves concluded that the medical efficacy of that screening was a 50% reduction in colorectal cancer deaths among that 42% PP group. The second RCT found a ten-fold reduction in mortality for a COVID-19 treatment drug vs. placebo by PP analysis, but only a minor benefit by ITT analysis. The third RCT, conducted as an arm of the same platform trial as the second RCT, tested another COVID-19 treatment drug and reported no significant benefit by ITT analysis. Inconsistencies and irregularities in the reporting of protocol compliance for this study required consideration of PP outcomes for deaths and hospitalizations, yet the study coauthors refused to disclose them, instead directing inquiring scientists to a data repository which never held the study's data. These three RCTs illustrate conditions under which PP outcomes may differ significantly from ITT outcomes and the need for data transparency when these reported or indicated discrepancies arise.
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Affiliation(s)
- David E Scheim
- US Public Health Service, Commissioned Corps, Inactive Reserve, Blacksburg, VA 24060, USA
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Barbara Osimani
- Center for Philosophy, Science, and Policy, Faculty of Medicine, Marche Polytechnic University, 60121 Ancona, Italy
| | | | - Wendy E Hoy
- Centre of Chronic Disease, Faculty of Medicine, University of Queensland, Brisbane 4072, Australia
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Yen FS, Wang SI, Lin SY, Cheng-Chung Wei J. Metformin use before COVID-19 vaccination and the risks of COVID-19 incidence, medical utilization, and all-cause mortality in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2023; 200:110692. [PMID: 37156428 PMCID: PMC10163786 DOI: 10.1016/j.diabres.2023.110692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
AIMS We designed this study to determine whether metformin use before COVID-19 vaccination influences the risk of COVID-19 infection, medical utilization, and mortality. METHODS We used the US collaborative network of TriNetX to identify 123,709 patients with type 2 diabetes mellitus fully vaccinated against COVID-19 between January 1, 2020, and November 22, 2022. The study selected 20,894 pairs of metformin users and nonusers by propensity score matching. The Kaplan-Meier method and Cox proportional hazards models were used to compare the risks of COVID-19 infection, medical utilization, and mortality between the study and control groups. RESULTS No significant difference was noted between metformin users and nonusers in the risk of COVID-19 incidence (aHR =1.02, 95% CI=0.94-1.10). Compared to the control cohort, the metformin cohort exhibited a significantly lower risk of hospitalization (aHR=0.85, 95% CI=0.81-0.89), critical care services (aHR=0.81, 95% CI=0.70-0.94), mechanical ventilation (aHR=0.75, 95% CI=0.60-0.95), and mortality (aHR=0.75, 95% CI=0.63-0.89). The subgroup analyses and sensitivity analysis showed similar results. CONCLUSION The present study showed that metformin use before COVID-19 vaccination could not reduce COVID-19 incidence; however, it was associated with significantly lower risks of hospitalization, intensive care service, mechanical ventilation, and mortality in fully vaccinated type 2 diabetes mellitus patients.
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Affiliation(s)
- Fu-Shun Yen
- Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan.
| | - Shiow-Ing Wang
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung 40201, Taiwan; Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung 40201, Taiwan.
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung 40705, Taiwan; Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Taipei 11221, Taiwan.
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung 40201, Taiwan; Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan.
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91
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Manu P. Therapeutic Messianism: Belladonna for Heroin Withdrawal, Ivermectin for COVID-19 Infection. Am J Ther 2023; 30:e257-e258. [PMID: 37278704 DOI: 10.1097/mjt.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Peter Manu
- Department of Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY and South Oaks Hospital, Amityville, NY
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92
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Trkulja V, Kodvanj I. Outpatients prescribed with fluvoxamine around the time of COVID-19 diagnosis are not at a reduced risk of subsequent hospitalization and death compared to their non-prescribed peers: population-based matched cohort study. Eur J Clin Pharmacol 2023; 79:643-655. [PMID: 36961578 PMCID: PMC10036980 DOI: 10.1007/s00228-023-03479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE To assess the effect of exposure to fluvoxamine around the COVID-19 diagnosis on subsequent hospitalizations and mortality in COVID-19 outpatients in a real-life setting. METHODS Using nationwide administrative data, we identified adult COVID-19 outpatients diagnosed up to August 15, 2021 and conducted two cohort studies. Study 1 included subjects prescribed fluvoxamine around the index COVID-19 diagnosis (Cohort A), their peers suffering similar psychiatric difficulties but not prescribed fluvoxamine (Cohort B) and those free of psychiatric difficulties/treatments (Cohort C). Study 2 included subjects prescribed fluvoxamine (Cohort Fluvoxamine) and their peers prescribed paroxetine (Cohort Paroxetine). Cohorts were mutually exactly matched and incidence of COVID-19-related hospitalization, 30-day all-cause hospitalization and of COVID-19-related mortality was estimated. RESULTS Of the 416,030 first-episode outpatients, Study 1 included 1016 Cohort A, 95,984 Cohort B and 275,804 Cohort C patients. Matched Cohort A (n = 749) vs. Cohort B (n = 31,336) relative risks (95%CI/CrI), frequentist and Bayes with skeptical, otpimistic and pesimistic priors, were COVID-related hospitalization 1.37 (0.56-3.33), 1.15 (0.55-2.11), 1.03 (0.56.1.96) and 1.43 (0.63-2.94), respectively; 30-day all-cause hospitalization 1.88 (0.76-4.67), 1.76 (1.39-2.25), 1.76 (1.39-2.24) and 1.86 (1.43-2.38), respectively; COVID-19-related mortality 0.73 (0.35-1.55), 0.93 (0.53-1.76), 0.79 (0.40-1.54) and 0.88 (0.37-2.11), respectively. Matched Cohort A vs. C (866 vs. 222,792) comparison yielded similar estimates, as did the matched Cohort Fluvoxamine vs. Paroxetine comparison in Study 2 (344 of 994 matched to 535 of 1796 patients). CONSLUSION Outpatients prescribed fluvoxamine around the time of COVID-19 diagnosis were not at a reduced risk of hospitalizations and mortality compared to their non-prescribed peers.
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Affiliation(s)
- Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Šalata 11, 10000, Zagreb, Croatia.
| | - Ivan Kodvanj
- Department of Pharmacology, Zagreb University School of Medicine, Šalata 11, 10000, Zagreb, Croatia
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93
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Toussi SS, Hammond JL, Gerstenberger BS, Anderson AS. Therapeutics for COVID-19. Nat Microbiol 2023; 8:771-786. [PMID: 37142688 DOI: 10.1038/s41564-023-01356-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 03/09/2023] [Indexed: 05/06/2023]
Abstract
Vaccines and monoclonal antibody treatments to prevent severe coronavirus disease 2019 (COVID-19) illness were available within a year of the pandemic being declared but there remained an urgent need for therapeutics to treat patients who were not vaccinated, were immunocompromised or whose vaccine immunity had waned. Initial results for investigational therapies were mixed. AT-527, a repurposed nucleoside inhibitor for hepatitis C virus, enabled viral load reduction in a hospitalized cohort but did not reduce viral load in outpatients. The nucleoside inhibitor molnupiravir prevented death but failed to prevent hospitalization. Nirmatrelvir, an inhibitor of the main protease (Mpro), co-dosed with the pharmacokinetic booster ritonavir, reduced hospitalization and death. Nirmatrelvir-ritonavir and molnupiravir received an Emergency Use Authorization in the United States at the end of 2021. Immunomodulatory drugs such as baricitinib, tocilizumab and corticosteroid, which target host-driven COVID-19 symptoms, are also in use. We highlight the development of COVID-19 therapies and the challenges that remain for anticoronavirals.
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94
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Reis G, Dos Santos Moreira Silva EA, Silva DCM, Thabane L, de Souza Campos VH, Ferreira TS, Quirino Dos Santos CV, Ribeiro Nogueira AM, Figueiredo Guimaraes Almeida AP, Cançado Monteiro Savassi L, de Figueiredo Neto AD, Bitarães C, Cruz Milagres A, Diniz Callegari E, Campos Simplicio MI, Barra Ribeiro L, Oliveira R, Harari O, Wilson LA, Forrest JI, Ruton H, Sprague S, McKay P, Guo CM, Guyatt GH, Rayner CR, Boulware DR, Ezer N, Lee TC, McDonald EG, Bafadhel M, Butler C, Silva JR, Dybul M, Mills EJ. Oral Fluvoxamine With Inhaled Budesonide for Treatment of Early-Onset COVID-19 : A Randomized Platform Trial. Ann Intern Med 2023; 176:667-675. [PMID: 37068273 PMCID: PMC10111398 DOI: 10.7326/m22-3305] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Previous trials have demonstrated the effects of fluvoxamine alone and inhaled budesonide alone for prevention of disease progression among outpatients with COVID-19. OBJECTIVE To determine whether the combination of fluvoxamine and inhaled budesonide would increase treatment effects in a highly vaccinated population. DESIGN Randomized, placebo-controlled, adaptive platform trial. (ClinicalTrials.gov: NCT04727424). SETTING 12 clinical sites in Brazil. PARTICIPANTS Symptomatic adults with confirmed SARS-CoV-2 infection and a known risk factor for progression to severe disease. INTERVENTION Patients were randomly assigned to either fluvoxamine (100 mg twice daily for 10 days) plus inhaled budesonide (800 mcg twice daily for 10 days) or matching placebos. MEASUREMENTS The primary outcome was a composite of emergency setting retention for COVID-19 for more than 6 hours, hospitalization, and/or suspected complications due to clinical progression of COVID-19 within 28 days of randomization. Secondary outcomes included health care attendance (defined as hospitalization for any cause or emergency department visit lasting >6 hours), time to hospitalization, mortality, patient-reported outcomes, and adverse drug reactions. RESULTS Randomization occurred from 15 January to 6 July 2022. A total of 738 participants were allocated to oral fluvoxamine plus inhaled budesonide, and 738 received placebo. The proportion of patients observed in an emergency setting for COVID-19 for more than 6 hours or hospitalized due to COVID-19 was lower in the treatment group than the placebo group (1.8% [95% credible interval {CrI}, 1.1% to 3.0%] vs. 3.7% [95% CrI, 2.5% to 5.3%]; relative risk, 0.50 [95% CrI, 0.25 to 0.92]), with a probability of superiority of 98.7%. No relative effects were found between groups for any of the secondary outcomes. More adverse events occurred in the intervention group than the placebo group, but no important differences between the groups were detected. LIMITATION Low event rate overall, consistent with contemporary trials in vaccinated populations. CONCLUSION Treatment with oral fluvoxamine plus inhaled budesonide among high-risk outpatients with early COVID-19 reduced the incidence of severe disease requiring advanced care. PRIMARY FUNDING SOURCE Latona Foundation, FastGrants, and Rainwater Charitable Foundation.
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Affiliation(s)
- Gilmar Reis
- ViRx@Stanford, Stanford Biosecurity and Pandemic Preparedness Initiative, Stanford, California; Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil; Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Minas Gerais, Brazil; and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (G.R.)
| | - Eduardo Augusto Dos Santos Moreira Silva
- Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil, and Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Minas Gerais, Brazil (E.A.d.S.M.S., D.C.M.S., V.H.d.S.C., C.V.Q.d.S.)
| | - Daniela Carla Medeiros Silva
- Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil, and Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Minas Gerais, Brazil (E.A.d.S.M.S., D.C.M.S., V.H.d.S.C., C.V.Q.d.S.)
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (L.T., S.S., P.M., G.H.G.)
| | - Vitoria Helena de Souza Campos
- Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil, and Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Minas Gerais, Brazil (E.A.d.S.M.S., D.C.M.S., V.H.d.S.C., C.V.Q.d.S.)
| | - Thiago Santiago Ferreira
- Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil (T.S.F., M.I.C.S., L.B.R., R.O.)
| | - Castilho Vitor Quirino Dos Santos
- Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil, and Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Minas Gerais, Brazil (E.A.d.S.M.S., D.C.M.S., V.H.d.S.C., C.V.Q.d.S.)
| | | | | | | | | | - Carina Bitarães
- Public Health, Mental and Family Medicine Department, Ouro Preto Federal University, Minas Gerais, Brazil, and Public Health Care Division, City of Ibirité, Brazil (C.B., A.C.M.)
| | - Aline Cruz Milagres
- Public Health, Mental and Family Medicine Department, Ouro Preto Federal University, Minas Gerais, Brazil, and Public Health Care Division, City of Ibirité, Brazil (C.B., A.C.M.)
| | - Eduardo Diniz Callegari
- Department of Public Health at UNIFIPMoc and Family Medicine Fellowship Program, City of Montes Claros, Brazil, and Public Health Care Division, City of Brumadinho, Brazil (E.D.C.)
| | - Maria Izabel Campos Simplicio
- Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil (T.S.F., M.I.C.S., L.B.R., R.O.)
| | - Luciene Barra Ribeiro
- Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil (T.S.F., M.I.C.S., L.B.R., R.O.)
| | - Rosemary Oliveira
- Research Division, Cardresearch - Cardiologia Assistencial e de Pesquisa, Belo Horizonte, Brazil (T.S.F., M.I.C.S., L.B.R., R.O.)
| | - Ofir Harari
- Cytel, Vancouver, British Columbia, Canada (O.H., H.R.)
| | - Lindsay A Wilson
- Platform Life Sciences, Vancouver, British Columbia, Canada (L.A.W., J.I.F., C.M.G., J.R.S.)
| | - Jamie I Forrest
- Platform Life Sciences, Vancouver, British Columbia, Canada (L.A.W., J.I.F., C.M.G., J.R.S.)
| | - Hinda Ruton
- Cytel, Vancouver, British Columbia, Canada (O.H., H.R.)
| | - Sheila Sprague
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (L.T., S.S., P.M., G.H.G.)
| | - Paula McKay
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (L.T., S.S., P.M., G.H.G.)
| | - Christina M Guo
- Platform Life Sciences, Vancouver, British Columbia, Canada (L.A.W., J.I.F., C.M.G., J.R.S.)
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (L.T., S.S., P.M., G.H.G.)
| | - Craig R Rayner
- Certara, Princeton, New Jersey, and Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia (C.R.R.)
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota (D.R.B.)
| | - Nicole Ezer
- Department of Medicine, Division of Respiratory Medicine, McGill University Health Centre, Montréal, Québec, Canada (N.E.)
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada (T.C.L.)
| | - Emily Gibson McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada (E.G.M.)
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom (M.B.)
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (C.B.)
| | - Josue Rodrigues Silva
- Platform Life Sciences, Vancouver, British Columbia, Canada (L.A.W., J.I.F., C.M.G., J.R.S.)
| | - Mark Dybul
- Global Health Institute, Georgetown University, Washington, DC (M.D.)
| | - Edward J Mills
- ViRx@Stanford, Stanford Biosecurity and Pandemic Preparedness Initiative, Stanford, California; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Cytel, Vancouver, British Columbia, Canada; and Platform Life Sciences, Vancouver, British Columbia, Canada (E.J.M.)
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95
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Nagendra L, Bhattacharya S, Kalra S, Kapoor N. Metformin in COVID-19: Is There a Role Beyond Glycemic Control? Int J Endocrinol Metab 2023; 21:e132965. [PMID: 37654526 PMCID: PMC10467582 DOI: 10.5812/ijem-132965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/26/2023] [Accepted: 04/15/2023] [Indexed: 09/02/2023] Open
Abstract
Context The coronavirus disease 2019 (COVID-19) pandemic is still a cause of worldwide health concern. Diabetes and its associated comorbidities are risk factors for mortality and morbidity in COVID-19. Selecting the right antidiabetic drug to achieve optimal glycemic control might mitigate some of the negative impacts of diabetes. Metformin continues to be the most widely administered antidiabetic agent. There is evidence of its beneficial outcome in COVID-19 independent of its glucose-lowering effect. Evidence Acquisition A thorough literature search was conducted in PubMed, Google Scholar, Scopus, and Web of Science to identify studies investigating metformin in COVID-19. Results Several overlapping mechanisms have been proposed to explain its antiviral properties. It could bring about conformational changes in the angiotensin-converting enzyme-2 receptor and decrease viral entry. The effects on the mammalian target of the rapamycin pathway and cellular pH have been proposed to reduce viral protein synthesis and replication. The immunomodulatory effects of metformin might counter the detrimental effects of hyperinflammation associated with COVID-19. Conclusions These findings call for broader metformin usage to manage hyperglycemia in COVID-19.
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Affiliation(s)
- Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research (JSS AHER), Mysore, Karnataka, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
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96
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Deng J, Affan E, Garcia C, Heybati K, Zhou F. Efficacy and safety of selective serotonin reuptake inhibitors in COVID-19 management – Author's reply. Clin Microbiol Infect 2023:S1198-743X(23)00147-7. [PMID: 37011810 PMCID: PMC10066581 DOI: 10.1016/j.cmi.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
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97
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Sandhu HS, Lambert J, Steckler Z, Park L, Stromberg A, Ramirez J, Yang CFJ. Outpatient medications associated with protection from COVID-19 hospitalization. PLoS One 2023; 18:e0282961. [PMID: 37000808 PMCID: PMC10065249 DOI: 10.1371/journal.pone.0282961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/28/2023] [Indexed: 04/01/2023] Open
Abstract
The COVID-19 pandemic remains the pre-eminent global health problem, and yet after more than three years there is still no prophylactic agent against the disease aside from vaccines. The objective of this study was to evaluate whether pre-existing, outpatient medications approved by the US Food and Drug Administration (FDA) reduce the risk of hospitalization due to COVID-19. This was a retrospective cohort study of patients from across the United States infected with COVID-19 in the year 2020. The main outcome was adjusted odds of hospitalization for COVID-19 amongst those positive for the infection. Outcomes were adjusted for known risk factors for severe disease. 3,974,272 patients aged 18 or older with a diagnosis of COVID-19 in 2020 met our inclusion criteria and were included in the analysis. Mean age was 50.7 (SD 18). Of this group, 290,348 patients (7.3%) were hospitalized due to COVID-19, similar to the CDC's reported estimate (7.5%). Four drugs showed protective effects against COVID-19 hospitalization: rosuvastatin (aOR 0.91, p = 0.00000024), empagliflozin-metformin (aOR 0.69, p = 0.003), metformin (aOR 0.97, p = 0.017), and enoxaparin (aOR 0.88, p = 0.0048). Several pre-existing medications for outpatient use may reduce severity of disease and protect against COVID-19 hospitalization. Well-designed clinical trials are needed to assess the efficacy of these agents in a therapeutic or prophylactic setting.
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Affiliation(s)
- Harpal Singh Sandhu
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, KY, United States of America
| | - Joshua Lambert
- University of Cincinnati College of Nursing, Cincinnati, OH, United States of America
| | - Zach Steckler
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY, United States of America
| | - Lee Park
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY, United States of America
| | - Arnold Stromberg
- Norton Infectious Diseases Institute, Norton Hospital, Louisville, KY, United States of America
| | - Julio Ramirez
- Norton Infectious Diseases Institute, Norton Hospital, Louisville, KY, United States of America
| | - Chi-fu Jeffrey Yang
- Department of Surgery, Harvard Medical School, Boston, MA, United States of America
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98
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Hashimoto K. Overview of the potential use of fluvoxamine for COVID-19 and long COVID. DISCOVER MENTAL HEALTH 2023; 3:9. [PMID: 36968793 PMCID: PMC10029802 DOI: 10.1007/s44192-023-00036-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/02/2023] [Indexed: 03/24/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has presented a serious worldwide threat to public health since its emergence in late 2019. From a safety point of view, drug repurposing has received particular attention. Several clinical studies have demonstrated that the use of fluvoxamine, a selective serotonin reuptake inhibitor with potent sigma-1 receptor agonism, in the early-stage of infection might be associated with the prevention of clinical deterioration in individuals with SARS-CoV-2 infection, although several reports have shown that a low dose of fluvoxamine may be ineffective. There is increasing evidence that SARS-CoV-2 can cross the blood-brain barrier, resulting in a number of psychiatric and neurologic symptoms in COVID-19 survivors. Importantly, about half of COVID-19 survivors experience a variety of long-term sequelae, including psychiatric and neurologic symptoms, known as long COVID. In this priority review, the author presents an overview of the potential use of fluvoxamine in the treatment of COVID-19 and long COVID.
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Affiliation(s)
- Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chiba, 260-8670 Japan
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99
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Bibbins-Domingo K, Malani PN. At a Higher Dose and Longer Duration, Ivermectin Still Not Effective Against COVID-19. JAMA 2023; 329:897-898. [PMID: 36805613 DOI: 10.1001/jama.2023.1922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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100
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Naggie S, Boulware DR, Lindsell CJ, Stewart TG, Slandzicki AJ, Lim SC, Cohen J, Kavtaradze D, Amon AP, Gabriel A, Gentile N, Felker GM, Jayaweera D, McCarthy MW, Sulkowski M, Rothman RL, Wilson S, DeLong A, Remaly A, Wilder R, Collins S, Dunsmore SE, Adam SJ, Thicklin F, Hanna GJ, Ginde AA, Castro M, McTigue K, Shenkman E, Hernandez AF. Effect of Higher-Dose Ivermectin for 6 Days vs Placebo on Time to Sustained Recovery in Outpatients With COVID-19: A Randomized Clinical Trial. JAMA 2023; 329:888-897. [PMID: 36807465 PMCID: PMC9941969 DOI: 10.1001/jama.2023.1650] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
Importance It is unknown whether ivermectin, with a maximum targeted dose of 600 μg/kg, shortens symptom duration or prevents hospitalization among outpatients with mild to moderate COVID-19. Objective To evaluate the effectiveness of ivermectin at a maximum targeted dose of 600 μg/kg daily for 6 days, compared with placebo, for the treatment of early mild to moderate COVID-19. Design, Setting, and Participants The ongoing Accelerating COVID-19 Therapeutic Interventions and Vaccines 6 (ACTIV-6) platform randomized clinical trial was designed to evaluate repurposed therapies among outpatients with mild to moderate COVID-19. A total of 1206 participants older than 30 years with confirmed COVID-19 experiencing at least 2 symptoms of acute infection for less than or equal to 7 days were enrolled at 93 sites in the US from February 16, 2022, through July 22, 2022, with follow-up data through November 10, 2022. Interventions Participants were randomly assigned to receive ivermectin, with a maximum targeted dose of 600 μg/kg (n = 602) daily, or placebo (n = 604) for 6 days. Main Outcomes and Measures The primary outcome was time to sustained recovery, defined as at least 3 consecutive days without symptoms. The 7 secondary outcomes included a composite of hospitalization, death, or urgent/emergent care utilization by day 28. Results Among 1206 randomized participants who received study medication or placebo, the median (IQR) age was 48 (38-58) years, 713 (59.1%) were women, and 1008 (83.5%) reported receiving at least 2 SARS-CoV-2 vaccine doses. The median (IQR) time to sustained recovery was 11 (11-12) days in the ivermectin group and 11 (11-12) days in the placebo group. The hazard ratio (posterior probability of benefit) for improvement in time to recovery was 1.02 (95% credible interval, 0.92-1.13; P = .68). Among those receiving ivermectin, 34 (5.7%) were hospitalized, died, or had urgent or emergency care visits compared with 36 (6.0%) receiving placebo (hazard ratio, 1.0 [95% credible interval, 0.6-1.5]; P = .53). In the ivermectin group, 1 participant died and 4 were hospitalized (0.8%); 2 participants (0.3%) were hospitalized in the placebo group and there were no deaths. Adverse events were uncommon in both groups. Conclusions and Relevance Among outpatients with mild to moderate COVID-19, treatment with ivermectin, with a maximum targeted dose of 600 μg/kg daily for 6 days, compared with placebo did not improve time to sustained recovery. These findings do not support the use of ivermectin in patients with mild to moderate COVID-19. Trial Registration ClinicalTrials.gov Identifier: NCT04885530.
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Affiliation(s)
- Susanna Naggie
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - David R. Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis
| | | | | | | | - Stephen C. Lim
- University Medical Center New Orleans, Louisiana State University Health Sciences Center, New Orleans
| | - Jonathan Cohen
- Jadestone Clinical Research, LLC, Silver Spring, Maryland
| | | | - Arch P. Amon
- Lakeland Regional Medical Center, Lakeland, Florida
| | - Ahab Gabriel
- Focus Clinical Research Solutions, Charlotte, North Carolina
| | - Nina Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - G. Michael Felker
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Dushyantha Jayaweera
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Mark Sulkowski
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | | | - Sybil Wilson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Allison DeLong
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - April Remaly
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Rhonda Wilder
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Sean Collins
- Vanderbilt University Medical Center, Nashville, Tennessee
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville
| | - Sarah E. Dunsmore
- National Center for Advancing Translational Sciences, Bethesda, Maryland
| | - Stacey J. Adam
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | | | - George J. Hanna
- Biomedical Advanced Research and Development Authority, Washington, DC
| | | | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Missouri-Kansas City School of Medicine, Kansas City
| | - Kathleen McTigue
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elizabeth Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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