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Yang F, Wang G, Han D. Inhaled corticosteroids on mortality in COVID-19: A systematic review and meta-analysis of randomized controlled trials. J Investig Med 2024; 72:567-573. [PMID: 38747526 DOI: 10.1177/10815589241249997] [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: 07/26/2024]
Abstract
This systematic review and meta-analysis aimed to determine the efficacy of inhaled corticosteroids (ICS) on mortality in patients with coronavirus disease-2019 (COVID-19). A systematic search was made of PubMed, Embase, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials (RCTs) on the treatment of COVID-19 with ICS were reviewed. Studies were pooled to risk ratios (RRs), with 95% confidence intervals (CIs). Eleven RCTs (enrolling 5832 participants) met the inclusion criteria. There was no statistically significant difference in COVID-19-related death (RR 0.88, 95% CI 0.38-2.04), all-cause death (RR 1.05, 95% CI 0.49-2.23), and invasive ventilation (RR 1.26, 95% CI 0.60-2.62) between the two groups. ICS was not associated with reduced mortality and invasive ventilation in patients with COVID-19.
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Affiliation(s)
- Fen Yang
- Intensive Care Unit, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Guizuo Wang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Dong Han
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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2
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Pei Z, Dong M, Meng X, Yao W, Guo Y, Wang F. Effects of Nicotinamide Adenine Dinucleotide on Older Patients with Heart Failure. Rev Cardiovasc Med 2024; 25:297. [PMID: 39228487 PMCID: PMC11366984 DOI: 10.31083/j.rcm2508297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 09/05/2024] Open
Abstract
Background Heart failure (HF) is the main cause of death in middle-aged and older people and is characterized by high morbidity, high mortality, a high rehospitalization rate, and many high-risk groups. Nicotinamide adenine dinucleotide (NAD+) is widely present in the mitochondria of cardiomyocytes and maintains the redox balance in the body, which can effectively treat HF. We sought to evaluate whether NAD+ therapy has some clinical efficacy in patients with HF. Methods Based on using conventional drugs to treat HF, patients (n = 60) were randomized 1:1 to saline and 50 mg NAD+ with 50 mL of normal saline for 7 days. The baseline characteristics of patients before and after treatment and cardiac function (N-terminal pro B-type natriuretic peptide (NT-proBNP) level and left ventricular ejection fraction (LVEF) value) were analyzed. Serological analysis (sirtuin-1 (SIRT1), sirtuin-3 (SIRT3), sirtuin-6 (SIRT6), reactive oxygen species (ROS), and endothelin) was also performed. Results Among the 60 patients with HF who were treated with NAD+ for 7 days, the improvement rate in NT-proBNP levels and LVEF values was better than in the saline group, although not statistically significant. These patients were more likely to benefit from NAD+ because of higher levels of anti-oxidative stress (SIRT1, SIRT3, SIRT6, and ROS) and anti-endothelial injury (endothelin) than those in the saline control group. Conclusions According to the results of this study, it is believed that 7 days of NAD+ injections has a positive effect on improving cardiac function, oxidative stress, and endothelial injury in patients with HF compared with the saline control. Clinical Trial Registration Chinese Clinical Trial Registry (http://www.chictr.org.cn/) ChiCTR2300074326; retrospectively registered on 3 August 2023.
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Affiliation(s)
- Zuowei Pei
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
- Department of Cardiology, Central Hospital of Dalian University of
Technology, 116033 Dalian, Liaoning, China
| | - Min Dong
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
| | - Xuyang Meng
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
| | - Wei Yao
- Department of Internal Medicine, Affiliated Zhong Shan Hospital of Dalian
University, 116001 Dalian, Liaoning, China
| | - Ying Guo
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
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Mańdziuk J, Kuchar E, Okarska-Napierała M. How international guidelines recommend treating children who have severe COVID-19 or risk disease progression. Acta Paediatr 2024. [PMID: 38984679 DOI: 10.1111/apa.17354] [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: 12/29/2023] [Revised: 06/09/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
AIM This study reviewed the current knowledge and guidelines on managing COVID-19 in children and proposed a practical approach to drug treatment. METHODS We analysed international guidelines from four prominent scientific bodies on treating COVID-19 in children. These were the UK National Institute for Health and Care Excellence, the American National Institutes of Health, the Infectious Diseases Society of America and the Australian National Clinical Evidence Taskforce COVID-19. RESULTS Most paediatric patients with COVID-19 only require symptomatic treatment. There was limited evidence on treatment recommendations for children with severe COVID-19 or at risk of disease progression. However, several drugs are available for children and we have summarised the guidelines, in order to provide a concise, practical format for clinicians. All the guidelines agree that nirmatrelvir plus ritonavir or remdesivir can be used as prophylaxis for severe COVID-19 in high-risk patients. Remdesivir can also be used for severe COVID-19 cases. Glucocorticosteroids are recommended, particularly in patients requiring oxygen therapy. Tocilizumab or baricitinib should be reserved for patients with progressive disease and/or signs of systemic inflammation. CONCLUSION The guidelines provide useful advice and a degree of consensus on specific drug treatment for children with severe COVID-19 or at risk of progression.
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Affiliation(s)
- Joanna Mańdziuk
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
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Bhimraj A, Morgan RL, Shumaker AH, Baden L, Cheng VCC, Edwards KM, Gallagher JC, Gandhi RT, Muller WJ, Nakamura MM, O’Horo JC, Shafer RW, Shoham S, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (September 2022). Clin Infect Dis 2024; 78:e250-e349. [PMID: 36063397 PMCID: PMC9494372 DOI: 10.1093/cid/ciac724] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023] Open
Abstract
There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19), with rapidly changing efficacy and safety evidence from trials. The objective was to develop evidence-based, rapid, living guidelines intended to support patients, clinicians, and other healthcare professionals in their decisions about treatment and management of patients with COVID-19. In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise to regularly review the evidence and make recommendations about the treatment and management of persons with COVID-19. The process used a living guideline approach and followed a rapid recommendation development checklist. The panel prioritized questions and outcomes. A systematic review of the peer-reviewed and grey literature was conducted at regular intervals. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Based on the most recent search conducted on 31 May 2022, the IDSA guideline panel has made 32 recommendations for the treatment and management of the following groups/populations: pre- and postexposure prophylaxis, ambulatory with mild-to-moderate disease, and hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at: https://idsociety.org/COVID19guidelines. At the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials. Since then, many trials were conducted that provided much-needed evidence for COVID-19 therapies. There still remain many unanswered questions as the pandemic evolved, which we hope future trials can answer.
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Affiliation(s)
- Adarsh Bhimraj
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Amy Hirsch Shumaker
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | | | - Vincent Chi Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center,Nashville, Tennessee
| | - Jason C Gallagher
- Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania
| | - Rajesh T Gandhi
- Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - William J Muller
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, Chicago, Illinois
| | - Mari M Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John C O’Horo
- Division of Infectious Diseases, Joint Appointment Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert W Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
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Lu CL, Yang LQ, Jin XY, Friedemann T, Li YF, Liu XH, Chen XY, Zou XY, Zhang BR, Wang FX, Lin YL, Tang YM, Cao ML, Jiang YL, Gao YF, Liu K, Tao ZG, Robinson N, Schröder S, Liu JP, Lu HZ. Chinese herbal medicine Shufeng Jiedu capsule for mild to moderate COVID-19: a multicenter, randomized, double-blind, placebo-controlled phase II trial. Front Pharmacol 2024; 15:1383831. [PMID: 38863976 PMCID: PMC11165997 DOI: 10.3389/fphar.2024.1383831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/23/2024] [Indexed: 06/13/2024] Open
Abstract
Background: The COVID-19 pandemic has had a profound global impact, although the majority of recently infected cases have presented with mild to moderate symptoms. Previous clinical studies have demonstrated that Shufeng Jiedu (SFJD) capsule, a Chinese herbal patent medicine, effectively alleviates symptoms associated with the common cold, H1N1 influenza, and COVID-19. This study aimed to assess the efficacy and safety of SFJD capsules in managing symptoms of mild to moderate COVID-19 infection. Methods: A randomized, double-blind, placebo-controlled trial was conducted from May to December 2022 at two hospitals in China. Mild and moderate COVID-19-infected patients presenting respiratory symptoms within 3 days from onset were randomly assigned to either the SFJD or placebo groups in a 1:1 ratio. Individuals received SFJD capsules or a placebo three times daily for five consecutive days. Participants were followed up for more than 14 days after their RT-PCR nucleoid acid test for SARS-CoV-2 turned negative. The primary outcome measure was time to alleviate COVID-19 symptoms from baseline until the end of follow-up. Results: A total of 478 participants were screened; ultimately, 407 completed the trial after randomization (SFJD, n = 203; placebo, n = 204). No statistically significant difference in baseline parameters was observed between the two groups. The median time to alleviate all symptoms was 7 days in the SFJD group compared to 8 days in the placebo group (p = 0.037). Notably, the SFJD group significantly attenuated fever/chills (p = 0.04) and headache (p = 0.016) compared to the placebo group. Furthermore, the median time taken to reach normal body temperature within 24 h was reduced by 7 hours in the SFJD group compared to the placebo group (p = 0.033). No deaths or instances of serious or critical conditions occurred during this trial period; moreover, no serious adverse events were reported. Conclusion: The trial was conducted in a unique controlled hospital setting, and the 5-day treatment with SFJD capsules resulted in a 1-day reduction in overall symptoms, particularly headache and fever/chills, among COVID-19-infected participants with mild or moderate symptoms. Compared to placebo, SFJD capsules were found to be safe with fewer side effects. SFJD capsules could potentially serve as an effective treatment for alleviating mild to moderate symptoms of COVID-19. Clinical Trial Registration: https://www.isrctn.com/, identifier ISRCTN14236594.
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Affiliation(s)
- Chun-li Lu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Liu-qing Yang
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | - Xin-yan Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Thomas Friedemann
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center, Hamburg, Germany
| | - Yu-fei Li
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-han Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-ying Chen
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiang-yun Zou
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Bing-rui Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fu-xiang Wang
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | - Yuan-long Lin
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | - Yi-min Tang
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | - Meng-li Cao
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | | | | | - Kui Liu
- The People’s Hospital of Bozhou, Bozhou, China
| | - Zhen-gang Tao
- Zhongshan Hospital Affiliated of Fudan University, Shanghai, China
| | - Nicola Robinson
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Health and Social Care, London South Bank University, London, United Kingdom
| | - Sven Schröder
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center, Hamburg, Germany
| | - Jian-ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-zhou Lu
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
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Ghasemiyeh P, Mohammadi-Samani S. Lessons we learned during the past four challenging years in the COVID-19 era: pharmacotherapy, long COVID complications, and vaccine development. Virol J 2024; 21:98. [PMID: 38671455 PMCID: PMC11055380 DOI: 10.1186/s12985-024-02370-6] [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: 01/30/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
About four years have passed since the detection of the first cases of COVID-19 in China. During this lethal pandemic, millions of people have lost their lives around the world. Since the first waves of COVID-19 infection, various pharmacotherapeutic agents have been examined in the management of COVID-19. Despite all these efforts in pharmacotherapy, drug repurposing, and design and development of new drugs, multiple organ involvement and various complications occurred during COVID-19. Some of these complications became chronic and long-lasting which led to the "long COVID" syndrome appearance. Therefore, the best way to eradicate this pandemic is prophylaxis through mass vaccination. In this regard, various vaccine platforms including inactivated vaccines, nucleic acid-based vaccines (mRNA and DNA vaccines), adenovirus-vectored vaccines, and protein-based subunit vaccines have been designed and developed to prevent or reduce COVID-19 infection, hospitalization, and mortality rates. In this focused review, at first, the most commonly reported clinical presentations of COVID-19 during these four years have been summarized. In addition, different therapeutic regimens and their latest status in COVID-19 management have been listed. Furthermore, the "long COVID" and related signs, symptoms, and complications have been mentioned. At the end, the effectiveness of available COVID-19 vaccines with different platforms against early SARS-CoV-2 variants and currently circulating variants of interest (VOI) and the necessity of booster vaccine shots have been summarized and discussed in more detail.
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Affiliation(s)
- Parisa Ghasemiyeh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soliman Mohammadi-Samani
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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Xie X, Zhang X, Li S, Du W. Involvement of Fgf2-mediated tau protein phosphorylation in cognitive deficits induced by sevoflurane in aged rats. Mol Med 2024; 30:39. [PMID: 38493090 PMCID: PMC10943822 DOI: 10.1186/s10020-024-00784-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/11/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE Anesthetics have been linked to cognitive alterations, particularly in the elderly. The current research delineates how Fibroblast Growth Factor 2 (Fgf2) modulates tau protein phosphorylation, contributing to cognitive impairments in aged rats upon sevoflurane administration. METHODS Rats aged 3, 12, and 18 months were subjected to a 2.5% sevoflurane exposure to form a neurotoxicity model. Cognitive performance was gauged, and the GEO database was employed to identify differentially expressed genes (DEGs) in the 18-month-old cohort post sevoflurane exposure. Bioinformatics tools, inclusive of STRING and GeneCards, facilitated detailed analysis. Experimental validations, both in vivo and in vitro, examined Fgf2's effect on tau phosphorylation. RESULTS Sevoflurane notably altered cognitive behavior in older rats. Out of 128 DEGs discerned, Fgf2 stood out as instrumental in regulating tau protein phosphorylation. Sevoflurane exposure spiked Fgf2 expression in cortical neurons, intensifying tau phosphorylation via the PI3K/AKT/Gsk3b trajectory. Diminishing Fgf2 expression correspondingly curtailed tau phosphorylation, neurofibrillary tangles, and enhanced cognitive capacities in aged rats. CONCLUSION Sevoflurane elicits a surge in Fgf2 expression in aging rats, directing tau protein phosphorylation through the PI3K/AKT/Gsk3b route, instigating cognitive aberrations.
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Affiliation(s)
- Xin Xie
- Department of Anesthesiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44, Xiaoheyan Road, Dandong District, Liaoning Province, Shenyang, 110042, P. R. China
| | - Xiaomin Zhang
- Department of Anesthesiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44, Xiaoheyan Road, Dandong District, Liaoning Province, Shenyang, 110042, P. R. China
| | - Songze Li
- Department of Anesthesiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44, Xiaoheyan Road, Dandong District, Liaoning Province, Shenyang, 110042, P. R. China
| | - Wei Du
- Department of Anesthesiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44, Xiaoheyan Road, Dandong District, Liaoning Province, Shenyang, 110042, P. R. China.
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Aribindi K, Lim M, Lakshminrusimha S, Albertson T. Investigational pharmacological agents for the treatment of ARDS. Expert Opin Investig Drugs 2024; 33:243-277. [PMID: 38316432 DOI: 10.1080/13543784.2024.2315128] [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: 10/31/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Acute Respiratory Distress Syndrome (ARDS) is a heterogeneous form of lung injury with severe hypoxemia and bilateral infiltrates after an inciting event that results in diffuse lung inflammation with a high mortality rate. While research in COVID-related ARDS has resulted in several pharmacotherapeutic agents that have undergone successful investigation, non-COVID ARDS studies have not resulted in many widely accepted pharmacotherapeutic agents despite exhaustive research. AREAS COVERED The aim of this review is to discuss adjuvant pharmacotherapies targeting non-COVID Acute Lung Injury (ALI)/ARDS and novel therapeutics in COVID associated ALI/ARDS. In ARDS, variable data may support selective use of neuromuscular blocking agents, corticosteroids and neutrophil elastase inhibitors, but are not yet universally used. COVID-ALI/ARDS has data supporting the use of IL-6 monoclonal antibodies, corticosteroids, and JAK inhibitor therapy. EXPERT OPINION Although ALI/ARDS modifying pharmacological agents have been identified in COVID-related disease, the data in non-COVID ALI/ARDS has been less compelling. The increased use of more specific molecular phenotyping based on physiologic parameters and biomarkers, will ensure equipoise between groups, and will likely allow more precision in confirming pharmacological agent efficacy in future studies.
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Affiliation(s)
- Katyayini Aribindi
- Department of Internal Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, U.C. Davis School of Medicine, Sacramento, CA, USA
- Department of Medicine, Veterans Affairs North California Health Care System, Mather, CA, USA
| | - Michelle Lim
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, U.C. Davis School of Medicine, Sacramento, CA, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, U.C. Davis School of Medicine, Sacramento, CA, USA
| | - Timothy Albertson
- Department of Internal Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, U.C. Davis School of Medicine, Sacramento, CA, USA
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Edwards KM. The Therapy of SARS-CoV-2 Infection in Children. J Clin Med 2023; 13:120. [PMID: 38202127 PMCID: PMC10779459 DOI: 10.3390/jcm13010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
The impact of SARS-CoV-2 infections in children has fortunately been lower than what has been seen in adults. However, even previously healthy children have developed severe disease, sometimes with subsequent mortality, and those who are infants or adolescents, are from racial and ethnic minority groups, or have certain chronic conditions are at higher risk of these outcomes. During the pandemic, extensive studies of therapeutic agents, including antivirals and immunomodulators, were conducted in adults. Few trials included children, and most were in older children and adolescents. Thus, the potential benefits of therapies in children must be extrapolated from adult evidence. Despite these limitations, advisory committees of the National Institute of Health (NIH), the Infectious Disease Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) were constituted, and expert consensus guidelines were developed. This review provides a synthesis of those comprehensive recommendations for therapy in children. These address treatment during the early infectious period with antiviral agents, including remdesivir and nirmatrelvir/ritonavir, as well as treatment in the later period of immune dysregulation with corticosteroids and immunomodulators. In addition, the therapeutic approach for multisystem inflammatory syndrome in children (MIS-C), also referred to as Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is also provided.
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Affiliation(s)
- Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Mettananda C, Peiris C, Abeyrathna D, Gunasekara A, Egodage T, Dantanarayana C, Pathmeswaran A, Ranasinha C. Inhaled beclomethasone in the treatment of early COVID-19: a double-blind, placebo-controlled, randomised, hospital-based trial in Sri Lanka. BMJ Open 2023; 13:e075803. [PMID: 38101843 PMCID: PMC10729268 DOI: 10.1136/bmjopen-2023-075803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES To study if early initiation of inhaled beclomethasone 1200 mcg in patients with asymptomatic, mild or moderate COVID-19 reduces disease progression to severe COVID-19. DESIGN Double-blinded, parallel-groups, randomised, placebo-controlled trial. SETTING A hospital-based study in Sri Lanka. PARTICIPANTS Adults with asymptomatic, mild or moderate COVID-19, presenting within the first 7 days of symptom onset or laboratory diagnosis of COVID-19, admitted to a COVID-19 intermediate treatment centre in Sri Lanka between July and November 2021. INTERVENTIONS All participants received inhaled beclomethasone 600 mcg or placebo two times per day, for 10 days from onset of symptoms/COVID-19 test becoming positive if asymptomatic or until reaching primary endpoint, whichever is earlier. PRIMARY OUTCOME MEASURE Progression of asymptomatic, mild or moderate COVID-19 to severe COVID-19. SECONDARY OUTCOME MEASURES The number of days with a temperature of 38°C or more and the time to self-reported clinical recovery. RESULTS A total of 385 participants were randomised to receive beclomethasone(n=193) or placebo(n=192) stratified by age (≤60 or >60 years) and sex. One participant from each arm withdrew from the study. All participants were included in final analysis. Primary outcome occurred in 24 participants in the beclomethasone group and 26 participants in the placebo group (RR 0.90 ; p=0.763). The median time for self-reported clinical recovery in all participants was 5 days (95% CI 3 to 7) in the beclomethasone group and 5 days (95% CI 3 to 8) in the placebo group (p=0.5). The median time for self-reported clinical recovery in patients with moderate COVID-19 was 5 days (95% CI 3 to 7) in the beclomethasone group and 6 days (95% CI 4 to 9) in the placebo group (p=0.05). There were no adverse events. CONCLUSIONS Early initiation of inhaled beclomethasone in patients with asymptomatic, mild or moderate COVID-19 did not reduce disease progression to severe COVID-19. TRIAL REGISTRATION NUMBER Sri Lanka Clinical Trials Registry; SLCTR/2021/017.
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Affiliation(s)
- Chamila Mettananda
- Department of Pharmacology, University of Kelaniya, Kelaniya, Sri Lanka
- Clinical trials unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Chathura Peiris
- COVID-19 Intermediate Treatment Centre, Base Hospital, Kandana, Sri Lanka
| | | | - Aloka Gunasekara
- Department of Pharmacology, University of Kelaniya, Kelaniya, Sri Lanka
| | - Thimira Egodage
- Department of Pharmacology, University of Kelaniya, Kelaniya, Sri Lanka
- Clinical trials unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Channaka Dantanarayana
- Department of Pharmacology, University of Kelaniya, Kelaniya, Sri Lanka
- Clinical trials unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - Channa Ranasinha
- Department of Pharmacology, University of Kelaniya, Kelaniya, Sri Lanka
- Clinical trials unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Suzuki J, Endo S, Suzuki T, Sasahara T, Hatakeyama S, Morisawa Y, Hayakawa M, Yamakawa K, Endo A, Ogura T, Hirayama A, Yasunaga H, Tagami T. Effect of Inhaled Ciclesonide in Non-Critically Ill Hospitalized Patients With Coronavirus Disease 2019: A Multicenter Observational Study in Japan. Open Forum Infect Dis 2023; 10:ofad571. [PMID: 38075018 PMCID: PMC10709541 DOI: 10.1093/ofid/ofad571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/14/2023] [Indexed: 12/30/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic. Although systemic steroids play an important role in treating patients with severe COVID-19, the role of inhaled corticosteroids in non-critically ill, hospitalized patients with COVID-19 remains unclear. Methods We analyzed findings in non-critically ill, hospitalized patients with COVID-19 who were >18 years old and were admitted to 64 Japanese hospitals between January and September 2020. We performed propensity score matching analysis to evaluate 28-day and in-hospital mortality rates with or without inhaled ciclesonide within 2 days of admission. Sensitivity analyses using inverse probability weighting analysis, and generalized estimating equation method were also performed. Results Eligible patients (n = 3638) were divided into ciclesonide (n = 290) and control (n = 3, 393) groups. The 1-to-4 propensity score matching analysis included 271 ciclesonide users and 1084 nonusers. There were no significant differences between the 2 groups for 28-day (3.3% vs 2.3%; risk difference, 1.0% [95% confidence interval, -1.2 to 3.3]) or in-hospital (4.8% vs 2.6%; risk difference, 2.2 [-.5 to 4.9]) mortality rates. The sensitivity analysis showed similar outcomes. Conclusions From this multicenter observational study in Japan, inhaled ciclesonide did not decrease 28-day or in-hospital mortality rates in non-critically ill, hospitalized patients with COVID-19. Future large, multinational, randomized trials are required to confirm our results.
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Affiliation(s)
- Jun Suzuki
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
- Division of Infectious Diseases, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
- Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
| | - Shiro Endo
- Division of Infectious Diseases, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
- Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
- Division of Crisis Management Network for Infectious Diseases, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan
| | - Takayuki Suzuki
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Teppei Sasahara
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
- Department of Infection and Immunity, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
- Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Yuji Morisawa
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
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12
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [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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13
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Yu SY, Choi M, Ryoo S, Cheong C, Huh K, Yoon YK, Jeong SJ. Clinical efficacy of inhaled corticosteroids in patients with coronavirus disease 2019: A living review and meta-analysis. PLoS One 2023; 18:e0294872. [PMID: 38015868 PMCID: PMC10684004 DOI: 10.1371/journal.pone.0294872] [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: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
Inhaled corticosteroids are known to be relatively safe for long-term use in inflammatory respiratory diseases and it has been repurposed as one of the potential therapies for outpatients with coronavirus disease 2019 (COVID-19). However, inhaled corticosteroids have not been accepted for COVID-19 as a standard therapy because of its lack of proven benefits. Therefore, this study aimed to evaluate the effectiveness of inhaled corticosteroids in patients with COVID-19. Randomized controlled trials comparing the efficacy of inhaled corticosteroid treatment in patients with COVID-19 were identified through literature electronic database searches up to March 10, 2023. Meta-analyses were conducted for predefined outcomes, and the certainty of evidence was graded using the grading of recommendations, assessment, development, and evaluation approach. Overall, seven trials (eight articles) were included in this systematic review. Compared with usual care, inhaled corticosteroids was associated with significantly improved clinical recovery at 7 and 14 days in patients with COVID-19. In subgroup analysis, only budesonide showed significant efficacy in clinical recovery, whereas no significant benefit was observed for ciclesonide. Moreover, inhaled corticosteroids use was not significantly associated with all-cause hospitalization, all-cause mortality, admission to intensive care unit, or the use of mechanical ventilation. Our systematic review used evidence with very low to moderate certainty. Although based on limited evidence, our results suggest that inhaled corticosteroids treatment, especially budesonide, improves the clinical recovery of patients with COVID-19. More trials and meta-analyses are needed to assess the efficacy of inhaled corticosteroids for COVID-19 treatment.
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Affiliation(s)
- Su-Yeon Yu
- Department of Medical Information, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Seungeun Ryoo
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
- Department of Public Health, Korea University Graduate School, Seoul, Korea
| | - Chelim Cheong
- Health-Care Insight Research, Seoul, Republic of Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Jeong
- Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Suzuki M, Matsunaga A, Miyoshi-Akiyama T, Terada-Hirashima J, Sadamasu K, Nagashima M, Takasaki J, Izumi S, Hojo M, Ishizaka Y, Sugiyama H. Inhaled ciclesonide does not affect production of antibodies or elimination of virus in patients with COVID-19: Subanalysis of a multicenter, open-label randomized trial. Drug Discov Ther 2023; 17:304-311. [PMID: 37899206 DOI: 10.5582/ddt.2023.01078] [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: 10/31/2023]
Abstract
During an earlier multicenter, open-label, randomized controlled trial designed to evaluate the effectiveness of high-dose inhaled ciclesonide in patients with asymptomatic or mild coronavirus disease 2019 (COVID-19), we observed that worsening of shadows on CT without worsening of clinical symptoms was more common with ciclesonide. The present study sought to determine if an association exists between worsening CT shadows and impaired antibody production in patients treated with inhaled ciclesonide. Eighty-nine of the 90 patients in the original study were prospectively enrolled. After exclusions, there were 36 patients each in the ciclesonide and control groups. We analyzed antibody titers against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid protein at various time points. Changes in viral load during treatment were compared. There was no significant difference in age, sex, body mass index, background clinical characteristics, or symptoms between the two groups. Although evaluation on day 8 suggested a greater tendency for worsening shadows on CT in the ciclesonide group (p = 0.072), there was no significant difference between them in the ability to produce antibodies (p = 0.379) or the maximum antibody titer during the clinical course. In both groups, worsening CT shadows and higher viral loads were observed on days 1-8, suggesting ciclesonide does not affect clearance of the virus (p = 0.134). High-dose inhaled ciclesonide did not impair production of antibodies against SARS-CoV-2 or affect elimination of the virus, suggesting that this treatment can be used safely in patients with COVID-19 patients who use inhaled steroids for asthma and other diseases.
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Affiliation(s)
- Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akihiro Matsunaga
- Department of Intractable Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junko Terada-Hirashima
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Sadamasu
- Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Mami Nagashima
- Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Jin Takasaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukihito Ishizaka
- Department of Intractable Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
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15
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Naik R, Avula S, Palleti SK, Gummadi J, Ramachandran R, Chandramohan D, Dhillon G, Gill AS, Paiwal K, Shaik B, Balachandran M, Patel B, Gurugubelli S, Mariswamy Arun Kumar AK, Nanjundappa A, Bellamkonda M, Rathi K, Sakhamuri PL, Nassar M, Bali A. From Emergence to Endemicity: A Comprehensive Review of COVID-19. Cureus 2023; 15:e48046. [PMID: 37916248 PMCID: PMC10617653 DOI: 10.7759/cureus.48046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/03/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), later renamed coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China, in early December 2019. Initially, the China office of the World Health Organization was informed of numerous cases of pneumonia of unidentified etiology in Wuhan, Hubei Province at the end of 2019. This would subsequently result in a global pandemic with millions of confirmed cases of COVID-19 and millions of deaths reported to the WHO. We have analyzed most of the data published since the beginning of the pandemic to compile this comprehensive review of SARS-CoV-2. We looked at the core ideas, such as the etiology, epidemiology, pathogenesis, clinical symptoms, diagnostics, histopathologic findings, consequences, therapies, and vaccines. We have also included the long-term effects and myths associated with some therapeutics of COVID-19. This study presents a comprehensive assessment of the SARS-CoV-2 virology, vaccines, medicines, and significant variants identified during the course of the pandemic. Our review article is intended to provide medical practitioners with a better understanding of the fundamental sciences, clinical treatment, and prevention of COVID-19. As of May 2023, this paper contains the most recent data made accessible.
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Affiliation(s)
- Roopa Naik
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
- Internal Medicine/Hospital Medicine, Geisinger Health System, Wilkes Barre, USA
| | - Sreekant Avula
- Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, USA
| | - Sujith K Palleti
- Nephrology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Jyotsna Gummadi
- Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, USA
| | | | | | - Gagandeep Dhillon
- Physician Executive MBA, University of Tennessee, Knoxville, USA
- Internal Medicine, University of Maryland Baltimore Washington Medical Center, Glen Burnie, USA
| | | | - Kapil Paiwal
- Oral & Maxillofacial Pathology, Daswani Dental College & Research Center, Kota, IND
| | - Bushra Shaik
- Internal Medicine, Onslow Memorial Hospital, Jacksonville, USA
| | | | - Bhumika Patel
- Oral Medicine and Radiology, Howard University, Washington, D.C., USA
| | | | | | | | - Mahita Bellamkonda
- Hospital Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Kanika Rathi
- Internal Medicine, University of Florida, Gainesville, USA
| | | | - Mahmoud Nassar
- Endocrinology, Diabetes, and Metabolism, Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Atul Bali
- Internal Medicine/Nephrology, Geisinger Medical Center, Danville, USA
- Internal Medicine/Nephrology, Geisinger Health System, Wilkes-Barre, USA
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
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16
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Hsu CW, Lee MC, Hua YM, Lai CC, Tang HJ, Chao CM. Inhaled corticosteroid for patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:921-930. [PMID: 37562996 DOI: 10.1016/j.jmii.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The efficacy of inhaled corticosteroid (ICS) in the treatment of patients with COVID-19 has been evaluated in randomized controlled trials (RCTs), however, their findings are not consistent. METHODS PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Scopus, Web of Science and Google Scholar were searched to June 10, 2023. Only RCTs that investigated the clinical efficacy and safety of ICS for patients with COVID-19 were included. RESULTS Eleven RCTs were included. ICS users had significantly higher rate of symptom alleviation at day 14 than the control group (risk ratio [RR], 1.13; 95% CI, 1.04-1.23; I2 = 42%). Additionally, no significant difference between the ICS users and the control group was observed in the composite outcome of urgent care, emergency department (ED) visit or hospitalization (RR, 0.43; 95% CI, 0.08-2.48; I2 = 85%) and hospitalization or death (RR, 0.85; 95% CI, 0.64-1.12; I2 = 0%). Finally, ICS user had a non-significantly lower risk of death at day 28 than the control group (0.63% vs 0.99%; RR, 0.82; 95% CI, 0.43-1.56; I2 = 0%). CONCLUSIONS Additional ICS use, particularly inhaled budesonide may help symptom relief in patients with COVID-19. However, ICS use did not help reduce the risk of urgent care, ED visit, hospitalization, or death.
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Affiliation(s)
- Chin-Wei Hsu
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan; School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Lee
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ming Hua
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan; Department of Dental Laboratory Technology, Min-Hwei College of Health Care Management, Tainan, Taiwan.
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17
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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: 7] [Impact Index Per Article: 7.0] [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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Bahsoun A, Fakih Y, Zareef R, Bitar F, Arabi M. Corticosteroids in COVID-19: pros and cons. Front Med (Lausanne) 2023; 10:1202504. [PMID: 37644981 PMCID: PMC10461317 DOI: 10.3389/fmed.2023.1202504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
The wide and rapid spread of the COVID-19 pandemic has placed an unanticipated burden on the global healthcare sector. This necessitated a swift response from the international community to reach a solution. Efforts were made in parallel to develop preventative and therapeutic modalities. Since then, drug repurposing has blossomed as a potentially rapid resolution and has included various agents with anti-viral and anti-inflammatory properties. Corticosteroids, being potent anti-inflammatory agents, have been placed under extensive investigation. Various trials have recorded the beneficial outcome of corticosteroids in decreasing the mortality and morbidity of COVID-19. With the high pace of escalating events, the quality and study design of clinical trials are varied. Therefore, this study aims to explore the role of corticosteroids in COVID-19 disease. It inspects the molecular, pharmacologic, and clinical proof behind this theory.
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Affiliation(s)
- Aymen Bahsoun
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yeva Fakih
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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19
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Labor M, Kirui BK, Nyberg F, Vanfleteren LEGW. Regular Inhaled Corticosteroids Use May Protect Against Severe COVID-19 Outcome in COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:1701-1712. [PMID: 37576828 PMCID: PMC10421743 DOI: 10.2147/copd.s404913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/14/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Population-based studies provide conflicting evidence about how inhaled corticosteroids (ICS) impact COVID-19 outcomes among COPD patients. We investigated whether regular ICS exposure affects risk, severity, or survival in SARS-CoV-2 infection, using a nationwide linked Swedish population register database. Patients and Methods During January-December 2020, we studied two defined Swedish adult populations - Whole population [≥40 years] (N = 5243479), and COPD subpopulation [≥40 years] (N = 133372), in three study cohorts, respectively: 1. Overall cohort (index date 1 Jan 2020), 2. COVID-19 diagnosed sub-cohort (index date = diagnosis date), and 3. COVID-19 hospitalized sub-cohort (index date = admission date). Regular exposure was defined as ≥3 ICS prescriptions in the year before index. Hazard ratios (HRs) for outcomes (COVID-19 onset, hospitalization, ICU admission, or death) related to ICS exposure were estimated using Cox regression. Confounding was controlled by propensity score methods applying Average Treatment effect in the Treated (ATT) weighting. Results Regular ICS use was associated with only very slightly increased onset of COVID-19, hospitalization, ICU admission, and death in the overall whole population cohort and in the overall COPD subpopulation cohort, except for ICU admission (marginally non-significant HRs, up to 1.13); and no clear increase in the diagnosed sub-cohorts. However, in the COVID-19 hospitalized COPD sub-cohort, ICS therapy showed reduced risks against progression to ICU admission and death, significant for death (HR 0.82 95% CI [0.67-0.99]). Conclusion For COPD patients, ICS therapy offers some protection against progression to ICU admission and death among COVID-19 hospitalized patients. Our findings alleviate concerns about increased risks of COVID-19 by ICS treatment and provide evidence supporting the continuation of ICS therapy for COPD patients.
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Affiliation(s)
- Marina Labor
- Cancer and Lung Health Care Unit, University Hospital in Linköping, Linköping, Sweden
| | - Brian K Kirui
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Badi Y, Hammad M, Tawfik AG, Eshag MME, Elhady MM, Ragab KM, Nourelden AZ, Gamal MH, Fathallah AH. Inhaled corticosteroids' effect on COVID-19 patients: A systematic review and meta-analysis of randomized controlled trials. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:154-166. [PMID: 37781348 PMCID: PMC10540159 DOI: 10.29390/001c.84260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023]
Abstract
Background More than six million people died due to COVID-19, and 10-15% of infected individuals suffer from post-covid syndrome. Corticosteroids are widely used in the management of severe COVID-19 and post-acute COVID-19 symptoms. This study synthesizes current evidence of the effectiveness of inhaled corticosteroids (ICS) on mortality, hospital length-of-stay (LOS), and improvement of smell scores in patients with COVID-19. Methods We searched Embase, Web of Science, PubMed, Cochrane Library, and Scopus until Aug 2022. The Cochrane risk of bias tool was used to assess the quality of studies. We evaluated the effectiveness of ICS in COVID-19 patients through measures of mortality, LOS, alleviation of post-acute COVID-19 symptoms, time to sustained self-reported cure, and sense of smell (visual analog scale (VAS)). Results Ten studies were included in the meta-analysis. Our study showed a significant decrease in the LOS in ICS patients over placebo (MD = -1.52, 95% CI [-2.77 to -0.28], p-value = 0.02). Patients treated with intranasal corticosteroids (INC) showed a significant improvement in VAS smell scores from week three to week four (MD =1.52, 95% CI [0.27 to 2.78], p-value = 0.02), and alleviation of COVID-related symptoms after 14 days (RR = 1.17, 95% CI [1.09 to 1.26], p-value < 0.0001). No significant differences were detected in mortality (RR= 0.69, 95% CI [0.36 to 1.35], p-value = 0.28) and time to sustained self-reported cure (MD = -1.28, 95% CI [-6.77 to 4.20], p-value = 0.65). Conclusion We concluded that the use of ICS decreased patient LOS and improved COVID-19-related symptoms. INC may have a role in improving the smell score. Therefore, using INC and ICS for two weeks or more may prove beneficial. Current data do not demonstrate an effect on mortality or time to sustained self-reported cure. However, the evidence is inconclusive, and more studies are needed for more precise data.
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Affiliation(s)
- Yasra Badi
- All Saints University School of Medicine
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Levitt JE, Hedlin H, Duong S, Lu D, Lee J, Bunning B, Elkarra N, Pinsky BA, Heffernan E, Springman E, Moss RB, Bonilla HF, Parsonnet J, Zamanian RT, Langguth JJ, Bollyky J, Khosla C, Nicolls MR, Desai M, Rogers AJ. Evaluation of Acebilustat, a Selective Inhibitor of Leukotriene B4 Biosynthesis, for Treatment of Outpatients With Mild-Moderate Coronavirus Disease 2019: A Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial. Clin Infect Dis 2023; 77:186-193. [PMID: 36996150 PMCID: PMC10517095 DOI: 10.1093/cid/ciad187] [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: 01/19/2023] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The vast majority of coronavirus disease 2019 (COVID-19) disease occurs in outpatients where treatment is limited to antivirals for high-risk subgroups. Acebilustat, a leukotriene B4 inhibitor, has potential to reduce inflammation and symptom duration. METHODS In a single-center trial spanning Delta and Omicron variants, outpatients were randomized to 100 mg/d of oral acebilustat or placebo for 28 days. Patients reported daily symptoms via electronic query through day 28 with phone follow-up on day 120 and collected nasal swab samples on days 1-10. The primary outcome was sustained symptom resolution to day 28. Secondary 28-day outcomes included time to first symptom resolution, area under the curve (AUC) for longitudinal daily symptom scores, duration of viral shedding through day 10, and symptoms on day 120. RESULTS Sixty participants were randomized to each study arm. At enrollment, the median duration was 4 days (interquartile range, 3-5 days), and the median number of symptoms was 9 (7-11). Most patients (90%) were vaccinated, with 73% having neutralizing antibodies. A minority of participants (44%; 35% in the acebilustat arm and 53% in placebo) had sustained symptom resolution at day 28 (hazard ratio, 0.6 [95% confidence interval, .34-1.04]; P = .07 favoring placebo). There was no difference in the mean AUC for symptom scores over 28 days (difference in mean AUC, 9.4 [95% confidence interval, -42.1 to 60.9]; P = .72). Acebilustat did not affect viral shedding or symptoms at day 120. CONCLUSIONS Sustained symptoms through day 28 were common in this low-risk population. Despite this, leukotriene B4 antagonism with acebilustat did not shorten symptom duration in outpatients with COVID-19. Clinical Trials Registration. NCT04662060.
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Affiliation(s)
- Joseph E Levitt
- Division of Pulmonary, Allergy, and Critical Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Sophie Duong
- Stanford Center for Clinical Research, Stanford, CA, USA
| | - Di Lu
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Justin Lee
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Bryan Bunning
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nadia Elkarra
- Stanford Center for Clinical Research, Stanford, CA, USA
| | - Benjamin A Pinsky
- Department of Pathology Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Richard B Moss
- Pediatrics (Pulmonary Medicine), Center for Excellence in Pulmonary Biology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Hector F Bonilla
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie Parsonnet
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Roham T Zamanian
- Division of Pulmonary, Allergy, and Critical Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Jenna Bollyky
- Stanford Innovative Medicines Accelerator, Stanford, CA, USA
| | - Chaitan Khosla
- Stanford Innovative Medicines Accelerator, Stanford, CA, USA
| | - Mark R Nicolls
- Division of Pulmonary, Allergy, and Critical Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela J Rogers
- Division of Pulmonary, Allergy, and Critical Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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22
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McManus D, Davis MW, Ortiz A, Britto-Leon C, Dela Cruz CS, Topal JE. Immunomodulatory Agents for Coronavirus Disease-2019 Pneumonia. Clin Chest Med 2023; 44:299-319. [PMID: 37085221 PMCID: PMC9678826 DOI: 10.1016/j.ccm.2022.11.009] [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] [Indexed: 11/23/2022]
Abstract
Morbidity and mortality from COVID-19 is due to severe inflammation and end-organ damage caused by a hyperinflammatory response. Multiple immunomodulatory agents to attenuate this response have been studied. Corticosteroids, specifically dexamethasone, have been shown to reduce mortality in hospitalized patients who require supplemental oxygen. Interleukin-6 antagonist, tocilizimab, and Janus kinase inhibitors have also been shown to reduce mortality. However, patients who have severe pulmonary end-organ damage requiring mechanical ventilation or extracorporeal membrane oxygenation appear not to benefit from immunomodulatory therapies. This highlights the importance of appropriate timing to initiate immunomodulatory therapies in the management of severe COVID-19 disease.
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Affiliation(s)
- Dayna McManus
- Department of Pharmacy Services, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA.
| | - Matthew W Davis
- Department of Pharmacy Services, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA
| | - Alex Ortiz
- Pulmonary, Critical Care & Sleep Medicine, 300 Cedar Street, P.O. Box 208057, New Haven, CT 06520-8057, USA
| | - Clemente Britto-Leon
- Pulmonary, Critical Care & Sleep Medicine, 300 Cedar Street, P.O. Box 208057, New Haven, CT 06520-8057, USA
| | - Charles S Dela Cruz
- Pulmonary, Critical Care & Sleep Medicine, 300 Cedar Street, P.O. Box 208057, New Haven, CT 06520-8057, USA
| | - Jeffrey E Topal
- Department of Pharmacy Services, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA.
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23
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Li G, Hilgenfeld R, Whitley R, De Clercq E. Therapeutic strategies for COVID-19: progress and lessons learned. Nat Rev Drug Discov 2023; 22:449-475. [PMID: 37076602 PMCID: PMC10113999 DOI: 10.1038/s41573-023-00672-y] [Citation(s) in RCA: 177] [Impact Index Per Article: 177.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 04/21/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has stimulated tremendous efforts to develop therapeutic strategies that target severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and/or human proteins to control viral infection, encompassing hundreds of potential drugs and thousands of patients in clinical trials. So far, a few small-molecule antiviral drugs (nirmatrelvir-ritonavir, remdesivir and molnupiravir) and 11 monoclonal antibodies have been marketed for the treatment of COVID-19, mostly requiring administration within 10 days of symptom onset. In addition, hospitalized patients with severe or critical COVID-19 may benefit from treatment with previously approved immunomodulatory drugs, including glucocorticoids such as dexamethasone, cytokine antagonists such as tocilizumab and Janus kinase inhibitors such as baricitinib. Here, we summarize progress with COVID-19 drug discovery, based on accumulated findings since the pandemic began and a comprehensive list of clinical and preclinical inhibitors with anti-coronavirus activities. We also discuss the lessons learned from COVID-19 and other infectious diseases with regard to drug repurposing strategies, pan-coronavirus drug targets, in vitro assays and animal models, and platform trial design for the development of therapeutics to tackle COVID-19, long COVID and pathogenic coronaviruses in future outbreaks.
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Affiliation(s)
- Guangdi Li
- Xiangya School of Public Health, Central South University; Hunan Children's Hospital, Changsha, China.
| | - Rolf Hilgenfeld
- Institute of Molecular Medicine & German Center for Infection Research (DZIF), University of Lübeck, Lübeck, Germany.
| | - Richard Whitley
- Department of Paediatrics, Microbiology, Medicine and Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Erik De Clercq
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
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24
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Gupta Y, Savytskyi OV, Coban M, Venugopal A, Pleqi V, Weber CA, Chitale R, Durvasula R, Hopkins C, Kempaiah P, Caulfield TR. Protein structure-based in-silico approaches to drug discovery: Guide to COVID-19 therapeutics. Mol Aspects Med 2023; 91:101151. [PMID: 36371228 PMCID: PMC9613808 DOI: 10.1016/j.mam.2022.101151] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
With more than 5 million fatalities and close to 300 million reported cases, COVID-19 is the first documented pandemic due to a coronavirus that continues to be a major health challenge. Despite being rapid, uncontrollable, and highly infectious in its spread, it also created incentives for technology development and redefined public health needs and research agendas to fast-track innovations to be translated. Breakthroughs in computational biology peaked during the pandemic with renewed attention to making all cutting-edge technology deliver agents to combat the disease. The demand to develop effective treatments yielded surprising collaborations from previously segregated fields of science and technology. The long-standing pharmaceutical industry's aversion to repurposing existing drugs due to a lack of exponential financial gain was overrun by the health crisis and pressures created by front-line researchers and providers. Effective vaccine development even at an unprecedented pace took more than a year to develop and commence trials. Now the emergence of variants and waning protections during the booster shots is resulting in breakthrough infections that continue to strain health care systems. As of now, every protein of SARS-CoV-2 has been structurally characterized and related host pathways have been extensively mapped out. The research community has addressed the druggability of a multitude of possible targets. This has been made possible due to existing technology for virtual computer-assisted drug development as well as new tools and technologies such as artificial intelligence to deliver new leads. Here in this article, we are discussing advances in the drug discovery field related to target-based drug discovery and exploring the implications of known target-specific agents on COVID-19 therapeutic management. The current scenario calls for more personalized medicine efforts and stratifying patient populations early on for their need for different combinations of prognosis-specific therapeutics. We intend to highlight target hotspots and their potential agents, with the ultimate goal of using rational design of new therapeutics to not only end this pandemic but also uncover a generalizable platform for use in future pandemics.
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Affiliation(s)
- Yash Gupta
- Department of Medicine, Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Oleksandr V Savytskyi
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; In Vivo Biosystems, Eugene, OR, USA
| | - Matt Coban
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Vasili Pleqi
- Department of Medicine, Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Caleb A Weber
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Rohit Chitale
- Department of Medicine, Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA; The Council on Strategic Risks, 1025 Connecticut Ave NW, Washington, DC, USA
| | - Ravi Durvasula
- Department of Medicine, Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA
| | | | - Prakasha Kempaiah
- Department of Medicine, Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Thomas R Caulfield
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Department of QHS Computational Biology, Mayo Clinic, Jacksonville, FL, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA; Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
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25
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Covello RD, Pasin L, Fresilli S, Tóth K, Damiani C, Hajjar LA, Zangrillo A, Landoni G. Meta-Analysis of Glucocorticoids for Covid-19 Patients Not Receiving Oxygen. NEJM EVIDENCE 2023; 2:EVIDoa2200283. [PMID: 38320047 DOI: 10.1056/evidoa2200283] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND: Glucocorticoids reduce mortality in hospitalized patients with severe and critical coronavirus disease 2019 (Covid-19), although a possible harm was documented in patients with Covid-19 not requiring oxygen. METHODS: We searched Embase, BioMed Central, medRxiv, bioRxiv, PubMed, and the Cochrane Central Register of Controlled Trials for any randomized trial or matched study ever performed on adult patients with Covid-19 not receiving oxygen therapy treated with intravenous or oral glucocorticoids versus any comparator (standard therapy or placebo); there were no restrictions on dose or time of administration. The primary end point was all-cause mortality at the longest available follow-up. RESULTS: Five randomized trials and one propensity-matched study involving 6634 hospitalized patients not on oxygen were finally included (3704 received glucocorticoids and 2930 received standard treatment). The overall mortality of patients treated with glucocorticoids was significantly higher than the mortality of patients in the control group (509 of 3704 [14%] in the glucocorticoid group vs. 294 of 2930 [10%] in the control group; odds ratio, 1.56 [95% confidence interval, 1.27 to 1.92], with three articles reporting mortality events and contributing to the combined odds ratio; P<0.001; number needed to harm=27). CONCLUSIONS: Glucocorticoid use likely increases mortality in hospitalized patients with Covid-19 not receiving oxygen, with a number needed to harm of 27. (PROSPERO number CRD42022342996.)
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Affiliation(s)
| | - Laura Pasin
- Anesthesia and Intensive Care, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Stefano Fresilli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Krisztina Tóth
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Caterina Damiani
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | | | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan
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26
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Giesen N, Busch E, Schalk E, Beutel G, Rüthrich MM, Hentrich M, Hertenstein B, Hirsch HH, Karthaus M, Khodamoradi Y, Koehler P, Krüger W, Koldehoff M, Krause R, Mellinghoff SC, Penack O, Sandherr M, Seggewiss-Bernhardt R, Spiekermann K, Sprute R, Stemler J, Weissinger F, Wörmann B, Wolf HH, Cornely OA, Rieger CT, von Lilienfeld-Toal M. AGIHO guideline on evidence-based management of COVID-19 in cancer patients: 2022 update on vaccination, pharmacological prophylaxis and therapy in light of the omicron variants. Eur J Cancer 2023; 181:102-118. [PMID: 36652889 PMCID: PMC9737523 DOI: 10.1016/j.ejca.2022.11.030] [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: 11/16/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
The novel coronavirus SARS-CoV-2 and the associated infectious disease COVID-19 pose a significant challenge to healthcare systems worldwide. Patients with cancer have been identified as a high-risk population for severe infections, rendering prophylaxis and treatment strategies for these patients particularly important. Rapidly evolving clinical research, resulting in the recent advent of various vaccines and therapeutic agents against COVID-19, offers new options to improve care and protection of cancer patients. However, ongoing epidemiological changes and rise of new virus variants require repeated revisions and adaptations of prophylaxis and treatment strategies to meet these new challenges. Therefore, this guideline provides an update on evidence-based recommendations with regard to vaccination, pharmacological prophylaxis and treatment of COVID-19 in cancer patients in light of the currently dominant omicron variants. It was developed by an expert panel of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) based on a critical review of the most recent available data.
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Affiliation(s)
- Nicola Giesen
- Department of Hematology, Oncology and Palliative Care, Robert Bosch Hospital, Stuttgart, Germany.
| | - Elena Busch
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Gernot Beutel
- Department for Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Working Party Intensive Care in Haematologic and Oncologic Patients (iCHOP) of the German Society of Haematology and Medical Oncology (DGHO), Germany
| | - Maria M Rüthrich
- Department of Interdisciplinary Intensive Care Medicine, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
| | | | - Hans H Hirsch
- Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland; Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Meinolf Karthaus
- Department of Hematology, Oncology and Palliative Care, Klinikum Neuperlach/Klinikum Harlaching, Munich, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - William Krüger
- Department of Hematology and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Greifswald, Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Department of Hygiene and Environmental Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sibylle C Mellinghoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Olaf Penack
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Michael Sandherr
- MVZ Penzberg, Department of Hematology and Oncology, Weilheim, Germany
| | - Ruth Seggewiss-Bernhardt
- Medizinische Klinik V, Sozialstiftung Bamberg, Bamberg, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Jannik Stemler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Weissinger
- Department of Internal Medicine, Hematology, Oncology, Stem Cell Transplantation and Palliative Care, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Bernhard Wörmann
- Division of Haematology, Oncology and Tumor Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Heinrich Wolf
- Department of Hematology, Oncology and Hemostaseology, Südharzklinikum Nordhausen, Nordhausen, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Christina T Rieger
- Hemato-Oncology Germering & Interdisciplinary Tumorcenter, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marie von Lilienfeld-Toal
- Department of Haematology and Medical Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
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27
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Park S. Corticosteroids for non-severe COVID-19 infections? Too early to conclude. Korean J Intern Med 2023; 38:144-146. [PMID: 36864598 PMCID: PMC9993106 DOI: 10.3904/kjim.2023.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
- Sunghoon Park
- Department of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Correspondence to Sunghoon Park, M.D., Ph.D. Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, Anyang 14068, Korea Tel: +82-31-380-3715 Fax: +82-31-380-3973 E-mail:
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28
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Fialho MFP, Brum ES, Oliveira SM. Could the fibromyalgia syndrome be triggered or enhanced by COVID-19? Inflammopharmacology 2023; 31:633-651. [PMID: 36849853 PMCID: PMC9970139 DOI: 10.1007/s10787-023-01160-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
Fibromyalgia (FM) is a complex disease with an uncertain aetiology and intricate pathophysiology. Although its genesis is not fully explained, potential environmental factors, such as viral infections might trigger FM or worsen patients' clinical outcomes. The SARS-CoV-2 virus may affect central and peripheral nervous systems, leading to musculoskeletal, neurological, and psychological disturbances. These symptoms might persist at least 12 months beyond the recovery, often referred to as post-COVID syndrome, which resembles FM syndrome. In this sense, we argued the potential consequences of COVID-19 exclusively on FM syndrome. First, we have described post-COVID syndrome and its painful symptoms. Afterwards, we argued whether FM syndrome could be triggered or enhanced by COVID-19 infection or by numerous and persistent stressors imposed daily by the pandemic setting (isolation, uncertainty, depression, mental stress, generalized anxiety, and fear of the virus). In addition, we have demonstrated similarities between pathophysiological mechanisms and cardinal symptoms of FM and COVID-19, speculating that SARS-CoV-2 might represent a critical mediator of FM or an exacerbator of its symptoms once both syndromes share similar mechanisms and complaints. Therefore, pharmacologic and non-pharmacological approaches commonly used to treat FM could serve as strategic therapies to attenuate painful and neurological manifestations of post-COVID syndrome. Although it is still theoretical, clinicians and researchers should be alert of patients who develop symptoms similar to FM or those who had their FM symptoms increased post-COVID to manage them better.
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Affiliation(s)
- Maria Fernanda Pessano Fialho
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Evelyne Silva Brum
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
- Department of Biochemistry and Molecular Biology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
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29
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Brodin D, Tornhammar P, Ueda P, Krifors A, Westerlund E, Athlin S, Wojt S, Elvstam O, Neumann A, Elshani A, Giesecke J, Edvardsson-Källkvist J, Bunpuckdee S, Unge C, Larsson M, Johansson B, Ljungberg J, Lindell J, Hansson J, Blennow O, Andersson DP. Inhaled ciclesonide in adults hospitalised with COVID-19: a randomised controlled open-label trial (HALT COVID-19). BMJ Open 2023; 13:e064374. [PMID: 36813503 PMCID: PMC9950582 DOI: 10.1136/bmjopen-2022-064374] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To assess the efficacy of inhaled ciclesonide in reducing the duration of oxygen therapy (an indicator of time to clinical improvement) among adults hospitalised with COVID-19. DESIGN Multicentre, randomised, controlled, open-label trial. SETTING 9 hospitals (3 academic hospitals and 6 non-academic hospitals) in Sweden between 1 June 2020 and 17 May 2021. PARTICIPANTS Adults hospitalised with COVID-19 and receiving oxygen therapy. INTERVENTION Inhaled ciclesonide 320 µg two times a day for 14 days versus standard care. MAIN OUTCOME MEASURES Primary outcome was duration of oxygen therapy, an indicator of time to clinical improvement. Key secondary outcome was a composite of invasive mechanical ventilation/death. RESULTS Data from 98 participants were analysed (48 receiving ciclesonide and 50 receiving standard care; median (IQR) age, 59.5 (49-67) years; 67 (68%) men). Median (IQR) duration of oxygen therapy was 5.5 (3-9) days in the ciclesonide group and 4 (2-7) days in the standard care group (HR for termination of oxygen therapy 0.73 (95% CI 0.47 to 1.11), with the upper 95% CI being compatible with a 10% relative reduction in oxygen therapy duration, corresponding to a <1 day absolute reduction in a post-hoc calculation). Three participants in each group died/received invasive mechanical ventilation (HR 0.90 (95% CI 0.15 to 5.32)). The trial was discontinued early due to slow enrolment. CONCLUSIONS In patients hospitalised with COVID-19 receiving oxygen therapy, this trial ruled out, with 0.95 confidence, a treatment effect of ciclesonide corresponding to more than a 1 day reduction in duration of oxygen therapy. Ciclesonide is unlikely to improve this outcome meaningfully. TRIAL REGISTRATION NUMBER NCT04381364.
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Affiliation(s)
- Daniel Brodin
- Department of Medicine, Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Per Tornhammar
- Functional Area of Emergency Medicine, Karolinska Institute, Stockholm, Sweden
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Krifors
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Västmanland, Uppsala University, Uppsala, Sweden
| | - Eli Westerlund
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Simon Athlin
- School of Medical Science, Örebro University, Örebro, Sweden
| | - Sandra Wojt
- Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Olof Elvstam
- Department of Infectious Diseases, Central Hospital Växjö, Vaxjo, Sweden
| | - Anca Neumann
- Department of Medicine, Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Arsim Elshani
- Department of Medicine and Geriatrics, Karlskoga Hospital, Karlskoga, Sweden
| | - Julia Giesecke
- Functional Area of Emergency Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Sayam Bunpuckdee
- Functional Area of Emergency Medicine, Karolinska Institute, Stockholm, Sweden
| | - Christian Unge
- Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Martin Larsson
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Björn Johansson
- Department of Infectious Diseases, Halland's Hospital Halmstad, Halmstad, Sweden
| | - Johan Ljungberg
- Department of Infectious Diseases, Halland's Hospital Halmstad, Halmstad, Sweden
| | - Jonas Lindell
- Department of Infectious Diseases, Visby Hospital, Visby, Sweden
| | - Johan Hansson
- Department of Infectious Diseases, Östersund Hospital, Ostersund, Sweden
| | - Ola Blennow
- Department of Medicine, Capio S:t Göran's Hospital, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Peter Andersson
- Department of Medicine Huddinge H7, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Yuan Y, Jiao B, Qu L, Yang D, Liu R. The development of COVID-19 treatment. Front Immunol 2023; 14:1125246. [PMID: 36776881 PMCID: PMC9909293 DOI: 10.3389/fimmu.2023.1125246] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic named coronavirus disease 2019 (COVID-19) that has become the greatest worldwide public health threat of this century. Recent studies have unraveled numerous mysteries of SARS-CoV-2 pathogenesis and thus largely improved the studies of COVID-19 vaccines and therapeutic strategies. However, important questions remain regarding its therapy. In this review, the recent research advances on COVID-19 mechanism are quickly summarized. We mainly discuss current therapy strategies for COVID-19, with an emphasis on antiviral agents, neutralizing antibody therapies, Janus kinase inhibitors, and steroids. When necessary, specific mechanisms and the history of therapy are present, and representative strategies are described in detail. Finally, we discuss key outstanding questions regarding future directions of the development of COVID-19 treatment.
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Affiliation(s)
- Yongliang Yuan
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Baihai Jiao
- Division of Nephrology, Department of Medicine, School of Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - Lili Qu
- Department of Immunology, School of Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - Duomeng Yang
- Department of Immunology, School of Medicine, University of Connecticut Health Center, Farmington, CT, United States,*Correspondence: Ruijuan Liu, ; Duomeng Yang,
| | - Ruijuan Liu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Ruijuan Liu, ; Duomeng Yang,
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31
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Bai AD, Jiang Y, Nguyen DL, Lo CKL, Stefanova I, Guo K, Wang F, Zhang C, Sayeau K, Garg A, Loeb M. Comparison of Preprint Postings of Randomized Clinical Trials on COVID-19 and Corresponding Published Journal Articles: A Systematic Review. JAMA Netw Open 2023; 6:e2253301. [PMID: 36705921 DOI: 10.1001/jamanetworkopen.2022.53301] [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: 01/28/2023] Open
Abstract
IMPORTANCE Randomized clinical trials (RCTs) on COVID-19 are increasingly being posted as preprints before publication in a scientific, peer-reviewed journal. OBJECTIVE To assess time to journal publication for COVID-19 RCT preprints and to compare differences between pairs of preprints and corresponding journal articles. EVIDENCE REVIEW This systematic review used a meta-epidemiologic approach to conduct a literature search using the World Health Organization COVID-19 database and Embase to identify preprints published between January 1 and December 31, 2021. This review included RCTs with human participants and research questions regarding the treatment or prevention of COVID-19. For each preprint, a literature search was done to locate the corresponding journal article. Two independent reviewers read the full text, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Time to publication was analyzed using a Cox proportional hazards regression model. Differences between preprint and journal article pairs in terms of outcomes, analyses, results, or conclusions were described. Statistical analysis was performed on October 17, 2022. FINDINGS This study included 152 preprints. As of October 1, 2022, 119 of 152 preprints (78.3%) had been published in journals. The median time to publication was 186 days (range, 17-407 days). In a multivariable model, larger sample size and low risk of bias were associated with journal publication. With a sample size of less than 200 as the reference, sample sizes of 201 to 1000 and greater than 1000 had hazard ratios (HRs) of 1.23 (95% CI, 0.80-1.91) and 2.19 (95% CI, 1.36-3.53) for publication, respectively. With high risk of bias as the reference, medium-risk articles with some concerns for bias had an HR of 1.77 (95% CI, 1.02-3.09); those with a low risk of bias had an HR of 3.01 (95% CI, 1.71-5.30). Of the 119 published preprints, there were differences in terms of outcomes, analyses, results, or conclusions in 65 studies (54.6%). The main conclusion in the preprint contradicted the conclusion in the journal article for 2 studies (1.7%). CONCLUSIONS AND RELEVANCE These findings suggest that there is a substantial time lag from preprint posting to journal publication. Preprints with smaller sample sizes and high risk of bias were less likely to be published. Finally, although differences in terms of outcomes, analyses, results, or conclusions were observed for preprint and journal article pairs in most studies, the main conclusion remained consistent for the majority of studies.
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Affiliation(s)
- Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Yunbo Jiang
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - David L Nguyen
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Carson K L Lo
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Kevin Guo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Frank Wang
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Cindy Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kyle Sayeau
- Mental Health and Addictions Care Program, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Akhil Garg
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Mark Loeb
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Perico N, Cortinovis M, Suter F, Remuzzi G. Home as the new frontier for the treatment of COVID-19: the case for anti-inflammatory agents. THE LANCET. INFECTIOUS DISEASES 2023. [PMID: 36030796 DOI: 10.1016/s1473-3099(22)00433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
COVID-19, caused by SARS-CoV-2, is characterised by a broad spectrum of symptom severity that requires varying amounts of care according to the different stages of the disease. Intervening at the onset of mild to moderate COVID-19 symptoms in the outpatient setting would provide the opportunity to prevent progression to a more severe illness and long-term complications. As early disease symptoms variably reflect an underlying excessive inflammatory response to the viral infection, the use of anti-inflammatory drugs, especially non-steroidal anti-inflammatory drugs (NSAIDs), in the initial outpatient stage of COVID-19 seems to be a valuable therapeutic strategy. A few observational studies have tested NSAIDs (especially relatively selective COX-2 inhibitors), often as part of multipharmacological protocols, for early outpatient treatment of COVID-19. The findings from these studies are promising and point to a crucial role of NSAIDs for the at-home management of people with initial COVID-19 symptoms.
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Affiliation(s)
- Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | - Monica Cortinovis
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | - Fredy Suter
- Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy; Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.
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Perico N, Cortinovis M, Suter F, Remuzzi G. Home as the new frontier for the treatment of COVID-19: the case for anti-inflammatory agents. THE LANCET. INFECTIOUS DISEASES 2023; 23:e22-e33. [PMID: 36030796 PMCID: PMC9411261 DOI: 10.1016/s1473-3099(22)00433-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 02/09/2023]
Abstract
COVID-19, caused by SARS-CoV-2, is characterised by a broad spectrum of symptom severity that requires varying amounts of care according to the different stages of the disease. Intervening at the onset of mild to moderate COVID-19 symptoms in the outpatient setting would provide the opportunity to prevent progression to a more severe illness and long-term complications. As early disease symptoms variably reflect an underlying excessive inflammatory response to the viral infection, the use of anti-inflammatory drugs, especially non-steroidal anti-inflammatory drugs (NSAIDs), in the initial outpatient stage of COVID-19 seems to be a valuable therapeutic strategy. A few observational studies have tested NSAIDs (especially relatively selective COX-2 inhibitors), often as part of multipharmacological protocols, for early outpatient treatment of COVID-19. The findings from these studies are promising and point to a crucial role of NSAIDs for the at-home management of people with initial COVID-19 symptoms.
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Affiliation(s)
- Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | - Monica Cortinovis
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | - Fredy Suter
- Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy,Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy,Correspondence to: Prof Giuseppe Remuzzi, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Parco Scientifico Tecnologico Kilometro Rosso, 24126 Bergamo, Italy
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34
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Qiao W, Meng L, Zhang Y, Li D, Chen J, Wang J, Xie D, Xue X. Safety and efficacy of glucocorticoids in the treatment of COVID-19: A meta-analysis of randomized control trials. Expert Rev Respir Med 2023; 17:81-96. [PMID: 36738136 DOI: 10.1080/17476348.2023.2177155] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is unclear the efficacy and safety of glucocorticoids compared with placebo or usual care for treatment of COVID-19. RESEARCH DESIGN AND METHODS Randomized controlled trials (RCTs) of corticosteroids in COVID-19 patients from 1 December 2019, to 30 June 2022, were assessed using Cochrane bias risk assessment method and improved Jadad score scale. GRADEpro was used to rate the quality of evidence for outcomes. RESULTS Fifteen RCTs were included, including 10,620 patients. Glucocorticoid treatment for severe and critical COVID-19 showed lesser all-cause mortality (OR = 0.85, 95% CI [0.76, 0.94], P = 0.002) than conventional treatment. However, for mildly ill patients, neither inhaled drugs nor intravenous drugs reduced mortality (OR = 0.64, 95% CI [0.24, 1.76], P = 0.39). Glucocorticoids had no significant effect on the adverse reactions of patients (OR = 1.18, 95% CI [0.77, 1.80], P = 0.44) compared with usual care/placebo. Subgroup analysis demonstrated that dexamethasone significantly reduced the mortality of COVID-19 patients. Low-dose glucocorticoids were also associated with lower all-cause mortality. CONCLUSION Glucocorticoids (especially dexamethasone) reduce mortality of patients with severe and critical COVID-19 with no significant effect on the incidence of adverse reactions (moderate quality). In contrast, glucocorticoids do not benefit patients with mild symptoms (low quality).
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Affiliation(s)
- Wenxiao Qiao
- Institute of Shanxi Traditional Chinese Medicine, Taiyuan, Shanxi, China.,Department of Respiration, Shanxi Traditional Chinese Medicine Hospital, Taiyuan, Shanxi, China
| | - Lihong Meng
- Department of Respiration, Shanxi Traditional Chinese Medicine Hospital, Taiyuan, Shanxi, China
| | - Ye Zhang
- Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Dian Li
- Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Jingjing Chen
- Department of Respiration, Shanxi Traditional Chinese Medicine Hospital, Taiyuan, Shanxi, China
| | - Jinyun Wang
- Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Di Xie
- Institute of Shanxi Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Xiaoming Xue
- Department of Respiration, Shanxi Traditional Chinese Medicine Hospital, Taiyuan, Shanxi, China
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35
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Bafadhel M, Faner R, Taillé C, Russell REK, Welte T, Barnes PJ, Agustí A. Inhaled corticosteroids for the treatment of COVID-19. Eur Respir Rev 2022; 31:220099. [PMID: 36450371 PMCID: PMC9724831 DOI: 10.1183/16000617.0099-2022] [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: 05/20/2022] [Accepted: 10/09/2022] [Indexed: 12/02/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused severe illness and mortality for millions worldwide. Despite the development, approval and rollout of vaccination programmes globally to prevent infection by SARS-CoV-2 and the development of coronavirus disease 2019 (COVID-19), treatments are still urgently needed to improve outcomes. Early in the pandemic it was observed that patients with pre-existing asthma or COPD were underrepresented among those with COVID-19. Evidence from clinical studies indicates that the inhaled corticosteroids (ICS) routinely taken for asthma and COPD could have had a protective role in preventing severe COVID-19 and, therefore, may be a promising treatment for COVID-19. This review summarises the evidence supporting the beneficial effects of ICS on outcomes in patients with COVID-19 and explores the potential protective mechanisms.
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Affiliation(s)
- Mona Bafadhel
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rosa Faner
- CIBER Enfermedades Respiratorias, IDIBAPS, Barcelona, Spain
| | - Camille Taillé
- Department of Pulmonary Diseases, University Hospital Bichat-Claude Bernard, AP-HP Nord, University of Paris, Paris, France
| | - Richard E K Russell
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Tobias Welte
- Department of Pulmonary and Infectious Diseases, Hannover University School of Medicine, Hannover, Germany
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alvar Agustí
- Cátedra de Salud Respiratoria (University of Barcelona), Respiratory Institute (Hospital Clinic Barcelona), IDIBAPS and CIBERES, Barcelona, Spain
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36
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Lei S, Chen X, Wu J, Duan X, Men K. Small molecules in the treatment of COVID-19. Signal Transduct Target Ther 2022; 7:387. [PMID: 36464706 PMCID: PMC9719906 DOI: 10.1038/s41392-022-01249-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 12/11/2022] Open
Abstract
The outbreak of COVID-19 has become a global crisis, and brought severe disruptions to societies and economies. Until now, effective therapeutics against COVID-19 are in high demand. Along with our improved understanding of the structure, function, and pathogenic process of SARS-CoV-2, many small molecules with potential anti-COVID-19 effects have been developed. So far, several antiviral strategies were explored. Besides directly inhibition of viral proteins such as RdRp and Mpro, interference of host enzymes including ACE2 and proteases, and blocking relevant immunoregulatory pathways represented by JAK/STAT, BTK, NF-κB, and NLRP3 pathways, are regarded feasible in drug development. The development of small molecules to treat COVID-19 has been achieved by several strategies, including computer-aided lead compound design and screening, natural product discovery, drug repurposing, and combination therapy. Several small molecules representative by remdesivir and paxlovid have been proved or authorized emergency use in many countries. And many candidates have entered clinical-trial stage. Nevertheless, due to the epidemiological features and variability issues of SARS-CoV-2, it is necessary to continue exploring novel strategies against COVID-19. This review discusses the current findings in the development of small molecules for COVID-19 treatment. Moreover, their detailed mechanism of action, chemical structures, and preclinical and clinical efficacies are discussed.
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Affiliation(s)
- Sibei Lei
- grid.412901.f0000 0004 1770 1022State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
| | - Xiaohua Chen
- grid.54549.390000 0004 0369 4060Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 China
| | - Jieping Wu
- grid.412901.f0000 0004 1770 1022State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
| | - Xingmei Duan
- grid.54549.390000 0004 0369 4060Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 China
| | - Ke Men
- grid.412901.f0000 0004 1770 1022State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
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Hsu CK, Chao CM, Lai CC. Inhaled ciclesonide for outpatients with COVID-19: A meta-analysis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1129-1130. [PMID: 35995666 PMCID: PMC9359495 DOI: 10.1016/j.jmii.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 12/27/2022]
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Mossadeq S, Shah R, Shah V, Bagul M. Formulation, Device, and Clinical Factors Influencing the Targeted Delivery of COVID-19 Vaccines to the Lungs. AAPS PharmSciTech 2022; 24:2. [PMID: 36416999 PMCID: PMC9684852 DOI: 10.1208/s12249-022-02455-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has proven to be an unprecedented health crisis in the human history with more than 5 million deaths worldwide caused to the SARS-CoV-2 and its variants ( https://www.who.int/emergencies/diseases/novel-coronavirus-2019 ). The currently authorized lipid nanoparticle (LNP)-encapsulated mRNA vaccines have been shown to have more than 90% vaccine efficacy at preventing COVID-19 illness (Baden et al. New England J Med 384(5):403-416, 2021; Thomas et al., 2021). In addition to vaccines, other small molecules belonging to the class of anti-viral and anti-inflammatory compounds have also been prescribed to reduce the viral proliferation and the associated cytokine storm. These anti-viral and anti-inflammatory compounds have also been shown to be effective in reducing COVID-19 exacerbations especially in reducing the host inflammatory response to SARS-CoV-2. However, all of the currently FDA-authorized vaccines for COVID-19 are meant for intramuscular injection directly into the systemic circulation. Also, most of the small molecules investigated for their anti-COVID-19 efficacy have also been explored using the intravenous route with a few of them explored for the inhalation route (Ramakrishnan et al. Lancet Respir Med 9:763-772, 2021; Horby et al. N Engl J Med 384(8):693-704, 2021). The fact that the SARS-CoV-2 enters the human body mainly via the nasal and airway route resulting in the lungs being the primary organs of infection as characterized by acute respiratory distress syndrome (ARDS)-mediated cytokine storm in the alveolar region has made the inhalation route gain significant attention for the purposes of targeting both vaccines and small molecules to the lungs (Mitchell et al., J Aerosol Med Pulm Drug Deliv 33(4):235-8, 2020). While there have been many studies reporting the safety and efficacy of targeting various therapeutics to the lungs to treat COVID-19, there is still a need to match the choice of inhalation formulation and the delivery device platform itself with the patient-related factors like breathing pattern and respiratory rate as seen in a clinical setting. In that perspective, this review aims to describe the various formulation and patient-related clinical factors that can play an important role in the judicious choice of the inhalation delivery platforms or devices for the development of inhaled COVID-19 vaccines.
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Affiliation(s)
- Sayeed Mossadeq
- Raptim Research Private Limited, 1378 Rt.206., STE 6/280, Skillman, NJ, 08558, USA.
| | - Rajen Shah
- Raptim Research Private Limited, 1378 Rt.206., STE 6/280, Skillman, NJ 08558 USA
| | - Viraj Shah
- Raptim Research Private Limited, 1378 Rt.206., STE 6/280, Skillman, NJ 08558 USA
| | - Milind Bagul
- Raptim Research Private Limited, 1378 Rt.206., STE 6/280, Skillman, NJ 08558 USA
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Takayama S, Namiki T, Arita R, Ono R, Kikuchi A, Ohsawa M, Saito N, Suzuki S, Nakae H, Kobayashi S, Yoshino T, Ishigami T, Tanaka K, Nochioka K, Takagi A, Mimura M, Yamaguchi T, Ishii T, Hisanaga A, Mitani K, Ito T. Multicenter, randomized controlled trial of traditional Japanese medicine, kakkonto with shosaikotokakikyosekko, for mild and moderate coronavirus disease patients. Front Pharmacol 2022; 13:1008946. [PMID: 36438822 PMCID: PMC9682103 DOI: 10.3389/fphar.2022.1008946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/07/2022] [Indexed: 07/30/2023] Open
Abstract
The traditional Japanese (Kampo) medicine, kakkonto with shosaikotokakikyosekko, has antiviral and anti-inflammatory effects. In this randomized trial, patients with mild and moderate coronavirus disease (COVID-19) were randomly allocated to the control group receiving conventional treatment for symptom relief such as antipyretics and antitussives or the Kampo group receiving mixed extract granules of kakkonto (2.5 g) and shosaikotokakikyosekko (2.5 g) three times a day for 14 days in addition to conventional treatment. The main outcome was the number of days until total symptom relief. The secondary outcome was the number of days until each symptom's relief and whether the disease progressed to respiratory failure. We enrolled a total of 161 patients (Kampo group, n = 81; control group, n = 80). The results from Kaplan-Meier estimates of symptom relief showed that there are no significant differences between the groups. However, covariate-adjusted cumulative incidence of fever relief considering competitive risk showed that the recovery was significantly faster in the Kampo group than in the control group (HR 1.76, 95% CI 1.03-3.01). Additionally, the risk of disease progression to moderate COVID-19 requiring oxygen inhalation was lower in the Kampo group than in the control group (Risk Difference -0.13, 95% CI -0.27-0.01). No significant drug-related side effects were observed. Kakkonto with shosaikotokakikyosekko is effective for fever relief with suppression of disease progression in COVID-19 patients. Clinical Trial Registration: https://jrct.niph.go.jp/en-latest-detail/jRCTs021200020, identifier [jRCTs021200020].
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Affiliation(s)
- Shin Takayama
- Department of Education and Support for Regional Medicine (General and Kampo medicine), Tohoku University Hospital, Sendai, Japan
| | - Takao Namiki
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryutaro Arita
- Department of Education and Support for Regional Medicine (General and Kampo medicine), Tohoku University Hospital, Sendai, Japan
| | - Rie Ono
- Department of Education and Support for Regional Medicine (General and Kampo medicine), Tohoku University Hospital, Sendai, Japan
| | - Akiko Kikuchi
- Department of Education and Support for Regional Medicine (General and Kampo medicine), Tohoku University Hospital, Sendai, Japan
| | - Minoru Ohsawa
- Department of Education and Support for Regional Medicine (General and Kampo medicine), Tohoku University Hospital, Sendai, Japan
| | - Natsumi Saito
- Department of Education and Support for Regional Medicine (General and Kampo medicine), Tohoku University Hospital, Sendai, Japan
| | - Satoko Suzuki
- Department of Education and Support for Regional Medicine (General and Kampo medicine), Tohoku University Hospital, Sendai, Japan
| | - Hajime Nakae
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Seiichi Kobayashi
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Tetsuhiro Yoshino
- Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomoaki Ishigami
- Department of Cardiology, Yokohama City University Hospital, Yokohama, Japan
| | - Koichiro Tanaka
- Department of Traditional Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Airi Takagi
- Clinical Research Data Center, Tohoku University Hospital, Sendai, Japan
| | - Masaru Mimura
- Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine (General and Kampo medicine), Tohoku University Hospital, Sendai, Japan
| | | | - Kazuo Mitani
- Medical Corporation Mitani Family Clinic, Osaka, Japan
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Hosseinpoor M, Kabiri M, Rajati Haghi M, Ghadam Soltani T, Rezaei A, Faghfouri A, Poustchian Gholkhatmi Z, Bakhshaee M. Intranasal Corticosteroid Treatment on Recovery of Long-Term Olfactory Dysfunction Due to COVID-19. Laryngoscope 2022; 132:2209-2216. [PMID: 36054369 PMCID: PMC9538270 DOI: 10.1002/lary.30353] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 08/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Olfactory dysfunction is a recognized manifestation in patients infected with Coronavirus Disease 2019 (COVID-19). This investigation aimed to assess the effect of mometasone furoate intranasal spray on the improvement of smell dysfunction in post-COVID-19 patients. MATERIALS AND METHODS This randomized placebo-controlled trial included 80 non-hospitalized adult patients who had persistent anosmia or severe microsmia for more than 4 weeks due to COVID-19 infection. The participants were randomly allocated to the intervention or placebo group to receive mometasone furoate nasal spray or sodium chloride intranasal spray during 4 weeks of follow-up, respectively. The patients' olfactory dysfunction was assessed in terms of visual analog scale (VAS), and smell test score according to the modified version of the University of Pennsylvania smell identification test for the Iranian population. RESULTS A total of 70 participants completed the follow-up period and were analyzed in this study. By comparing the olfactory scores including smell test and VAS scores, no significant differences were found between case and control groups at baseline, 2, and 4 weeks intervals. However, the change of both olfactory scores at pre to post-treatment intervals and 2-4 weeks was significantly higher in the mometasone group relative to the placebo group. At post-treatment, the frequency of anosmia was 22.9% reduced in the case group compared to the control group. CONCLUSION Overall, there was no significant difference in olfactory dysfunction between the two groups during follow-up. However, based on the significant between-group difference in terms of olfactory scores changes, it seems that the nasal corticosteroids may be a positive effect on the recovery process of patients who received more than 2 weeks. LEVEL OF EVIDENCE 2 Laryngoscope, 132:2209-2216, 2022.
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Affiliation(s)
- Masoumeh Hosseinpoor
- Sinus and Surgical Endoscopic Research CenterMashhad University of Medical SciencesMashhadIran
| | - Mona Kabiri
- Clinical Research Development Unit, Ghaem Hospital, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mohsen Rajati Haghi
- Department of Otorhinolaryngology, Sinus and Surgical Endoscopic Research CenterMashhad University of Medical SciencesMashhadIran
| | | | - Alireza Rezaei
- Department of Pathology, Mashhad BranchIslamic Azad University of Medical SciencesMashhadIran
| | - Atiyeh Faghfouri
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Mehdi Bakhshaee
- Department of Otorhinolaryngology, Sinus and Surgical Endoscopic Research CenterMashhad University of Medical SciencesMashhadIran
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COVID-19 in patients with chronic lung disease. Clin Chest Med 2022; 44:385-393. [PMID: 37085227 PMCID: PMC9678841 DOI: 10.1016/j.ccm.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes an acute respiratory tract infection known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 enters cells by binding the ACE2 receptor and coreceptors notably TMPRSS2 or Cathepsin L. Severe COVID-19 infection can lead to acute lung injury. Below we describe the current evidence of the impact of common chronic lung diseases (CLDs) on the development of COVID-19. The impact of treatment of CLD on COVID-19 and any risk of vaccination in patients with CLD are considered.
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Cosentino M, Vernocchi V, Martini S, Marino F, Allasino B, Bàlzola MA, Burigana F, Dallari A, Pagano CSF, Palma A, Rango M. Early Outpatient Treatment of COVID-19: A Retrospective Analysis of 392 Cases in Italy. J Clin Med 2022; 11:6138. [PMID: 36294461 PMCID: PMC9605012 DOI: 10.3390/jcm11206138] [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] [Received: 09/13/2022] [Revised: 10/06/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022] Open
Abstract
COVID-19 was declared a pandemic in March 2020. The knowledge of COVID-19 pathophysiology soon provided a strong rationale for the early use of both anti-inflammatory and antithrombotic drugs; however, its evidence was slowly and partially incorporated into institutional guidelines. The unmet needs of COVID-19 outpatients were taken care of by networks of physicians and researchers. We analyse the characteristics, management and outcomes in COVID-19 outpatients who were taken care of by physicians within the IppocrateOrg Association. In this observational retrospective study, volunteering doctors provided data on 392 COVID-19 patients. The mean age of patients was 48.5 years (range: 0.5-97), and patients were taken care of in COVID-19 stage 0 (15.6%), stage 1 (50.0%), stage 2a (28.8%) and stage 2b (5.6%). Many patients were overweight (26%) or obese (11.5%), with chronic comorbidities (34.9%), mainly cardiovascular (23%) and metabolic (13.3%). The most frequently prescribed drugs included: vitamins and supplements (98.7%), aspirin (66.1%), antibiotics (62%), glucocorticoids (41.8%), hydroxychloroquine (29.6%), enoxaparin (28.6%), colchicine (8.9%), oxygen therapy (6.9%), and ivermectin (2.8%). Hospitalization occurred in 5.8% of cases, mainly in stage 2b (27.3%). A total of 390 patients (99.6%) recovered; one patient was lost at follow up, and one patient died after hospitalization. This is the first real-world study describing the behaviours of physicians caring for COVID-19 outpatients, and the outcomes of COVID-19 early treatment. The lethality in this cohort was 0.2%, while overall, and over the same period, the COVID-19 lethality in Italy was over 3%. The drug use described in this study appears effective and safe. The present evidence should be carefully considered by physicians and political decision makers.
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Affiliation(s)
- Marco Cosentino
- Center for Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
| | | | - Stefano Martini
- Center for Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
| | - Franca Marino
- Center for Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
| | - Barbara Allasino
- IppocrateOrg Association, Via Canova 15, 6900 Lugano, Switzerland
| | | | - Fabio Burigana
- IppocrateOrg Association, Via Canova 15, 6900 Lugano, Switzerland
| | - Alberto Dallari
- IppocrateOrg Association, Via Canova 15, 6900 Lugano, Switzerland
| | | | - Antonio Palma
- IppocrateOrg Association, Via Canova 15, 6900 Lugano, Switzerland
| | - Mauro Rango
- IppocrateOrg Association, Via Canova 15, 6900 Lugano, Switzerland
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White H, McDonald SJ, Barber B, Davis J, Burr L, Nair P, Mukherjee S, Tendal B, Elliott J, McGloughlin S, Turner T. Care for adults with COVID-19: living guidelines from the National COVID-19 Clinical Evidence Taskforce. Med J Aust 2022; 217:368-378. [PMID: 36150213 PMCID: PMC9538623 DOI: 10.5694/mja2.51718] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The Australian National COVID-19 Clinical Evidence Taskforce was established in March 2020 to maintain up-to-date recommendations for the treatment of people with coronavirus disease 2019 (COVID-19). The original guideline (April 2020) has been continuously updated and expanded from nine to 176 recommendations, facilitated by the rapid identification, appraisal, and analysis of clinical trial findings and subsequent review by expert panels. MAIN RECOMMENDATIONS In this article, we describe the recommendations for treating non-pregnant adults with COVID-19, as current on 1 August 2022 (version 61.0). The Taskforce has made specific recommendations for adults with severe/critical or mild disease, including definitions of disease severity, recommendations for therapy, COVID-19 prophylaxis, respiratory support, and supportive care. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINE The Taskforce currently recommends eight drug treatments for people with COVID-19 who do not require supplemental oxygen (inhaled corticosteroids, casirivimab/imdevimab, molnupiravir, nirmatrelvir/ritonavir, regdanvimab, remdesivir, sotrovimab, tixagevimab/cilgavimab) and six for those who require supplemental oxygen (systemic corticosteroids, remdesivir, tocilizumab, sarilumab, baricitinib, casirivimab/imdevimab). Based on evidence of their achieving no or only limited benefit, ten drug treatments or treatment combinations are not recommended; an additional 42 drug treatments should only be used in the context of randomised trials. Additional recommendations include support for the use of continuous positive airway pressure, prone positioning, and endotracheal intubation in patients whose condition is deteriorating, and prophylactic anticoagulation for preventing venous thromboembolism. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- Heath White
- Cochrane AustraliaMonash UniversityMelbourneVIC
| | | | | | - Joshua Davis
- John Hunter HospitalNewcastleNSW
- The University of NewcastleNewcastleNSW
| | - Lucy Burr
- Mater Hospital BrisbaneBrisbaneQLD
- Mater Research InstituteUniversity of QueenslandBrisbaneQLD
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Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper. J Hepatol 2022; 77:1161-1197. [PMID: 35868584 PMCID: PMC9296253 DOI: 10.1016/j.jhep.2022.07.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has presented a serious challenge to the hepatology community, particularly healthcare professionals and patients. While the rapid development of safe and effective vaccines and treatments has improved the clinical landscape, the emergence of the omicron variant has presented new challenges. Thus, it is timely that the European Association for the Study of the Liver provides a summary of the latest data on the impact of COVID-19 on the liver and issues guidance on the care of patients with chronic liver disease, hepatobiliary cancer, and previous liver transplantation, as the world continues to deal with the consequences of the COVID-19 pandemic.
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Kuo KC, Chen CH, Wang CJ, Wu JC, Chung HP, Chen YT, Tang YH, Chang WK, Lin CY, Wu CL. Clinical benefits of inhaled ciclesonide for hospitalized patients with COVID-19 infection: a retrospective study. BMC Pulm Med 2022; 22:368. [PMID: 36171597 PMCID: PMC9517967 DOI: 10.1186/s12890-022-02168-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/20/2022] [Indexed: 01/08/2023] Open
Abstract
Background The successful management of patients infected with coronavirus disease 2019 (COVID-19) with inhaled ciclesonide has been reported, however few studies have investigated its application among hospitalized patients. Methods This retrospective cohort study enrolled all adult patients admitted to our hospital with confirmed COVID-19 infection from May to June 2021. Critical patients who received mechanical ventilation within 24 h after admission and those who started ciclesonide more than 14 days after symptom onset were excluded. The in-hospital mortality rate was compared between those who did and did not receive inhaled ciclesonide. Results A total of 269 patients were enrolled, of whom 184 received inhaled ciclesonide and 85 did not. The use of ciclesonide was associated with lower in-hospital mortality (7.6% vs. 23.5%, p = 0.0003) and a trend of shorter hospital stay (12.0 (10.0–18.0) days vs. 13.0 (10.0–25.3) days, p = 0.0577). In subgroup analysis, the use of inhaled ciclesonide significantly reduced mortality in the patients with severe COVID-19 infection (6.8% vs. 50.0%, p < 0.0001) and in those with a high risk of mortality (16.4% vs. 43.2%, p = 0.0037). The use of inhaled ciclesonide also reduced the likelihood of receiving mechanical ventilation in the patients with severe COVID-19 infection. After multivariate analysis, inhaled ciclesonide remained positively correlated with a lower risk of in-hospital mortality (odds ratio: 0.2724, 95% confidence interval: 0.087–0.8763, p = 0.0291). Conclusions The use of inhaled ciclesonide in hospitalized patients with COVID-19 infection can reduce in-hospital mortality. Further randomized studies in patients with moderate to severe COVID-19 infection are urgently needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02168-8.
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Affiliation(s)
- Kuan-Chih Kuo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chao-Hsien Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chieh-Jen Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan. .,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| | - Jou-Chun Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hsin-Pei Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yen-Ting Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yen-Hsiang Tang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wen-Kuei Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chang-Yi Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chien-Liang Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan
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46
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Doi A, Tomita Y, Okura H, Matsuyama S. Frequent occurrence of mutations in nsp3 and nsp4 of SARS-CoV-2, presumably caused by the inhaled asthma drug ciclesonide. PNAS NEXUS 2022; 1:pgac197. [PMID: 36714870 PMCID: PMC9802299 DOI: 10.1093/pnasnexus/pgac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/17/2022] [Indexed: 02/01/2023]
Abstract
Mutations in nonstructural protein 3 (nsp3) and nsp4 of SARS-CoV-2, presumably induced by the asthma drug ciclesonide (which also has anti-SARS-CoV-2 activity), were counted 5,851 cases in the GISAID EpiCoV genome database. Sporadic occurrence of mutants not linked to each other in the phylogenetic tree were identified at least 88 times; of which, 58 had one or more descendants in the same branch. Five of these had spread to more than 100 cases, and one had expanded to 4,748 cases, suggesting the mutations are frequent, selected in individual patients, and transmitted to form clusters of cases. Clinical trials of ciclesonide as a treatment for COVID-19 are the presumed cause of the frequent occurrence of mutations between 2020 June and 2021 November. In addition, because ciclesonide is a common treatment for asthma, it can drive mutations in asthmatics suffering from COVID-19. Ciclesonide-resistant mutations, which have unpredictable effects in humans, are likely to continue to emerge because SARS-CoV-2 remains prevalent globally.
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Affiliation(s)
- Akihiro Doi
- Research Center for Influenza and Respiratory Viruses, National Institute of Infectious Diseases, Murayama Branch, 4-7-1 Gakuen, Musashi-Murayama, Tokyo 208-0011, Japan
| | - Yuriko Tomita
- Research Center for Influenza and Respiratory Viruses, National Institute of Infectious Diseases, Murayama Branch, 4-7-1 Gakuen, Musashi-Murayama, Tokyo 208-0011, Japan
| | - Hiyori Okura
- Research Center for Influenza and Respiratory Viruses, National Institute of Infectious Diseases, Murayama Branch, 4-7-1 Gakuen, Musashi-Murayama, Tokyo 208-0011, Japan
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47
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Manna PR, Gray ZC, Sikdar M, Reddy H. COVID-19 and its genomic variants: Molecular pathogenesis and therapeutic interventions. EXCLI JOURNAL 2022; 21:1196-1221. [PMID: 36381644 PMCID: PMC9650701 DOI: 10.17179/excli2022-5315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022]
Abstract
Coronavirus disease-19 (COVID-19), caused by a β-coronavirus and its genomic variants, is associated with substantial morbidities and mortalities globally. The COVID-19 virus and its genomic variants enter host cells upon binding to the angiotensin converting enzyme 2 receptors that are expressed in a variety of tissues, but predominantly in the lungs, heart, and blood vessels. Patients afflicted with COVID-19 may be asymptomatic or present with critical symptoms possibly due to diverse lifestyles, immune responses, aging, and underlying medical conditions. Geriatric populations, especially men in comparison to women, with immunocompromised conditions, are most vulnerable to severe COVID-19 associated infections, complications, and mortalities. Notably, whereas immunomodulation, involving nutritional consumption, is essential to protecting an individual from COVID-19, immunosuppression is detrimental to a person with this aggressive disease. As such, immune health is inversely correlated to COVID-19 severity and resulting consequences. Advances in genomic and proteomic technologies have helped us to understand the molecular events underlying symptomatology, transmission and, pathogenesis of COVID-19 and its genomic variants. Accordingly, there has been development of a variety of therapeutic interventions, ranging from mask wearing to vaccination to medication. This review summarizes the current understanding of molecular pathogenesis of COVID-19, effects of comorbidities on COVID-19, and prospective therapeutic strategies for the prevention and treatment of this contagious disease.
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Affiliation(s)
- Pulak R. Manna
- Department of Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA,*To whom correspondence should be addressed: Pulak R. Manna, Department of Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA; Tel: +1-806-743-3573, Fax: +1-806-743-3143, E-mail:
| | - Zackery C. Gray
- Department of Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA
| | - Malabika Sikdar
- Department of Zoology, Dr. Hari Singh Gour Vishwavidyalaya, Sagar, MP 470003, India
| | - Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA,Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA,Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA,Public Health Department of the Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA,Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA,Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
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Zhang H, Lao Q, Zhang J, Zhu J. Coagulopathy in COVID-19 and anticoagulation clinical trials. Best Pract Res Clin Haematol 2022; 35:101377. [PMID: 36494146 PMCID: PMC9395291 DOI: 10.1016/j.beha.2022.101377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/02/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory disease coronavirus 2 (SARS-COV-2) first emerged in Wuhan, China, in December 2019 and has caused a global pandemic of a scale unprecedented in the modern era. People infected with SARS-CoV-2 can be asymptomatic, moderate symptomatic or develop severe COVID-19. Other than the typical acute respiratory distress syndrome (ARDS), patients with moderate or severe COVID-19 also develop a distinctive systemic coagulopathy, known as COVID-19-associated coagulopathy (CAC), which is different from sepsis-related forms of disseminated intravascular coagulation (DIC). Endotheliopathy or endotheliitis are other unique features of CAC. The endothelial cell perturbation can further increase the risk of thrombotic events in COVID-19 patients. In this review, we will summarize the current knowledge on COVID-19 coagulopathy and the possible mechanisms for the condition. We also discuss the results of clinical trials testing methods for mitigating thrombosis events in COVID-19 patients.
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Affiliation(s)
- Heng Zhang
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI, USA
| | - Qifang Lao
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI, USA; Department of Critical Care Medicine, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Jue Zhang
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI, USA
| | - Jieqing Zhu
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI, USA; Department of Biochemistry, Medical College of Wisconsin, Milwaukee, WI, USA.
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ESCMID COVID-19 guidelines: update on treatment for patients with mild/moderate disease. Clin Microbiol Infect 2022; 28:1578-1590. [PMID: 36028088 PMCID: PMC9398787 DOI: 10.1016/j.cmi.2022.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022]
Abstract
Scope Despite the large availability of vaccines, coronavirus disease 2019 (COVID-19), induced by severe acute respiratory syndrome coronavirus 2, continues to be a major threat for health-care providers and fragile people. A number of options are now available for outpatients with mild-to-moderate COVID-19 at the risk of disease progression for the prevention of deaths or hospitalization. Methods A European Society of Clinical Microbiology and Infectious Diseases COVID-19 guidelines task force was established by the European Society of Clinical Microbiology and Infectious Diseases Executive Committee. A small group was established, half appointed by the chair and the remaining selected based on an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A long list of clinical questions using the population, intervention, comparison, outcome format was developed at the beginning of the process. For each population, intervention, comparison, outcome, two panel members performed a literature search, with a third panelist involved in case of inconsistent results. Voting was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendations In this update, we focus on anti-viral agents, monoclonal antibodies (mAbs) and other treatment options proposed for patients with mild or moderate COVID-19 who are at the risk of hospitalization or death. Although the use of anti-virals is recommended, especially nirmatrelvir/ritonavir and remdesivir or, alternatively, molnupirarvir, the administration of mAbs against the spike protein strictly depends on circulating variants or the ability to test timely for variants and sub-variants. At the time of writing (April–June 2022), the only active mAb was tixagevimab/cilgavimab given the predominance of the Omicron BA.2, BA.3, BA.4 and BA.5 sub-lineages in Europe. However, considering that the epidemiological scenario is extremely dynamic, constant monitoring of variants of concern is mandatory.
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50
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Wang S, Gelfand JM, Calabrese C. Outpatient Management of COVID-19: A Primer for the Dermatologist. CURRENT DERMATOLOGY REPORTS 2022; 11:318-327. [PMID: 36035078 PMCID: PMC9391204 DOI: 10.1007/s13671-022-00368-3] [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] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review To summarize diagnostic and therapeutic management of COVID-19 in the outpatient setting for dermatologists. Recent Findings Paxlovid (nirmatrelvir-ritonavir) is the preferred treatment in patients with mild symptoms at high risk of progression to severe SARS-CoV2 infection. Additional options include monoclonal antibodies (bebtelovimab), remdesivir, and molnupiravir. Summary Dermatologists need to be aware of recent developments in diagnostic and therapeutic management of COVID-19 in the outpatient setting, as their patients may rely on dermatologists to provide advice, particularly in cases where treatments for dermatological disease may impact the risk of COVID-19 and/or vaccine efficacy. Supplementary Information The online version contains supplementary material available at 10.1007/s13671-022-00368-3.
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Affiliation(s)
- Sonia Wang
- University of Pennsylvania, Perelman School of Medicine, PA 19104 Philadelphia, USA
| | - Joel M. Gelfand
- University of Pennsylvania, Perelman School of Medicine, PA 19104 Philadelphia, USA
- Department of Dermatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Cassandra Calabrese
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, OH 44195 USA
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