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El Taguri A, Nasef A. The world is waiting, use sequential analysis and get us the evidence-based treatment we need for COVID-19. Libyan J Med 2020; 15:1770518. [PMID: 32459574 PMCID: PMC7646536 DOI: 10.1080/19932820.2020.1770518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In spite of the relatively high morbidity and mortality, there is no approved medication yet for COVID-19. There are more than 200 ongoing trials on different drugs or vaccines, but new medications may take until 2021 to develop. Defining the optimal number of patients to be included in a study is a considerable challenge in these interventional researches. Ethical considerations prompt researchers to minimize the number of patients included in a trial. This gains particular importance when the disease is rare or lethal which is particularly so in the case of COVID-19. It is of paramount importance to explore some of the available tools that could help accelerate the adoption of any or some of the many proposed modalities for the treatment of diseases. These tools should be effective, yet efficient, for rapid testing of such treatments. Sequential analysis has not been frequently used in many clinical trials where it should have been used. None of the authors in published literature, as far as we know, used sequential analysis techniques to test potential drugs for COVID-19. In addition to its usefulness when the results of new forms of treatment are quickly needed, other important benefit of sequential analysis includes the ability to reach a similar conclusion about the utility of a new drug without unduly exposing more patients to the side effect of the old drug, in particularly, for the treatment of a rare disease.
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Affiliation(s)
- Adel El Taguri
- National Center for Accreditation of Health Establishments- , Tripoli-Libya, Libya.,Community Medicine Department, Faculty of Medicine-University of Tripoli , Tripoli-Libya, Libya
| | - Aisha Nasef
- Authority of Natural Science Research and Technology , Tripoli-Libya, Libya.,Scientific Council of Laboratory Medicine, Medical Specialty council , Tripoli-Libya, Libya
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Nieber K, Raskopf E, Möller J, Kelber O, Fürst R, Shah-Hosseini K, Singh J, Kraft K, Mösgens R. Pharmaco-epidemiological research on herbal medicinal products in the paediatric population: data from the PhytoVIS study. Eur J Pediatr 2020; 179:507-512. [PMID: 31823076 PMCID: PMC7028796 DOI: 10.1007/s00431-019-03532-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
In paediatrics, clinical study data are limited, especially on herbal medicinal products. To address this gap, 2063 datasets from the paediatric population were evaluated in the PhytoVIS data base. By screening for paediatric data, information on indication, gender, treatment, co-medication and tolerability were evaluated. The majority of patients was treated because of common cold, fever, digestive complaints, skin diseases, sleep disturbances and anxiety. The perceived effect of the therapy was rated in 84% of the patients as very good or good without adverse events. The data shed light on a still neglected field of phyto-pharmacotherapy by giving information on the use of herbal medicines in an unselected cohort of paediatric patients. The results confirm the good clinical effects and safety of herbal medicinal products in this patient population and show that they are widely used in Germany.What is Known:• In Germany, about 85% of children receive one or more herbal medicinal products per year.• Despite international initiatives to promote clinical research in paediatrics, there are still many gaps of knowledge in the use of drugs in paediatrics.What is New:• The PhytoVIS project evaluated 2063 data sets from the paediatric population using herbal medicinal products.• The majority of patients was treated because of common cold, fever, digestive complaints, skin diseases, sleep disturbances and anxiety, and 84% of the patients rated the therapy as very good or good without adverse events.
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Affiliation(s)
- Karen Nieber
- Institute of Pharmacy, University of Leipzig, Brüderstr. 34, 04103, Leipzig, Germany. .,Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173, Bonn, Germany.
| | - Esther Raskopf
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany ,ClinNovis GmbH, Genter Str. 7, 50672 Cologne, Germany
| | - Johanna Möller
- Bayer Consumer Health, Research & Development, Phytomedicines Supply and Development Center, Steigerwald Arzneimittelwerk GmbH, Havelstr. 5, 64295 Darmstadt, Germany
| | - Olaf Kelber
- Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173 Bonn, Germany ,ClinNovis GmbH, Genter Str. 7, 50672 Cologne, Germany
| | - Robert Fürst
- Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173 Bonn, Germany ,grid.7839.50000 0004 1936 9721Institute of Pharmaceutical Biology, Goethe University Frankfurt, Max-von-Laue-Str. 9, 60438 Frankfurt, Germany
| | - Kija Shah-Hosseini
- Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173 Bonn, Germany
| | - Jaswinder Singh
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany ,ClinNovis GmbH, Genter Str. 7, 50672 Cologne, Germany
| | - Karin Kraft
- Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173 Bonn, Germany ,grid.10493.3f0000000121858338Chair of Naturopathy, University Medicine Rostock, Ernst-Heydemann Str. 6, 18057 Rostock, Germany
| | - Ralph Mösgens
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany ,ClinNovis GmbH, Genter Str. 7, 50672 Cologne, Germany
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Treatment of opioid withdrawal in neonates with morphine, phenobarbital, or chlorpromazine: a randomized double-blind trial. Eur J Pediatr 2020; 179:141-149. [PMID: 31691849 PMCID: PMC6942588 DOI: 10.1007/s00431-019-03486-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 01/09/2023]
Abstract
Three suitable compounds (morphine, chlorpromazine, and phenobarbital) to treat neonatal abstinence syndrome were compared in a prospective multicenter, double-blind trial. Neonates exposed to opioids in utero were randomly allocated to one of three treatment groups. When a predefined threshold of a modified Finnegan score was reached, treatment started and increased stepwise until symptoms were controlled. If symptoms could not be controlled with the predefined maximal dose of a single drug, a second drug was added. Among 143 infants recruited, 120 needed pharmacological treatment. Median length of treatment for morphine was 22 days (95% CI 18 to 33), for chlorpromazine 25 days (95% CI 21 to 34), and for phenobarbital 32 days (95% CI 27 to 38) (p = ns). In the morphine group, only 3% of infants (1/33) needed a second drug; in the chlorpromazine group, this proportion was 56% (24/43), and in the phenobarbital group 30% (13/44).Conclusion: None of the drugs tested for treating neonatal abstinence syndrome resulted in a significantly shorter treatment length than the others. As morphine alone was able to control symptoms in almost all infants, it may be preferred to the two other drugs but should still be tested against more potent opioids such as buprenorphine.Trial registration: At ClinicalTrials.gov NCT02810782 (registered retrospectively).What is Known:• Neonates exposed to opiates in utero and presenting with withdrawal symptoms should first be treated by non-pharmacological supportive measures.• In those who fail, drugs have to be given, but there is controversy which drug is best.What is New:• Among three candidates, morphine, chlorpromazine and phenobarbital, none resulted in significantly shorter treatment time.• As morphine alone was able to control symptoms in almost all infants, it may be preferred to the two other drugs.
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