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Zhang RR, Shao MY, Fu Y, Zhao RX, Wang JW, Fang YX. Benefit-Risk Assessment of Chinese Medicine Injections for Primary Liver Cancer Based on Multi-criteria Decision Analysis. Chin J Integr Med 2024; 30:559-564. [PMID: 37697203 DOI: 10.1007/s11655-023-3704-2] [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] [Accepted: 04/14/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To evaluate the benefit-risk of 3 commonly used Chinese medicine injections, Aidi Injection (ADI), Cinobufagin Injection (CINI) and Compound Kushen Injection (CKI), in the treatment of primary liver cancer (PLC), so as to provide a reference for clinical decision-making. METHODS Randomized controlled trials (RCTs) of ADI, CINI and CKI in the treatment of PLC published in the databases of China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, SinoMed, PubMed, Cochrane Library, and Web of Science were retrieved from January 2020 to October 2022. The data of benefit and risk indicators were combined to obtain the effect value. The multi-criteria decision analysis (MCDA) model was applied to build the decision tree. The benefit value, risk value and benefit risk value of the 3 injections in PLC treatment were calculated. Monte Carlo simulation was carried out to calculate the 95% confidence interval and probability of differences among the 3 injections, so as to optimize the evaluation results. RESULTS A total of 71 RCTs were included. The benefit values of ADI, CINI and CKI combined with transcatheter arterial chemoembolization (TACE) were 42, 38 and 36, respectively. The risk values were 42, 25 and 37, respectively. The benefit risk values were 42, 31 and 37, respectively. The benefit risk differences of ADI vs. CINI, ADI vs. CKI, and CKI vs. CINI were 11 (-0.86, 17.75), 5 (-5.01, 11.09), and 6 (-1.87, 12.63), respectively. The probability that ADI superior to CINI, ADI superior to CKI, and CKI superior to CINI was 96.26%, 77.27%, and 92.62%, respectively. CONCLUSION Based on the results of MCDA model, CINI combined with TACE has the greatest risk in the treatment of the PLC. Considering the efficacy and safety, the possible priority of the 3 Chinese medicine injections combined with TACE in the treatment of PLC is ADI, CKI and CINI.
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Affiliation(s)
- Rong-Rong Zhang
- The First Clinical Medical College of Henan University of Traditional Chinese Medicine, Zhengzhou, 450046, China
| | - Ming-Yi Shao
- Personal Department, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China.
| | - Yu Fu
- Scientific Research Department, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China
| | - Rui-Xia Zhao
- Scientific Research Department, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China
| | - Jing-Wen Wang
- Digestive Department, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China
| | - Yu-Xuan Fang
- The First Clinical Medical College of Henan University of Traditional Chinese Medicine, Zhengzhou, 450046, China
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2
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Kubiliute I, Urboniene J, Majauskaite F, Bobkov E, Svetikas L, Jancoriene L. Elevated Cardiac Troponin I as a Mortality Predictor in Hospitalised COVID-19 Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:842. [PMID: 38929459 PMCID: PMC11205688 DOI: 10.3390/medicina60060842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/05/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: SARS-CoV-2 affects multiple organ systems, including the cardiovascular system, leading to immediate and long-term cardiovascular complications. Acute myocardial injury is one of the earliest and most common cardiac issues in the acute phase of COVID-19. This study aimed to evaluate the prognostic value of cardiac troponin I (cTnI) levels in predicting in-hospital mortality among hospitalised COVID-19 patients. Materials and Methods: A retrospective observational cohort study included 2019 adult patients hospitalised with a confirmed COVID-19 infection stratified by cTnI levels on admission into three groups: <19 ng/L (1416 patients), 19-100 ng/L (431 patients), and >100 ng/L (172 patients). Myocardial injury was defined as blood serum cTnI levels increased above the 99th percentile upper reference limit. Depersonalised datasets were extracted from digital health records. Statistical analysis included multivariable binary logistic and Cox proportional hazards regressions. Results: Overall, 29.87% of patients experienced acute myocardial injury, which development was associated with age, male sex, chronic heart failure, arterial hypertension, obesity, and chronic kidney disease. Among patients with cTnI levels of 19-100 ng/L, the odds ratio for requiring invasive mechanical ventilation was 3.18 (95% CI 2.11-4.79) and, for those with cTnI > 100 ng/L, 5.38 (95% CI 3.26-8.88). The hazard ratio for in-hospital mortality for patients with cTnI levels of 19-100 ng/L was 2.58 (95% CI 1.83-3.62) and, for those with cTnI > 100 ng/L, 2.97 (95% CI 2.01-4.39) compared to patients with normal cTnI levels. Conclusions: Increased cardiac troponin I, indicating myocardial injury, on admission is associated with a more adverse clinical disease course, including a higher likelihood of requiring invasive mechanical ventilation and increased risk of in-hospital mortality. This indicates cardiac troponin I to be a beneficial biomarker for clinicians trying to identify high-risk COVID-19 patients, choosing the optimal monitoring and treatment strategy for these patients.
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Affiliation(s)
- Ieva Kubiliute
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (F.M.); (L.S.); (L.J.)
| | - Jurgita Urboniene
- Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania;
| | - Fausta Majauskaite
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (F.M.); (L.S.); (L.J.)
| | - Edgar Bobkov
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Linas Svetikas
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (F.M.); (L.S.); (L.J.)
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (F.M.); (L.S.); (L.J.)
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Jansen-van Vuuren RD, Jedlovčnik L, Košmrlj J, Massey TE, Derdau V. Deuterated Drugs and Biomarkers in the COVID-19 Pandemic. ACS OMEGA 2022; 7:41840-41858. [PMID: 36440130 PMCID: PMC9685803 DOI: 10.1021/acsomega.2c04160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/18/2022] [Indexed: 06/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially identified in Wuhan (China) in December 2019, COVID-19 rapidly spread globally, resulting in the COVID-19 pandemic. Carriers of the SARS-CoV-2 can experience symptoms ranging from mild to severe (or no symptoms whatsoever). Although vaccination provides extra immunity toward SARS-CoV-2, there has been an urgent need to develop treatments for COVID-19 to alleviate symptoms for carriers of the disease. In seeking a potential treatment, deuterated compounds have played a critical role either as therapeutic agents or as internal MS standards for studying the pharmacological properties of new drugs by quantifying the parent compounds and metabolites. We have identified >70 examples of deuterium-labeled compounds associated with treatment of COVID-19. Of these, we found 9 repurposed drugs and >20 novel drugs studied for potential therapeutic roles along with a total of 38 compounds (drugs, biomarkers, and lipids) explored as internal mass spectrometry standards. This review details the synthetic pathways and modes of action of these compounds (if known), and a brief analysis of each study.
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Affiliation(s)
- Ross D. Jansen-van Vuuren
- Faculty
of Chemistry and Chemical Technology, University
of Ljubljana, Večna pot 113, Ljubljana 1000, Slovenia
- Department
of Chemistry, Queen’s University, 90 Bader Lane, Kingston, Ontario K7L
3N6, Canada
| | - Luka Jedlovčnik
- Faculty
of Chemistry and Chemical Technology, University
of Ljubljana, Večna pot 113, Ljubljana 1000, Slovenia
| | - Janez Košmrlj
- Faculty
of Chemistry and Chemical Technology, University
of Ljubljana, Večna pot 113, Ljubljana 1000, Slovenia
| | - Thomas E. Massey
- Department
of Biomedical and Molecular Sciences, School of Medicine, Queen’s University, Botterell Hall, 18 Stuart Street, Kingston, Ontario K7L 3N6, Canada
| | - Volker Derdau
- Research
& Development, Integrated Drug Discovery, Isotope Chemistry, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst G876, Frankfurt/Main 65926, Germany
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Gülhan M, Önal U, Demirci N, Cetin G, Calisir A, Köksalan D, Solmaz K, Kars A, Kilinc C, Gülten S. Tocilizumab is useful for coronavirus disease 2019 patients: the key point is timing. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:318-322. [PMID: 35442357 DOI: 10.1590/1806-9282.20210602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In coronavirus disease 2019, a rapidly progressive inflammatory process is considered to be the main cause of organ damage and mortality. Therefore, the importance of anti-inflammatory treatments such as tocilizumab is increasing. METHODS A total of 107 patients who received tocilizumab between March 2020 and March 2021 were included in the study. The primary termination point was mortality. We compared surviving and deceased patients by the stage of the disease and where the drug was given (service or intensive care unit). RESULTS The mean age was 60.8±14.6 years (minimum 29 years, maximum 96 years). According to the WHO staging system, 16 (15%) patients had moderate, 47 (43.9%) patients had severe, 44 (41.1%) patients had a critical illness. Although all patients were admitted to the service, 26 (24.3%) patients received tocilizumab in the intensive care unit. Of 107 patients, 80 (74.7%) survived and 27 (25.2%) died. Mortality was found to be significantly higher in critical patients (96.3%), severe patients (3.7%), and moderate patients (0%) (p<0.001). Peripheral oxygen saturation measured at admission was found to be significantly lower in patients who died. The initial saturations (p=0.008) were found to have independent effects on mortality. CONCLUSION The results showed that tocilizumab is an effective treatment option for coronavirus disease 2019 disease and reduces mortality, but the key point is timing.
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Affiliation(s)
- Muhammet Gülhan
- Kastamonu Training and Research Hospital, Department of Infectious Diseases - Kastamonu, Turkey
| | - Uğur Önal
- Kastamonu Training and Research Hospital, Department of Infectious Diseases - Kastamonu, Turkey
| | - Neşe Demirci
- Kastamonu Training and Research Hospital, Department of Infectious Diseases - Kastamonu, Turkey
| | - Gulcan Cetin
- Kastamonu Training and Research Hospital, Department of Chest Diseases - Kastamonu, Turkey
| | - Abdullah Calisir
- Kastamonu Training and Research Hospital, Department of Internal Medicine - Kastamonu, Turkey
| | - Damla Köksalan
- Kastamonu Training and Research Hospital, Department of Internal Medicine - Kastamonu, Turkey
| | - Kübra Solmaz
- Kastamonu Training and Research Hospital, Department of Internal Medicine - Kastamonu, Turkey
| | - Ayhan Kars
- Kastamonu Training and Research Hospital, Department of Ear, Nose and Throat Diseases - Kastamonu, Turkey
| | - Cetin Kilinc
- Kastamonu Training and Research Hospital, Department of Microbiology - Kastamonu, Turkey
| | - Sedat Gülten
- Kastamonu Training and Research Hospital, Department of Biochemistry - Kastamonu, Turkey
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Yousif M, Abd El-Raheem G, Mohamed D. Use of Remdesivir in the treatment of Coronavirus Disease 2019 (COVID-19) infection among Sudanese patients: a case series. F1000Res 2022; 10:512. [PMID: 35387271 PMCID: PMC8941288 DOI: 10.12688/f1000research.51375.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic is affecting populations worldwide. Remdesivir is an anti-retroviral agent, with a broad spectrum of usage. Remdesivir usage against COVID-19 had been studied both
in vitro and
in vivo but is still considered a new treatment for COVID-19 and is not available in all countries. The aim of our study was to report several cases of the use of Remdesivir in Sudanese patients and report the adverse events related to the course of treatment. Methods: A case series study was conducted in Imperial Hospital, Khartoum, Sudan reporting two cases who received Remdesivir for treating COVID-19 besides other treatments such as steroids and supportive therapy in December 2020. Cases were males aged over 65 years. Cases presentation: Both patients were severe cases of COVID-19 admitted to the intensive care unit (ICU), who received Remdesivir for treating COVID-19 infection. Several side effects were reported: the first case had increased liver enzymes and then unexpectedly died from severe resistant hypotension; and hypoalbuminemia was noticed in the second case. Conclusions: Remdesivir use among patients in Sudan must be studied extensively in order to determine the unexpected fatal event and assess the association of this event to Remdesivir use, as well as to report the frequency of the side effects.
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Affiliation(s)
- Maysoun Yousif
- Emergency, Imperial Hospital, Khartoum, Khartoum, 11114, Sudan
| | - Ghada Abd El-Raheem
- Pharmacy, Imperial Hospital, Military Hospital, Soba University Hospital, Khartoum, Khartoum, 11114, Sudan
| | - Doaa Mohamed
- Emergency Department, Imperial Hospital, Khartoum, Khartoum, 11114, Sudan
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Molecular Insights of SARS-CoV-2 Antivirals Administration: A Balance between Safety Profiles and Impact on Cardiovascular Phenotypes. Biomedicines 2022; 10:biomedicines10020437. [PMID: 35203646 PMCID: PMC8962379 DOI: 10.3390/biomedicines10020437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has resulted in a complex clinical challenge, caused by a novel coronavirus, partially similar to previously known coronaviruses but with a different pattern of contagiousness, complications, and mortality. Since its global spread, several therapeutic agents have been developed to address the heterogeneous disease treatment, in terms of severity, hospital or outpatient management, and pre-existing clinical conditions. To better understand the rationale of new or old repurposed medications, the structure and host–virus interaction molecular bases are presented. The recommended agents by EDSA guidelines comprise of corticosteroids, JAK-targeting monoclonal antibodies, IL-6 inhibitors, and antivirals, some of them showing narrow indications due to the lack of large population trials and statistical power. The aim of this review is to present FDA-approved or authorized for emergency use antivirals, namely remdesivir, molnupinavir, and the combination nirmatrelvir-ritonavir and their impact on the cardiovascular system. We reviewed the literature for metanalyses, randomized clinical trials, and case reports and found positive associations between remdesivir and ritonavir administration at therapeutic doses and changes in cardiac conduction, relatable to their previously known pro-arrhythmogenic effects and important ritonavir interactions with cardioactive medications including antiplatelets, anti-arrhythmic agents, and lipid-lowering drugs, possibly interfering with pre-existing therapeutic regimens. Nonetheless, safety profiles of antivirals are largely questioned and addressed by health agencies, in consideration of COVID-19 cardiac and pro-thrombotic complications generally experienced by predisposed subjects. Our advice is to continuously adhere to the strict indications of FDA documents, monitor the possible side effects of antivirals, and increase physicians’ awareness on the co-administration of antivirals and cardiovascular-relevant medications. This review dissects the global and local tendency to structure patient-based treatment plans, for a glance towards practical application of precision medicine.
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7
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Most published systematic reviews of remdesivir for COVID-19 were redundant and lacked currency. J Clin Epidemiol 2022; 146:22-31. [PMID: 35192923 PMCID: PMC8858007 DOI: 10.1016/j.jclinepi.2022.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
Objective To investigate the completeness and currency of published systematic reviews of remdesivir for COVID-19 and to compare this with a living guidelines approach. Study Design and Setting In this cross-sectional study, we searched Europe PMC on May 20, 2021 for systematic reviews of remdesivir (including preprints, living review updates). Completeness and currency were based on the inclusion of four major randomized trials of remdesivir available at the time of publication of the review (including as preliminary results and preprints). Results We included 38 reviews (45 reports), equivalent to a new publication every 9 days. 23 (51%) reports were out of date at the time of publication. Eleven reviews that were current on publication had a median survival time of 10 days (range 4–57). A third of reviews cited other systematic reviews, but only four provided justifications for why another review was necessary. Eight (21%) of the reviews were registered in PROSPERO. The Australian COVID-19 Clinical Evidence Taskforce living guidelines were updated within 14 days for three of the remdesivir trials, and within 28 days for the fourth. Conclusion There was considerable duplication of systematic reviews of remdesivir, and half were already out of date at the time of publication.
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8
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Monroe I, Dale M, Schwabe M, Schenkel R, Schenarts PJ. The COVID-19 Patient in the Surgical Intensive Care Unit. Surg Clin North Am 2022; 102:1-21. [PMID: 34800379 PMCID: PMC8479422 DOI: 10.1016/j.suc.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
COVID-19 continues to rampage around the world. Noncritical care-trained physicians may be deployed into the intensive care unit to manage these complex patients. Although COVID-19 is primarily a respiratory disease, it is also associated with significant pathology in the brain, heart, vasculature, lungs, gastrointestinal tract, and kidneys. This article provides an overview of COVID-19 using an organ-based, systematic approach.
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9
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Malik MI, Zafar SAF, Malik M, Qayyum F, Akram I, Arshad A, Waheed K, Saleem J, Jabbar A, Tahir MJ, Yousaf Z. The utility of remdesivir in SARS-CoV-2: A single tertiary care center experience from a developing country. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100107. [PMID: 35156078 PMCID: PMC8823973 DOI: 10.1016/j.rcsop.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Remdesivir is a monophosphoramidate prodrug of an adenosine analog, and it has a broad-spectrum antiviral activity against paramyxoviruses, flaviviruses, and coronaviruses. Remdesivir is associated with decreased hospital stay and improved outcomes in coronavirus- disease 2019 (COVID-19). Methodology Of 846 suspected COVID-19 patients admitted to the hospital, 612 SARS-CoV-2 nasopharyngeal RT-PCR positive patients were evaluated for enrollment in this prospective cohort study. 159 RT-PCR positive patients were given remdesivir. Their clinical, biochemical parameters, hospital stay, and outcomes related to morbidity and mortality were followed. Results Out of the 159 patients, 141 recovered after remdesivir use. The Chi-square test for independence examined the relation between the day of the first dose, dose of remdesivir, and clinical outcome. The standardized case fatality ratio (CFR) in the 453 hospitalized patients who did not receive remdesivir was 32.89% (N = 149) as compared to 11.32% (N = 18) in the patients who received remdesivir. These findings are in keeping with the therapeutic value of remdesivir in symptomatic SARS-CoV-2 infection of varying severity. Conclusion The use of remdesivir is associated with a decrease in the severity of the SARS-CoV-2 infection. Its use is also associated with a decreased length of hospital stay and lower mortality than the patients who did not receive remdesivir. In this study remdesivir was used as adjuvant therapy in moderate COVID-19 illness. Earlier administration of remdesivir led to a lower mortality rate and a shorter duration of hospital stay. Inflammatory parameters improved by 7th day of treatment. There is a reduction in case fatality ratio with use of remdesivir in moderate COVID-19.
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Xu X, Yue L, Li B, Liu Y, Wang Y, Zhang W, Wang L. DSGAT: predicting frequencies of drug side effects by graph attention networks. Brief Bioinform 2022; 23:6511198. [DOI: 10.1093/bib/bbab586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 12/22/2022] Open
Abstract
Abstract
A critical issue of drug risk–benefit evaluation is to determine the frequencies of drug side effects. Randomized controlled trail is the conventional method for obtaining the frequencies of side effects, while it is laborious and slow. Therefore, it is necessary to guide the trail by computational methods. Existing methods for predicting the frequencies of drug side effects focus on modeling drug–side effect interaction graph. The inherent disadvantage of these approaches is that their performance is closely linked to the density of interactions but which is highly sparse. More importantly, for a cold start drug that does not appear in the training data, such methods cannot learn the preference embedding of the drug because there is no link to the drug in the interaction graph. In this work, we propose a new method for predicting the frequencies of drug side effects, DSGAT, by using the drug molecular graph instead of the commonly used interaction graph. This leads to the ability to learn embeddings for cold start drugs with graph attention networks. The proposed novel loss function, i.e. weighted $\varepsilon$-insensitive loss function, could alleviate the sparsity problem. Experimental results on one benchmark dataset demonstrate that DSGAT yields significant improvement for cold start drugs and outperforms the state-of-the-art performance in the warm start scenario. Source code and datasets are available at https://github.com/xxy45/DSGAT.
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KÜÇÜK BEYZANUR, ŞİMŞEK RAHİME, ERDEMLİ KÖSE SELİNAYBAŞAK, YİRÜN ANIL, Erkekoglu P. Adverse Effects of COVID-19 Treatments: A Special Focus on Susceptible Populations. J Environ Pathol Toxicol Oncol 2022; 41:45-64. [DOI: 10.1615/jenvironpatholtoxicoloncol.2022039271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Abstract
Background COVID-19 is an ongoing viral pandemic produced by SARS-CoV-2. In light of in vitro efficacy, several medications were repurposed for its management. During clinical use, many of these medications produced inconsistent results or had varying limitations. Objective The purpose of this literature review is to explain the variable efficacy or limitations of Lopinavir/Ritonavir, Remdesivir, Hydroxychloroquine, and Favipiravir in clinical settings. Method A study of the literature on the pharmacodynamics (PD), pharmacokinetics (PK), safety profile, and clinical trials through academic databases using relevant search terms. Results & discussion The efficacy of an antiviral drug against COVID-19 is associated with its ability to achieve therapeutic concentration in the lung and intestinal tissues. This efficacy depends on the PK properties, particularly protein binding, volume of distribution, and half-life. The PK and PD of the model drugs need to be integrated to predict their limitations. Conclusion Current antiviral drugs have varying pharmacological constraints that may associate with limited efficacy, especially in severe COVID-19 patients, or safety concerns.
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Qomara WF, Primanissa DN, Amalia SH, Purwadi FV, Zakiyah N. Effectiveness of Remdesivir, Lopinavir/Ritonavir, and Favipiravir for COVID-19 Treatment: A Systematic Review. Int J Gen Med 2021; 14:8557-8571. [PMID: 34849001 PMCID: PMC8627269 DOI: 10.2147/ijgm.s332458] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/09/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel strain that causes acute respiratory illnesses known as coronavirus disease 2019 (COVID-19). Currently, there is limited information regarding the therapeutic management for this disease. Several studies have stated that antivirals drugs such as remdesivir, favipiravir, and lopinavir/ritonavir may potentially inhibit the virus from spreading to the host. OBJECTIVE The aim of this systematic review was to summarize the clinical effectiveness and safety of remdesivir, favipiravir, and lopinavir/ritonavir on COVID-19. METHODS The PubMed and Cochrane Library databases were searched up to July 2021 to identify eligible experimental randomized controlled trials on remdesivir, favipiravir, and lopinavir/ritonavir for COVID-19 patients. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. RESULTS From 158 references, 15 studies were included in the review. The results showed that remdesivir has some potential benefits for hospitalized COVID-19 patients, as seen from clinical improvements such as faster recovery time, less duration of hospitalization, and fewer respiratory side effects among COVID-19 patients. However, the impact of remdesivir in reducing mortality remains uncertain. Treatment with favipiravir has shown promising improvement in the clinical status of COVID-19 patients, although the results suggested no significant differences in some clinical parameters such as length of hospitalizations and clinical recovery. A combination of favipiravir with other supportive therapy showed more favorable outcomes for COVID-19 patients. Furthermore, the use of lopinavir/ritonavir in COVID-19 patients reported no significant clinical improvement compared to standard care with notable adverse effect reactions. CONCLUSION This study provides an overview of the evidence-based role of remdesivir, favipiravir, and lopinavir/ritonavir in the management of COVID-19. A thorough assessment of the benefit-risk profile in COVID-19 patients is urgently needed. The current review was based on very limited available data; therefore, further well-designed clinical trials are required.
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Affiliation(s)
- Windi Fresha Qomara
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, 40132, Indonesia
| | - Delya Nur Primanissa
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, 40132, Indonesia
| | - Salma Hasni Amalia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, 40132, Indonesia
| | - Febby V Purwadi
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, 40132, Indonesia
| | - Neily Zakiyah
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, 40132, Indonesia
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, 40132, Indonesia
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Rouamba T, Barry H, Ouédraogo E, Tahita MC, Yaméogo NV, Poda A, Diendéré AE, Ouedraogo AS, Valea I, Koné AM, Thiombiano C, Traoré I, Tarnagda Z, Sawadogo SA, Gansané Z, Kambiré Y, Sanou I, Barro-Traoré F, Drabo MK, Tinto H. Safety of Chloroquine or Hydroxychloroquine Plus Azithromycin for the Treatment of COVID-19 Patients in Burkina Faso: An Observational Prospective Cohort Study. Ther Clin Risk Manag 2021; 17:1187-1198. [PMID: 34815671 PMCID: PMC8604637 DOI: 10.2147/tcrm.s330813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/31/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Though chloroquine derivatives are used in the treatment of coronavirus disease 2019 (COVID-19) in many countries worldwide, doubts remain about the safety and efficacy of these drugs, especially in African communities where published data are scarce. METHODS We conducted an observational prospective cohort study from April 24 to September 03, 2020, in Burkina Faso to assess (as primary outcome) the clinical, biological, and cardiac (electrocardiographic) safety of chloroquine or hydroxychloroquine plus azithromycin administered to COVID-19 patients. The main secondary outcomes were all-cause mortality and median time of viral clearance. RESULTS A total of 153 patients were enrolled and followed for 21 days. Among patients who took at least one dose of chloroquine or hydroxychloroquine (90.1% [138/153]), few clinical adverse events were reported and were mainly rash/pruritus, diarrhea, chest pain, and palpitations. No statistically significant increase in hepatic, renal, and hematological parameters or electrolyte disorders were reported. However, there was a significant increase in the QTc value without exceeding 500ms, especially in those who received chloroquine phosphate. Three adverse events of special interest classified as serious (known from chloroquine derivatives) were recorded namely pruritus, paresthesia, and drowsiness. One case of death occurred. The average onset of SARS-CoV-2 PCR negativity was estimated at 7.0 (95% CI: 5.0-10.0) days. CONCLUSION Hydroxychloroquine appeared to be well tolerated in treated COVID-19 patients in Burkina Faso. In the absence of a robust methodological approach that could generate a high level of scientific evidence, our results could at least contribute to guide health decisions that should be made based on different sources of scientific evidence including those from our study.
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Affiliation(s)
- Toussaint Rouamba
- Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso
| | - Houreratou Barry
- Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Esperance Ouédraogo
- Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso
| | | | | | - Armel Poda
- Centre Hospitalier Universitaire Sourou Sanon, Bobo-Dioulasso, Burkina Faso
| | | | | | - Innocent Valea
- Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso
| | - Amariane M Koné
- Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | - Isidore Traoré
- Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Zekiba Tarnagda
- Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso
| | - Serge A Sawadogo
- Centre PrïmO Nelson Mandela (Promotion de la Recherche et de l’Innovation en Immunologie Médicale de Ouagadougou), Ouagadougou, Burkina Faso
| | - Zakaria Gansané
- Clinical Monitoring in Africa-Clinical Research Organization, Ouagadougou, Burkina Faso
| | - Yibar Kambiré
- Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
| | - Idrissa Sanou
- Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
| | - Fatou Barro-Traoré
- Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
| | - Maxime K Drabo
- Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso
| | - On behalf of the CHLORAZ Study Group
- Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso
- Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
- Centre Hospitalier Universitaire Sourou Sanon, Bobo-Dioulasso, Burkina Faso
- Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
- Centre PrïmO Nelson Mandela (Promotion de la Recherche et de l’Innovation en Immunologie Médicale de Ouagadougou), Ouagadougou, Burkina Faso
- Clinical Monitoring in Africa-Clinical Research Organization, Ouagadougou, Burkina Faso
- Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
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15
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Potential Cardiotoxic Effects of Remdesivir on Cardiovascular System: A Literature Review. Cardiovasc Toxicol 2021; 22:268-272. [PMID: 34643857 PMCID: PMC8511861 DOI: 10.1007/s12012-021-09703-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/07/2021] [Indexed: 01/20/2023]
Abstract
Corona disease 2019 (COVID-19) pandemic continues to spread around the world with no efficacious treatment. Intravenous remdesivir is the only authorized drug for treatment of COVID-19 disease under an Emergency Use Authorization. Remdesivir is a 1′-cyano-substituted adenosine nucleotide prodrug which inhibits viral RNA synthesis. This metabolite is an adenosine analog but with a significantly longer half-life than adenosine. Adenosine is a powerful vasodilator that can cause profound hypotension which is followed by the compensatory release of catecholamines. It can also shorten atrial action potential and refractoriness and lead to atrial fibrillation (AF). These effects may also occur in ventricular cells and predispose patients to ventricular fibrillation. Remdesivir can also induce significant cytotoxic effects in cardiomyocytes that is considerably worse than chloroquine cardiotoxic effects. Remdesivir-induced cardiotoxicity is due to its binding to human mitochondrial RNA polymerase. On the other hand, remdesivir can increase field potential duration with decreased Na+ peak amplitudes and spontaneous beating rates in a dose-dependent manner that might induce prolonged QT interval and torsade de point. There are some reports of sinus bradycardia, hypotension, T-wave abnormalities, AF, and a prolonged QT interval and few cases of cardiac arrest and complete heat block following remdesivir infusion. It seems remdesivir have some cardiotoxic and proarrhythmic effects that are especially more pronounced in patients with previous cardiovascular diseases. The current safety profile of remdesivir is still not completely known and further prospective clinical trials are needed to assess its safety profile and potential adverse cardiovascular effects.
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16
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Rao GK, Gowthami B, Naveen NR, Samudrala PK. An updated review on potential therapeutic drug candidates, vaccines and an insight on patents filed for COVID-19. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100063. [PMID: 34870158 PMCID: PMC8498785 DOI: 10.1016/j.crphar.2021.100063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/08/2023] Open
Abstract
The outbreak of COVID-19 was recognized in December 2019 in China and as of October5th, the pandemic was swept through 216 countries and infected around 34,824,108 individuals, thus posing an unprecedented threat to world's health and economy. Several researchers reported that, a significant mutation in membrane proteins and receptor binding sites of preceding severe acute respiratory syndrome coronavirus (SARS-CoV) to turned as novel SARS-CoV-2 virus and disease was named as COVID-19 (Coronavirus disease 2019). Unfortunately, there is no specific treatment available for COVID-19 patients. The lessons learned from the past management of SARS-CoV and other pandemics, have provided some insights to treat COVID-19. Currently, therapies like anti-viral treatment, immunomodulatory agents, plasma transfusion and supportive intervention etc., are using to treat the COVID-19. Few of these were proven to provide significant therapeutic benefits in treating the COVID-19, however no drug is approved by the regulatory agencies. As the fatality rate is high in patients with comorbid conditions, we have also enlightened the current in-line treatment therapies and specific treatment strategies in comorbid conditions to combat the emergence of COVID-19. In addition, pharmaceutical, biological companies and research institutions across the globe have begun to develop thesafe and effective vaccine for COVID-19. Globally around 170 teams of researchers are racing to develop the COVID-19 vaccine and here we have discussed about their current status of development. Furthermore, recent patents filed in association with COVID-19 was elaborated. This can help many individuals, researchers or health workers, in applying these principles for diagnosis/prevention/management/treatment of the current pandemic.
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Affiliation(s)
- G.S.N. Koteswara Rao
- College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Andhra Pradesh 522502, India
| | - Buduru Gowthami
- Department of Pharmaceutics, Annamacharya College of Pharmacy, New Boyanapalli, Rajampet, Andhra Pradesh 516126, India
| | - N. Raghavendra Naveen
- Department of Pharmaceutics, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, B.G.Nagar, Karnataka, 571448, India
| | - Pavan Kumar Samudrala
- Department of Pharmacology, Shri Vishnu College of Pharmacy, Vishnupur, Bhimavaram, 534202, Andhra Pradesh, India
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17
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Huang CW, Ha HA, Tsai SC, Lu CC, Lee CY, Tsai YF, Tsai FJ, Chiu YJ, Wang GK, Hsu CH, Yang JS. In Silico Target Analysis of Treatment for COVID-19 Using Huang-Lian-Shang-Qing-Wan, a Traditional Chinese Medicine Formula. Nat Prod Commun 2021. [DOI: 10.1177/1934578x211030818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Due to the significantly negative impact of the coronavirus (CoV) disease (COVID-19) pandemic on the health of the community and the economy, it remains urgent and necessary to develop a safe and effective treatment method for COVID-19. Huang-Lian-Shang-Qing-Wan (HLSQW) is a herbal formula of traditional Chinese medicine (TCM) that has been applied extensively for treating “wind-heat-associated” symptoms in the upper parts of the body. The objective of the present in silico study was to investigate the potential effects of HLSQW in the context of severe acute respiratory syndrome (SARS)-CoV-2 infection. We analyzed the possible interactions between bioactive compounds within HLSQW on targets that may confer antiviral activity using network pharmacology and pharmacophore-based screening. HLSQW was found to potentially target a number of pathways and the expression of various genes to regulate cell physiology and, consequently, the anti-viral effects against SARS-CoV-2. Bioactive compounds contained within HLSQW may exert combined effects to reduce the production of proinflammatory factors, which may trigger the “cytokine storm” in patients with severe COVID-19. Results from molecular modeling suggested that the bioactive HLSQW components puerarin, baicalin, and daidzin exhibit high binding affinity to the active site of 3-chymotrypsin-like cysteine protease (3CLpro) to form stable ligand-protein complexes, thereby suppressing SARS-CoV-2 replication. In addition, our results also demonstrated protective effects of the HLSQW extract against cell injury induced by the proinflammatory cytokines tumor necrosis factor-α, interleukin (IL)-1β, and IL-6, against reactive oxygen species production and nuclear factor-κB activity in normal human lung cells in vitro. To conclude, HLSQW is a potential TCM remedy that warrants further study with the aim of developing an effective treatment for COVID-19 in the future.
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Affiliation(s)
- Ching-Wen Huang
- Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University,
Taipei, Taiwan
| | - Hai-Anh Ha
- China Medical University, Taichung, Taiwan
- Duy Tan University, Da Nang, Vietnam
| | | | - Chi-Cheng Lu
- National Taiwan University of Sport, Taichung, Taiwan
| | | | - Yuh-Feng Tsai
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University,
Taipei, Taiwan
- Fu-Jen Catholic University, New Taipei, Taiwan
| | - Fuu-Jen Tsai
- China Medical University, Taichung, Taiwan
- China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Jen Chiu
- Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Guo-Kai Wang
- Anhui University of Chinese Medicine, Anhui Province Key Laboratory of Research & Development of Chinese Medicine, Hefei, China
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University,
Taipei, Taiwan
- Branch of Linsen, Chinese Medicine, and Kunming, Taipei City Hospital, Taipei, Taiwan
| | - Jai-Sing Yang
- China Medical University Hospital, China Medical University, Taichung, Taiwan
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18
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Banerjee A, Kanwar M, Maiti S. Theaflavin-3'-O-gallate a Black-tea Constituent Blocked SARS CoV-2 RNA dependant RNA Polymerase Active-site with Better Docking Results than Remdesivir. Drug Res (Stuttg) 2021; 71:462-472. [PMID: 34517419 DOI: 10.1055/a-1467-5828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Replication of SARS-CoV-2 depends on viral RNA-dependent RNA-polymerase (RdRp). Remdesivir, the broad-spectrum RdRp inhibitor acts as nucleoside-analogues (NAs). Remdesivir has initially been repurposed as a promising drug against SARS-CoV-2 infection with some health hazards like liver damage, allergic reaction, low blood-pressure, and breathing-shortness, throat-swelling. In comparison, theaflavin-3'-O-gallate (TFMG), the abundant black tea component has gained importance in controlling viral infection. TFMG is a non-toxic, non-invasive, antioxidant, anticancer and antiviral molecule. RESULTS Here, we analyzed the inhibitory effect of theaflavin-3'-O-gallate on SARS CoV-2 RdRp in comparison with remdesivir by molecular-docking study. TFMG has been shown more potent in terms of lower Atomic-Contact-Energy (ACE) and higher occupancy of surface area; -393.97 Kcal/mol and 771.90 respectively, favoured with lower desolvation-energy; -9.2: Kcal/mol. TFMG forms more rigid electrostatic and H-bond than remdesivir. TFMG showed strong affinity to RNA primer and template and RNA passage-site of RdRp. CONCLUSIONS TFMG can block the catalytic residue, NTP entry site, cation binding site, nsp7-nsp12 junction with binding energy of -6. 72 Kcal/mol with Ki value of 11.79, and interface domain with binding energy of -7.72 and -6.16 Kcal/mol with Ki value of 2.21 and 30.71 µM. And most importantly, TFMG shows antioxidant/anti-inflammatory/antiviral effect on human studies.
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Affiliation(s)
- Amrita Banerjee
- Department of Biochemistry and Biotechnology, Cell and Molecular Therapeutics Laboratory Oriental Institute of Science and Technology, Midnapore, India
| | - Mehak Kanwar
- Department of Biochemistry and Biotechnology, Cell and Molecular Therapeutics Laboratory Oriental Institute of Science and Technology, Midnapore, India
| | - Smarajit Maiti
- Department of Biochemistry and Biotechnology, Cell and Molecular Therapeutics Laboratory Oriental Institute of Science and Technology, Midnapore, India.,Founder and Secretary, Agricure Biotech Research Society, Epidemiology and Human Health Division, Midnapore, India
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19
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Singh P, Tripathi MK, Yasir M, Khare R, Shrivastava R. In silico identification of promising inhibitor against RNA-dependent RNA polymerase target of SARS-CoV-2. MOLECULAR BIOLOGY RESEARCH COMMUNICATIONS 2021; 10:131-140. [PMID: 34476266 PMCID: PMC8340315 DOI: 10.22099/mbrc.2021.40367.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The severe acute respiratory syndrome is a viral respiratory disease recognised as COVID-19, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Formerly, no precise remedies are available, and many studies regarding COVID-19 prevention and treatment are under development. Several targets for the design of drugs are identified, and studies are in headway to explore the potential target. RNA-dependent RNA polymerase (RdRp) protein identified as a promising target against SARS-CoV-2 infection for the drug design due to its significant role in viral replication. The present study focuses on identifying the binding effect of previously known RdRp inhibitors with RdRp of SARS-CoV-2 using molecular docking and molecular dynamics simulation approaches. Molecular docking and binding free energy calculations against RdRp enzyme identified suramin as a potential compound that showed the highest docking score of -7.83 Kcal/mole and binding energy of -80.83 Kcal/mole as a comparison to other compounds. Further, molecular dynamics simulation studies were moreover showed the stable binding behaviour of suramin docked complex in the protein active site. Thus, the study concludes that suramin might be helpful as a potential inhibitor against RNA-dependent RNA polymerase of SRAS-CoV-2. However, further investigation is needed to assess the possible effect of inhibitors on RdRp through in vitro and in vivo experiments.
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Affiliation(s)
- Pushpendra Singh
- State Virus Research and Diagnostic Laboratory, Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh-492099 India.,Equally contributed, Pushpendra Singh and Manish Kumar Tripathi both are joint first author
| | - Manish Kumar Tripathi
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi-110029, India.,Equally contributed, Pushpendra Singh and Manish Kumar Tripathi both are joint first author
| | - Mohammad Yasir
- Department of Nephrology, All India Institute of Medical Science Bhopal, Madhya Pradesh-462020 India
| | - Ruchi Khare
- Department of Biological Science and Engineering, Maulana Azad National Institute of Technology, Bhopal, Madhya Pradesh-462003 India
| | - Rahul Shrivastava
- Department of Biological Science and Engineering, Maulana Azad National Institute of Technology, Bhopal, Madhya Pradesh-462003 India
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20
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Zhai G, Li M, Wang Y, Wu J. Drug-Induced Liver Disturbance During the Treatment of COVID-19. Front Pharmacol 2021; 12:719308. [PMID: 34483929 PMCID: PMC8416279 DOI: 10.3389/fphar.2021.719308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, China, at the end of 2019. The World Health Organization named the resulting infectious disease as coronavirus disease-2019 (COVID-19). Many studies concluded that patients infected with SARS-CoV-2 have different degrees of liver disturbance. However, the relationship between the drugs used for COVID-19 treatment and liver disturbance remains controversial. It is essential to evaluate the potential liver damage caused by various drugs in order to help guide clinical practice. This review analyzed the effect of drugs on hepatic function during the treatment of COVID-19.
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Affiliation(s)
- Guanghua Zhai
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Meifen Li
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Ying Wang
- Department of Infection Management, Suzhou Hosptial Affiliated to Nanjing Medical University, Suzhou, China
| | - Jian Wu
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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21
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Narożna M, Rubiś B. Anti-SARS-CoV-2 Strategies and the Potential Role of miRNA in the Assessment of COVID-19 Morbidity, Recurrence, and Therapy. Int J Mol Sci 2021; 22:8663. [PMID: 34445368 PMCID: PMC8395427 DOI: 10.3390/ijms22168663] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
Recently, we have experienced a serious pandemic. Despite significant technological advances in molecular technologies, it is very challenging to slow down the infection spread. It appeared that due to globalization, SARS-CoV-2 spread easily and adapted to new environments or geographical or weather zones. Additionally, new variants are emerging that show different infection potential and clinical outcomes. On the other hand, we have some experience with other pandemics and some solutions in virus elimination that could be adapted. This is of high importance since, as the latest reports demonstrate, vaccine technology might not follow the new, mutated virus outbreaks. Thus, identification of novel strategies and markers or diagnostic methods is highly necessary. For this reason, we present some of the latest views on SARS-CoV-2/COVID-19 therapeutic strategies and raise a solution based on miRNA. We believe that in the face of the rapidly increasing global situation and based on analogical studies of other viruses, the possibility of using the biological potential of miRNA technology is very promising. It could be used as a promising diagnostic and prognostic factor, as well as a therapeutic target and tool.
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Affiliation(s)
- Maria Narożna
- Department of Pharmaceutical Biochemistry, Poznan University of Medical Sciences, 4 Święcickiego St., 60-781 Poznan, Poland;
| | - Błażej Rubiś
- Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland
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22
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Shahrbaf MA, Tabary M, Khaheshi I. Cardiovascular considerations of Remdesivir and Favipiravir in the treatment of COVID-19. Cardiovasc Hematol Disord Drug Targets 2021; 21:88-90. [PMID: 34387172 DOI: 10.2174/1871529x21666210812103535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/12/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022]
Abstract
After the outbreak of COVID-19, many novel drugs have been introduced to improve patients' condition. Remdesivir and Favipiravir are among the most common drugs used against SARS-CoV-2. Although promising, cardiovascular side effects of these drugs should be considered by physicians and nurses. In this study, we searched databases for assessing the cardiovascular side effects of Remdesivir and Favipiravir. It seems that despite the beneficial effects of these drugs, due to the cardiovascular complications of COVID-19 and cardiovascular side effects of these drugs which can overlap with each other, the use of these drugs can be a challenging issue in the cardiovascular practice. .
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Affiliation(s)
- Mohammad Amin Shahrbaf
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| | - Mohammadreza Tabary
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran. Iran
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23
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Angamo MT, Mohammed MA, Peterson GM. Efficacy and safety of remdesivir in hospitalised COVID-19 patients: a systematic review and meta-analysis. Infection 2021; 50:27-41. [PMID: 34331674 PMCID: PMC8325414 DOI: 10.1007/s15010-021-01671-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/21/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE This review was aimed to synthesise the best available evidence on the effectiveness and safety of remdesivir in the treatment of moderate to severe COVID-19. METHOD Randomised controlled trials (RCTs) and observational studies reporting the effectiveness and safety of remdesivir were searched via databases and other sources from December 2019 to December 2020. Two independent reviewers performed literature screening, data extraction and assessment of risk bias. Seven studies involving 3686 patients were included. RESULTS Treatment with remdesivir was associated with an increase in clinical recovery rate by 21% (RR 1.21; 95% CI 1.08-1.35) on day 7 and 29% (RR 1.29; 95% CI 1.22-1.37) on day 14. The likelihoods of requiring high-flow supplemental oxygen and invasive mechanical ventilation in the remdesivir group were lower than in the placebo group by 27% (RR 0.73; 95% CI 0.54-0.99) and 47% (RR 0.53; 95% CI 0.39-0.72), respectively. Remdesivir-treated patients showed a 39% (RR 0.61; 95% CI 0.46-0.79) reduction in the risk of mortality on day 14 compared to the control group; however, there was no significant difference on day 28. Serious adverse effects (SAEs) were significantly less common in patients treated with remdesivir, with an absolute risk difference of 6% (RD -0.06; 95% CI -0.09 to -0.03). CONCLUSION Despite conditional recommendation against its use, remdesivir could still be effective in early clinical improvement; reduction of early mortality and avoiding high-flow supplemental oxygen and invasive mechanical ventilation among hospitalised COVID-19 patients. Remdesivir was also well tolerated without significant SAEs compared to placebo, yet available evidence from clinical studies support the need to conduct close monitoring.
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Affiliation(s)
- Mulugeta T Angamo
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia.
| | | | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
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24
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Yousif M, Abd El-Raheem G, Mohamed D. Use of Remdesivir in the treatment of Coronavirus Disease 2019 (COVID-19) infection among Sudanese patients: a case series. F1000Res 2021; 10:512. [PMID: 35387271 PMCID: PMC8941288 DOI: 10.12688/f1000research.51375.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 09/02/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic is affecting populations worldwide. Remdesivir is an anti-retroviral agent, with a broad spectrum of usage. Remdesivir usage against COVID-19 had been studied both in vitro and in vivo but is still considered a new treatment for COVID-19 and is not available in all countries. The aim of our study was to report several cases of the use of Remdesivir in Sudanese patients and report the adverse events related to the course of treatment. Methods: A case series study was conducted in Imperial Hospital, Khartoum, Sudan reporting two cases who received Remdesivir for treating COVID-19 besides other treatments such as steroids and supportive therapy in December 2020. Cases were males aged over 65 years. Cases presentation: Both patients were severe cases of COVID-19 admitted to the intensive care unit (ICU), who received Remdesivir for treating COVID-19 infection. Several side effects were reported: the first case had increased liver enzymes and then unexpectedly died from severe resistant hypotension; and hypoalbuminemia was noticed in the second case. Conclusions: Remdesivir use among patients in Sudan must be studied extensively in order to determine the unexpected fatal event and assess the association of this event to Remdesivir use, as well as to report the frequency of the side effects.
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Affiliation(s)
- Maysoun Yousif
- Emergency, Imperial Hospital, Khartoum, Khartoum, 11114, Sudan
| | - Ghada Abd El-Raheem
- Pharmacy, Imperial Hospital, Military Hospital, Soba University Hospital, Khartoum, Khartoum, 11114, Sudan
| | - Doaa Mohamed
- Emergency Department, Imperial Hospital, Khartoum, Khartoum, 11114, Sudan
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Alam S, Kamal TB, Sarker MMR, Zhou JR, Rahman SMA, Mohamed IN. Therapeutic Effectiveness and Safety of Repurposing Drugs for the Treatment of COVID-19: Position Standing in 2021. Front Pharmacol 2021; 12:659577. [PMID: 34220503 PMCID: PMC8243370 DOI: 10.3389/fphar.2021.659577] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
COVID-19, transmitted by SARS-CoV-2, is one of the most serious pandemic situations in the history of mankind, and has already infected a huge population across the globe. This horrendously contagious viral outbreak was first identified in China and within a very short time it affected the world's health, transport, economic, and academic sectors. Despite the recent approval of a few anti-COVID-19 vaccines, their unavailability and insufficiency along with the lack of other potential therapeutic options are continuing to worsen the situation, with valuable lives continuing to be lost. In this situation, researchers across the globe are focusing on repurposing prospective drugs and prophylaxis such as favipiravir, remdesivir, chloroquine, hydroxychloroquine, ivermectin, lopinavir-ritonavir, azithromycin, doxycycline, ACEIs/ARBs, rivaroxaban, and protease inhibitors, which were preliminarily based on in vitro and in vivo pharmacological and toxicological study reports followed by clinical applications. Based on available preliminary data derived from limited clinical trials, the US National Institute of Health (NIH) and USFDA also recommended a few drugs to be repurposed i.e., hydroxychloroquine, remdesivir, and favipiravir. However, World Health Organization later recommended against the use of chloroquine, hydroxychloroquine, remdesivir, and lopinavir/ritonavir in the treatment of COVID-19 infections. Combining basic knowledge of viral pathogenesis and pharmacodynamics of drug molecules as well as in silico approaches, many drug candidates have been investigated in clinical trials, some of which have been proven to be partially effective against COVID-19, and many of the other drugs are currently under extensive screening. The repurposing of prospective drug candidates from different stages of evaluation can be a handy wellspring in COVID-19 management and treatment along with approved anti-COVID-19 vaccines. This review article combined the information from completed clinical trials, case series, cohort studies, meta-analyses, and retrospective studies to focus on the current status of repurposing drugs in 2021.
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Affiliation(s)
- Safaet Alam
- Department of Pharmacy, State University of Bangladesh, Dhaka, Bangladesh
| | | | - Md. Moklesur Rahman Sarker
- Department of Pharmacy, State University of Bangladesh, Dhaka, Bangladesh
- Pharmacology and Toxicology Research Division, Health Med Science Research Limited, Dhaka, Bangladesh
| | - Jin-Rong Zhou
- Nutrition/Metabolism Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - S. M. Abdur Rahman
- Department of Clinical Pharmacy and Pharmacology, Faculty of Pharmacy, University of Dhaka, Dhaka, Bangladesh
| | - Isa Naina Mohamed
- Pharmacology Department, Medical Faculty, Universiti Kebangsaan Malaysia (The National University of Malaysia), Kuala Lumpur, Malaysia
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Abolaban FA, Djouider FM. Gamma irradiation-mediated inactivation of enveloped viruses with conservation of genome integrity: Potential application for SARS-CoV-2 inactivated vaccine development. Open Life Sci 2021; 16:558-570. [PMID: 34131589 PMCID: PMC8174122 DOI: 10.1515/biol-2021-0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/12/2021] [Accepted: 04/13/2021] [Indexed: 12/23/2022] Open
Abstract
Radiation inactivation of enveloped viruses occurs as the result of damages at the molecular level of their genome. The rapidly emerging and ongoing coronavirus disease 2019 (COVID-19) pneumonia pandemic prompted by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now a global health crisis and an economic devastation. The readiness of an active and safe vaccine against the COVID-19 has become a race against time in this unqualified global panic caused by this pandemic. In this review, which we hope will be helpful in the current situation of COVID-19, we analyze the potential use of γ-irradiation to inactivate this virus by damaging at the molecular level its genetic material. This inactivation is a vital step towards the design and development of an urgently needed, effective vaccine against this disease.
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Affiliation(s)
- Fouad A. Abolaban
- Nuclear Engineering Department, Faculty of Engineering, King Abdulaziz University, PO Box 80204, Jeddah, 21589, Saudi Arabia
| | - Fathi M. Djouider
- Nuclear Engineering Department, Faculty of Engineering, King Abdulaziz University, PO Box 80204, Jeddah, 21589, Saudi Arabia
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Kugener VF, Freedland ES, Maynard KI, Aimer O, Webster PS, Salas M, Gossell-Williams M. Enhancing Pharmacovigilance from the US Experience: Current Practices and Future Opportunities. Drug Saf 2021; 44:843-852. [PMID: 33993430 PMCID: PMC8123099 DOI: 10.1007/s40264-021-01078-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/17/2022]
Abstract
This review is intended to present perspectives from the US experience in enhancing pharmacovigilance on current practices and future opportunities. Best practices concepts could be applied worldwide through the presentation of how three pillars of pharmacovigilance: (1) medical and scientific excellence, (2) operational and compliance excellence, and (3) knowledge sharing and experts development in the field could serve as a framework for the establishment of an efficient and successful global pharmacovigilance system.
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Affiliation(s)
- Veronique F. Kugener
- Global Patient Safety Evaluation, Research & Development, Takeda Pharmaceuticals International Co., 300 Massachusetts Avenue, Cambridge, MA 02139 USA
| | - Eric S. Freedland
- Global Patient Safety Evaluation, Research & Development, Takeda Pharmaceuticals International Co., 300 Massachusetts Avenue, Cambridge, MA 02139 USA
| | - Kenneth I. Maynard
- Global Patient Safety Evaluation, Research & Development, Takeda Pharmaceuticals International Co., 300 Massachusetts Avenue, Cambridge, MA 02139 USA
| | | | | | - Maribel Salas
- Daiichi Sankyo, Inc. and CCEB/CPeRT, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Maxine Gossell-Williams
- Section of Pharmacology and Pharmacy, Faculty of Medical Sciences Teaching and Research Complex, University of The West Indies, Kingston, Jamaica
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Sarfraz A, Sarfraz Z, Sanchez-Gonzalez M, Michel J, Michel G, Frontela O, Posada J, Cardona J, Angueira E. Randomized controlled trials of remdesivir in hospitalized coronavirus disease 2019 patients: A meta-analysis. Turk J Emerg Med 2021; 21:43-50. [PMID: 33969238 PMCID: PMC8091999 DOI: 10.4103/2452-2473.309139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The first cases of the coronavirus disease 2019 (COVID-19) were reported in Wuhan, China. No antiviral treatment options are currently available with proven clinical efficacy. However, preliminary findings from phase III trials suggest that remdesivir is an effective and safe treatment option for COVID-19 patients with both moderate and severe disease. OBJECTIVE The aim of the present meta-analysis was to investigate whether remdesivir was effective for treating COVID-19 including reduced in-hospital adverse events, oxygen support, and mortality rates. METHODS According to the PRISMA reporting guidelines, a review was conducted from January 1, 2020, until August 25, 2020, with MeSH terms including COVID-19, COVID, coronavirus, SARS-CoV-2, remdesivir, adenosine nucleoside triphosphate analog, and Veklury using MEDLINE, Scopus, and CINAHL Plus. A modified Delphi process was utilized to include the studies and ensure that the objectives were addressed. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel-Haenszel random-effects method in Review Manager 5.4. RESULTS Randomized controlled trials pooled in 3013 participants with 46.3% (n = 1395) in the remdesivir group and 53.7% (n = 1618) in the placebo group. The placebo group had a higher risk of mortality as compared to the intervention group with significant OR (0.61) (95% confidence interval of 0.45-0.82; P = 0.001). There was minimal heterogeneity among the studies (I 2 = 0%). CONCLUSIONS Our findings suggest that remdesivir extends clinical benefits by reducing mortality, adverse events, and oxygen support in moderate to severely ill COVID-19 patients. Concerted efforts and further randomized placebo-controlled trials are warranted to examine the potency of antiviral drugs and immunopathological host responses contributing to the severity of COVID-19.
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Affiliation(s)
- Azza Sarfraz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Zouina Sarfraz
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
- Department of Research and Publication, Fatima Jinnah Medical University, Lahore, Pakistan
| | | | - Jack Michel
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - George Michel
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Odalys Frontela
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Jorge Posada
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Jose Cardona
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
| | - Eugenio Angueira
- Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
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Jo Y, Jamieson L, Edoka I, Long L, Silal S, Pulliam JRC, Moultrie H, Sanne I, Meyer-Rath G, Nichols BE. Cost-effectiveness of Remdesivir and Dexamethasone for COVID-19 Treatment in South Africa. Open Forum Infect Dis 2021; 8:ofab040. [PMID: 33732750 PMCID: PMC7928624 DOI: 10.1093/ofid/ofab040] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Dexamethasone and remdesivir have the potential to reduce coronavirus disease 2019 (COVID)-related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown. METHODS We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed the cost-effectiveness of (1) administration of dexamethasone to ventilated patients and remdesivir to nonventilated patients, (2) dexamethasone alone to both nonventilated and ventilated patients, (3) remdesivir to nonventilated patients only, and (4) dexamethasone to ventilated patients only, all relative to a scenario of standard care. We estimated costs from the health care system perspective in 2020 US dollars, deaths averted, and the incremental cost-effectiveness ratios of each scenario. RESULTS Remdesivir for nonventilated patients and dexamethasone for ventilated patients was estimated to result in 408 (uncertainty range, 229-1891) deaths averted (assuming no efficacy [uncertainty range, 0%-70%] of remdesivir) compared with standard care and to save $15 million. This result was driven by the efficacy of dexamethasone and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone for nonventilated and ventilated patients requires an additional $159 000 and averts 689 [uncertainty range, 330-1118] deaths, resulting in $231 per death averted, relative to standard care. CONCLUSIONS The use of remdesivir for nonventilated patients and dexamethasone for ventilated patients is likely to be cost-saving compared with standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICUs could save lives and costs in South Africa.
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Affiliation(s)
- Youngji Jo
- Section of Infectious Disease, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Sheetal Silal
- Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Juliet R C Pulliam
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Harry Moultrie
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Ian Sanne
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Brooke E Nichols
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
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COVID-19: Reasons for Guarded Optimism. Pharmaceut Med 2021; 35:67-69. [PMID: 33594604 PMCID: PMC7885747 DOI: 10.1007/s40290-021-00381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Strom A, Shah R, Wagner CR. "Switching On" Enzyme Substrate Specificity Analysis with a Fluorescent Competitive Inhibitor. Biochemistry 2021; 60:440-450. [PMID: 33513008 DOI: 10.1021/acs.biochem.0c00954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Enzymatically driven change to the spectroscopic properties of a chemical substrate or product has been a linchpin in the development of continuous enzyme kinetics assays. These assays inherently necessitate substrates or products that naturally comply with the constraints of the spectroscopic technique being used, or they require structural changes to the molecules involved to make them observable. Here we demonstrate a new analytical kinetics approach with enzyme histidine triad nucleotide binding protein 1 (HINT1) that allows us to extract both useful kcat values and a rank-ordered list of substrate specificities without the need to track substrates or products directly. Instead, this is accomplished indirectly using a "switch on" competitive inhibitor that fluoresces maximally only when bound to the HINT1 enzyme active site. Kinetic information is extracted from the duration of the diminished fluorescence when the monitorable inhibitor-bound enzyme is challenged with saturating concentrations of a nonfluorescent substrate. We refer to the loss of fluorescence, while the substrate competes for the fluorescent probe in the active site, as the substrate's residence transit time (RTT). The ability to assess kcat values and substrate specificity by monitoring the RTTs for a set of substrates with a competitive "switch on" inhibitor should be broadly applicable to other enzymatic reactions in which the "switch on" inhibitor has sufficient binding affinity over the enzymatic product.
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Affiliation(s)
- Alexander Strom
- Department of Medicinal Chemistry, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Rachit Shah
- Department of Medicinal Chemistry, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Carston R Wagner
- Department of Medicinal Chemistry, University of Minnesota, Minneapolis, Minnesota 55455, United States
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Lopes-Pacheco M, Silva PL, Cruz FF, Battaglini D, Robba C, Pelosi P, Morales MM, Caruso Neves C, Rocco PRM. Pathogenesis of Multiple Organ Injury in COVID-19 and Potential Therapeutic Strategies. Front Physiol 2021; 12:593223. [PMID: 33584343 PMCID: PMC7876335 DOI: 10.3389/fphys.2021.593223] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/08/2021] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory disease coronavirus 2 (SARS-CoV-2, formerly 2019-nCoV) is a novel coronavirus that has rapidly disseminated worldwide, causing the coronavirus disease 2019 (COVID-19) pandemic. As of January 6th, 2021, there were over 86 million global confirmed cases, and the disease has claimed over 1.87 million lives (a ∼2.2% case fatality rate). SARS-CoV-2 is able to infect human cells by binding its spike (S) protein to angiotensin-conversing enzyme 2 (ACE2), which is expressed abundantly in several cell types and tissues. ACE2 has extensive biological activities as a component of the renin-angiotensin-aldosterone system (RAAS) and plays a pivotal role as counter-regulator of angiotensin II (Ang II) activity by converting the latter to Ang (1-7). Virion binding to ACE2 for host cell entry leads to internalization of both via endocytosis, as well as activation of ADAM17/TACE, resulting in downregulation of ACE2 and loss of its protective actions in the lungs and other organs. Although COVID-19 was initially described as a purely respiratory disease, it is now known that infected individuals can rapidly progress to a multiple organ dysfunction syndrome. In fact, all human structures that express ACE2 are susceptible to SARS-CoV-2 infection and/or to the downstream effects of reduced ACE2 levels, namely systemic inflammation and injury. In this review, we aim to summarize the major features of SARS-CoV-2 biology and the current understanding of COVID-19 pathogenesis, as well as its clinical repercussions in the lung, heart, kidney, bowel, liver, and brain. We also highlight potential therapeutic targets and current global efforts to identify safe and effective therapies against this life-threatening condition.
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Affiliation(s)
- Miquéias Lopes-Pacheco
- Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Brazil
- Rio de Janeiro Innovation Network in Nanosystems for Health-NanoSAÚDE/FAPERJ, Rio de Janeiro, Brazil
- COVID-19 Virus Network, Ministry of Science, Technology and Innovation, Brasília, Brazil
- COVID-19 Virus Network, Brazilian Council for Scientific and Technological Development, Brasília, Brazil
- COVID-19 Virus Network, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ, Rio de Janeiro, Brazil
| | - Fernanda Ferreira Cruz
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Brazil
- Rio de Janeiro Innovation Network in Nanosystems for Health-NanoSAÚDE/FAPERJ, Rio de Janeiro, Brazil
- COVID-19 Virus Network, Ministry of Science, Technology and Innovation, Brasília, Brazil
- COVID-19 Virus Network, Brazilian Council for Scientific and Technological Development, Brasília, Brazil
- COVID-19 Virus Network, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ, Rio de Janeiro, Brazil
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic, University of Genoa, Genoa, Italy
| | - Marcelo Marcos Morales
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Brazil
- Rio de Janeiro Innovation Network in Nanosystems for Health-NanoSAÚDE/FAPERJ, Rio de Janeiro, Brazil
- COVID-19 Virus Network, Ministry of Science, Technology and Innovation, Brasília, Brazil
- COVID-19 Virus Network, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ, Rio de Janeiro, Brazil
- Laboratory of Cellular and Molecular Physiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Celso Caruso Neves
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Brazil
- Rio de Janeiro Innovation Network in Nanosystems for Health-NanoSAÚDE/FAPERJ, Rio de Janeiro, Brazil
- COVID-19 Virus Network, Brazilian Council for Scientific and Technological Development, Brasília, Brazil
- COVID-19 Virus Network, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ, Rio de Janeiro, Brazil
- Laboratory of Biochemistry and Cell Signaling, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Brazil
- Rio de Janeiro Innovation Network in Nanosystems for Health-NanoSAÚDE/FAPERJ, Rio de Janeiro, Brazil
- COVID-19 Virus Network, Ministry of Science, Technology and Innovation, Brasília, Brazil
- COVID-19 Virus Network, Brazilian Council for Scientific and Technological Development, Brasília, Brazil
- COVID-19 Virus Network, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ, Rio de Janeiro, Brazil
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Pimentel J, Laurie C, Cockcroft A, Andersson N. Clinical studies assessing the efficacy, effectiveness and safety of remdesivir in management of COVID-19: A scoping review. Br J Clin Pharmacol 2020; 87:2663-2684. [PMID: 33245577 PMCID: PMC7753529 DOI: 10.1111/bcp.14677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
Aims Remdesivir is 1 of the repurposed drugs under investigation to treat patients with COVID‐19. Clinicians and decision‐makers need a summary of the most recent evidence. This scoping review maps the evidence on the efficacy, effectiveness and safety of remdesivir for patients with COVID‐19, up to 14 September 2020. Methods Our scoping review searched Pubmed, Embase (Ovid), Scopus and 17 primary trial registries for empirical publications or active registered clinical trials for data on the efficacy, effectiveness, or safety of remdesivir for COVID‐19 or SARS‐CoV‐2. We conducted a narrative synthesis of the included publications. Results Seventeen empirical studies and 23 clinical trial registrations (n = 40) accumulated 46 508 participants. We found 4 published randomized–controlled trials accumulating 2293 patients. Two trials reported shorter median recovery time and better clinical status among patients who received remdesivir compared with the control groups. Observational studies report an association between remdesivir treatment and decreased mortality, as well as increased survival. The most common adverse reaction was hepatic impairment, although the trials reported a similar proportion of adverse events in the intervention and control groups. Conclusion Remdesivir might shorten the time to clinical improvement among hospitalized adults with severe COVID‐19. Trial data report a similar proportion of adverse events in treated and control groups. The results of the 23 registered active trials, including more than 30 000 participants, will shed light on the efficacy and safety of the antiviral. The findings of the remaining clinical trials expected to report results in 2020 will allow a quantitative synthesis of available evidence.
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Affiliation(s)
- Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada.,Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia.,Grupo de Estudios en Sistemas Tradicionales de Salud, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Cassandra Laurie
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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Capasso C, Nocentini A, Supuran CT. Protease inhibitors targeting the main protease and papain-like protease of coronaviruses. Expert Opin Ther Pat 2020; 31:309-324. [PMID: 33246378 DOI: 10.1080/13543776.2021.1857726] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The two cysteine proteases from the coronaviruses, which produced deadly outbreaks in the last two decades, SARS CoV-1/2, and MERS, the main protease (Mpro) and the papain-like protease (PLP) are conserved among the three pathogens and started to be considered as exciting drug targets for developing antivirals. AREAS COVERED We review the drug design landscape in the scientific and patent literature to design peptidomimetic and non-peptidomimetic protease inhibitors (PIs) targeting these proteins. EXPERT OPINION The X-ray crystal structures of some of these proteases, alone and in complex with various inhibitors, were crucial for the discovery of effective such compounds, some of which also showed considerable antiviral activity and are considered preclinical candidates to fight these emerging infections, which in the case of Covid-19 already provoked an unprecedented worldwide pandemic.
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Affiliation(s)
- Clemente Capasso
- Department of Biology, Agriculture and Food Sciences, CNR, Institute of Biosciences and Bioresources, Napoli, Italy
| | - Alessio Nocentini
- Dipartimento Neurofarba, Sezione di Scienze Farmaceutiche e Nutraceutiche, Università Degli Studi di Firenze, Sesto Fiorentino (Florence), Italy
| | - Claudiu T Supuran
- Dipartimento Neurofarba, Sezione di Scienze Farmaceutiche e Nutraceutiche, Università Degli Studi di Firenze, Sesto Fiorentino (Florence), Italy
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López Rodríguez CA, Pons MB, Sánchez BQ, Serra AT, Martí JC, Martínez Cáceres EM. SARS-CoV-2: a new threat. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200083. [PMID: 37360613 PMCID: PMC10197769 DOI: 10.1515/almed-2020-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/22/2020] [Indexed: 06/28/2023]
Abstract
Background The pandemic caused by the emergence of the new SARS-CoV-2 virus worldwide has had a major impact at all levels and has forced in-depth research into its behavior, pathogenicity and treatment. Content This review provides an overview of various aspects of the virus and the immune response it triggers, as well as a description of the different diagnostic and therapeutic approaches adopted. Summary SARS-COV-2 is a RNA virus with some peculiarities that make it different from its predecessors SARS-CoV and MERS. Given its structural characteristics and pathogenesis, it can cause different clinical manifestations as the disease progresses. The immune system has been proven to play a major role in the response to this virus and, therefore, the study of antibodies and lymphocyte populations during the different stages of the disease is crucial. Outlook The knowledge of the effect of the virus and the immune response is crucial for the development of good quality vaccines, therapies and diagnostic techniques, which are essential for the control and eradication of the disease.
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Affiliation(s)
- Cristina A. López Rodríguez
- Immunology Division, Laboratori Clínic Metropolitana Nord, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Marc Boigues Pons
- Immunology Division, Laboratori Clínic Metropolitana Nord, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Bibiana Quirant Sánchez
- Immunology Division, Laboratori Clínic Metropolitana Nord, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Aina Teniente Serra
- Immunology Division, Laboratori Clínic Metropolitana Nord, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Joan Climent Martí
- Immunology Division, Laboratori Clínic Metropolitana Nord, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Eva Ma Martínez Cáceres
- Immunology Division, Laboratori Clínic Metropolitana Nord, Germans Trias i Pujol University Hospital, Barcelona, Spain
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López Rodríguez CA, Boigues Pons M, Quirant Sánchez B, Teniente Serra A, Climent Martí J, Martínez Cáceres EM. SARS-CoV-2: una nueva amenaza. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200045. [PMID: 37360616 PMCID: PMC10197510 DOI: 10.1515/almed-2020-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/22/2020] [Indexed: 06/28/2023]
Abstract
Objetivos Aportar una breve revisión del conocimiento actual sobre el virus SARS-CoV-2, cuya irrupción ha causado un gran impacto en la sociedad a escala mundial. Contenido Esta revisión aporta una visión general de diversos aspectos del virus y de la respuesta inmunitaria que desencadena, así como aproximaciones diagnósticas y terapéuticas que se están llevando a cabo. Resumen SARS-CoV-2 es un virus RNA con características peculiares que lo diferencian de sus predecesores SARS-CoV y MERS. Dada sus características estructurales y su patogenia, es capaz de provocar diversas manifestaciones clínicas según avanza la enfermedad. Se ha demostrado que el sistema inmunitario juega un papel importante en la respuesta frente a este virus y, por ende, es crucial el estudio de los anticuerpos y las poblaciones linfocitarias durante los distintos estadios de la enfermedad. Perspectiva El conocimiento del efecto del virus y la respuesta inmunitaria es determinante para el desarrollo de vacunas, terapias y técnicas diagnósticas de calidad, esenciales para el control y la erradicación de la enfermedad.
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Affiliation(s)
- Cristina A. López Rodríguez
- Servicio de Inmunología, Laboratori Clínic Metropolitana Nord, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marc Boigues Pons
- Servicio de Inmunología, Laboratori Clínic Metropolitana Nord, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Bibiana Quirant Sánchez
- Servicio de Inmunología, Laboratori Clínic Metropolitana Nord, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Aina Teniente Serra
- Servicio de Inmunología, Laboratori Clínic Metropolitana Nord, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Climent Martí
- Servicio de Inmunología, Laboratori Clínic Metropolitana Nord, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eva Ma Martínez Cáceres
- Servicio de Inmunología, Laboratori Clínic Metropolitana Nord, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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Babaei F, Mirzababaei M, Nassiri-Asl M, Hosseinzadeh H. Review of registered clinical trials for the treatment of COVID-19. Drug Dev Res 2020; 82:474-493. [PMID: 33251593 PMCID: PMC7753306 DOI: 10.1002/ddr.21762] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID‐19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The disease was first reported in December 2019 in Wuhan, China, but now more than 200 countries have been affected and the coronavirus pandemic is still ongoing. The severity of COVID‐19 symptoms can range from mild to severe. FDA approved remdesivir as a treatment of COVID‐19 so far. Various clinical trials are underway to find an effective method to treat patients with COVID‐19. This review aimed at summarizing 219 registered clinical trials in the ClinicalTrials.gov database with possible mechanisms, and novel findings of them, and other recent publications related to COVID‐19. According to our analyses, various treatment approaches and drugs are being investigated to find an effective drug to cure COVID‐19 and among all strategies, three important mechanisms are suggested to be important against COVID‐19 including antiviral, anti‐inflammatory, and immunomodulatory properties. Our review can help future studies get on the way to finding an effective drug for COVID‐19 treatment by providing ideas for similar researches.
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Affiliation(s)
- Fatemeh Babaei
- Department of Clinical Biochemistry, School of Medicine, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Mirzababaei
- Department of Clinical Biochemistry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Marjan Nassiri-Asl
- Department of Pharmacology and Neurobiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hosseinzadeh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Liu Y, Liang C, Xin L, Ren X, Tian L, Ju X, Li H, Wang Y, Zhao Q, Liu H, Cao W, Xie X, Zhang D, Wang Y, Jian Y. The development of Coronavirus 3C-Like protease (3CL pro) inhibitors from 2010 to 2020. Eur J Med Chem 2020; 206:112711. [PMID: 32810751 PMCID: PMC7409838 DOI: 10.1016/j.ejmech.2020.112711] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 01/24/2023]
Abstract
This review fully describes the coronavirus 3CLpro peptidomimetic inhibitors and nonpeptidic small molecule inhibitors developed from 2010 to 2020. Specifically, the structural characteristics, binding modes and SARs of these 3CLpro inhibitors are expounded in detail by division into two categories: peptidomimetic inhibitors mainly utilize electrophilic warhead groups to covalently bind the 3CLpro Cys145 residue and thereby achieve irreversible inhibition effects, whereas nonpeptidic small molecule inhibitors mainly interact with residues in the S1', S1, S2 and S4 pockets via hydrogen bonds, hydrophobic bonds and van der Waals forces. Based on the emerging PROTAC technology and the existing 3CLpro inhibitors, 3CLpro PROTAC degraders are hypothesised to be next-generation anti-coronavirus drugs.
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Affiliation(s)
- Yuzhi Liu
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Chengyuan Liang
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China.
| | - Liang Xin
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Xiaodong Ren
- Medical College, Guizhou University, Guiyang, 550025, PR China
| | - Lei Tian
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Xingke Ju
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Han Li
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Yongbo Wang
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Qianqian Zhao
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Hong Liu
- Zhuhai Jinan Selenium Source Nanotechnology Co., Ltd., Hengqin, Zhuhai, Guangdong, 519030, PR China.
| | - Wenqiang Cao
- Zhuhai Jinan Selenium Source Nanotechnology Co., Ltd., Hengqin, Zhuhai, Guangdong, 519030, PR China
| | - Xiaolin Xie
- Shaanxi Panlong Pharmaceutical Group Co., Ltd., Xi'an, 710025, PR China
| | - Dezhu Zhang
- Shaanxi Panlong Pharmaceutical Group Co., Ltd., Xi'an, 710025, PR China
| | - Yu Wang
- Shaanxi Panlong Pharmaceutical Group Co., Ltd., Xi'an, 710025, PR China
| | - Yanlin Jian
- Laboratory for Medicinal Chemistry (FFW), Ghent University, Ottergemsesteenweg 460, B9000, Gent, Belgium.
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Seifirad S. Pirfenidone: A novel hypothetical treatment for COVID-19. Med Hypotheses 2020; 144:110005. [PMID: 32575019 PMCID: PMC7297676 DOI: 10.1016/j.mehy.2020.110005] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 01/01/2023]
Abstract
Cytokine storm, multiorgan failure, and particularly acute respiratory distress syndrome (ARDS) is the leading cause of mortality and morbidity in patients with COVID-19. A fulminant ARDS kills the majority of COVID-19 victims. Pirfenidone (5-methyl-1-phenyl-2-[1H]-pyridone), is a novel anti-fibrotic agent with trivial adverse effects. Pirfenidone is approved for the treatment of Idiopathic Pulmonary Fibrosis (IPF) for patients with mild to moderate disease. Pirfenidone could inhibit apoptosis, downregulate ACE receptors expression, decrease inflammation by several mechanisms and ameliorate oxidative stress and hence protect pneumocytes and other cells from COVID-19 invasion and cytokine storm simultaneously. Based on the pirfenidone mechanism of action and the known pathophysiology of COVID-19, I believe that pirfenidone has the potential for the treatment of COVID-19 patients.
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Affiliation(s)
- Soroush Seifirad
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Medicine, Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, USA.
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Nugraha RV, Ridwansyah H, Ghozali M, Khairani AF, Atik N. Traditional Herbal Medicine Candidates as Complementary Treatments for COVID-19: A Review of Their Mechanisms, Pros and Cons. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:2560645. [PMID: 33101440 PMCID: PMC7569437 DOI: 10.1155/2020/2560645] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/11/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a new infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that belongs to the coronavirus family. The first case was reported in December 2019, and the disease has become a pandemic. Impaired immune regulation is one of the factors that play a role in its pathogenesis and results in poor outcomes of COVID-19 patients. There have been many studies with drug candidates used as antivirals or immunomodulators. However, the results of these investigations showed that the drug candidates were not significantly effective against the disease. Meanwhile, people believe that consuming herbal immunomodulators can prevent or even cure COVID-19. Unfortunately, specific preclinical and clinical trials to evaluate the effects of herbal immunoregulators have not been conducted. Certain natural compounds might be effective for the treatment of COVID-19 based on general concepts from previous experiments. This review discusses some herbal agents extracted from various plants, including Echinacea, Cinchona, Curcuma longa, and Curcuma xanthorrhiza, which are considered for the treatment of COVID-19. In addition, we discuss the pros and cons of utilising herbal medicine during the COVID-19 pandemic, draw some conclusions, and make recommendations at the end of the session.
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Affiliation(s)
- Rhea Veda Nugraha
- Graduate School of Biomedical Sciences Master Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Hastono Ridwansyah
- Graduate School of Biomedical Sciences Master Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Mohammad Ghozali
- Department of Biomedical Sciences, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Astrid Feinisa Khairani
- Department of Biomedical Sciences, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Nur Atik
- Department of Biomedical Sciences, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
- Immunology Study Group, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
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Yang CJ, Wei YJ, Chang HL, Chang PY, Tsai CC, Chen YH, Hsueh PR. Remdesivir use in the coronavirus disease 2019 pandemic: A mini-review. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:27-36. [PMID: 33060041 PMCID: PMC7534785 DOI: 10.1016/j.jmii.2020.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/01/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative viral pathogen of coronavirus disease 2019 (COVID-19), appears to have various clinical presentations and may result in severe respiratory failure. The global SARS-CoV-2-associated viral pneumonia pandemic was first reported in December 2019 in China. Based on known pharmacological mechanisms, many therapeutic drugs have been repurposed to target SARS-CoV-2. Among these drugs, remdesivir appears to be the currently most promising according to several clinical trials and reports of compassionate use. In this mini-review, we summarize the current evidence on the efficacy and challenges of remdesivir for the treatment of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Chih-Jen Yang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Jui Wei
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsu-Liang Chang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Yu Chang
- Department of Management, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Chen Tsai
- Department of Medical Information of Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan.
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Jo Y, Jamieson L, Edoka I, Long L, Silal S, Pulliam JRC, Moultrie H, Sanne I, Meyer-Rath G, Nichols BE. Cost-effectiveness of remdesivir and dexamethasone for COVID-19 treatment in South Africa. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32995824 DOI: 10.1101/2020.09.24.20200196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background South Africa recently experienced a first peak in COVID-19 cases and mortality. Dexamethasone and remdesivir both have the potential to reduce COVID-related mortality, but their cost-effectiveness in a resource-limited setting with scant intensive care resources is unknown. Methods We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed cost-effectiveness of 1) administration of dexamethasone to ventilated patients and remdesivir to non-ventilated patients, 2) dexamethasone alone to both non-ventilated and ventilated patients, 3) remdesivir to non-ventilated patients only, and 4) dexamethasone to ventilated patients only; all relative to a scenario of standard care. We estimated costs from the healthcare system perspective in 2020 USD, deaths averted, and the incremental cost effectiveness ratios of each scenario. Results Remdesivir for non-ventilated patients and dexamethasone for ventilated patients was estimated to result in 1,111 deaths averted (assuming a 0-30% efficacy of remdesivir) compared to standard care, and save $11.5 million. The result was driven by the efficacy of the drugs, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to ventilated and non-ventilated patients requires additional $159,000 and averts 1,146 deaths, resulting in $139 per death averted, relative to standard care. Conclusions The use of dexamethasone for ventilated and remdesivir for non-ventilated patients is likely to be cost-saving compared to standard care. Given the economic and health benefits of both drugs, efforts to ensure access to these medications is paramount.
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Sarkar C, Mondal M, Torequl Islam M, Martorell M, Docea AO, Maroyi A, Sharifi-Rad J, Calina D. Potential Therapeutic Options for COVID-19: Current Status, Challenges, and Future Perspectives. Front Pharmacol 2020; 11:572870. [PMID: 33041814 PMCID: PMC7522523 DOI: 10.3389/fphar.2020.572870] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic represents an unprecedented challenge for the researchers to offer safe, tolerable, and effective treatment strategies for its causative agent known as SARS-CoV-2. With the rapid evolution of the pandemic, even the off-label use of existing drugs has been restricted by limited availability. Several old antivirals, antimalarial, and biological drugs are being reconsidered as possible therapies. The effectiveness of the controversial treatment options for COVID-19 such as nonsteroidal antiinflammatory drugs, angiotensin 2 conversion enzyme inhibitors and selective angiotensin receptor blockers was also discussed. A systemic search in the PubMed, Science Direct, LitCovid, Chinese Clinical Trial Registry, and ClinicalTrials.gov data bases was conducted using the keywords "coronavirus drug therapy," passive immunotherapy for COVID-19', "convalescent plasma therapy," (CPT) "drugs for COVID-19 treatment," "SARS-CoV-2," "COVID-19," "2019-nCoV," "coronavirus immunology," "microbiology," "virology," and individual drug names. Systematic reviews, case presentations and very recent clinical guidelines were included. This narrative review summarizes the available information on possible therapies for COVID-19, providing recent data to health professionals.
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Affiliation(s)
- Chandan Sarkar
- Department of Pharmacy, Life Science School, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj (Dhaka), Bangladesh
| | - Milon Mondal
- Department of Pharmacy, Life Science School, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj (Dhaka), Bangladesh
| | - Muhammad Torequl Islam
- Laboratory of Theoretical and Computational Biophysics, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, and Centre for Healthy Living, University of Concepción, Concepción, Chile
- Universidad de Concepción, Unidad de Desarrollo Tecnológico, UDT, Concepción, Chile
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Alfred Maroyi
- Department of Botany, University of Fort Hare, Alice, South Africa
| | - Javad Sharifi-Rad
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Li C, Wang L, Ren L. Antiviral mechanisms of candidate chemical medicines and traditional Chinese medicines for SARS-CoV-2 infection. Virus Res 2020; 286:198073. [PMID: 32592817 PMCID: PMC7313518 DOI: 10.1016/j.virusres.2020.198073] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023]
Abstract
The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become a global pandemic. Up to now, numerous medicines have been applied or approved for the prevention and control of the virus infection. However, the efficiency of each medicine or combination is completely different or still unknown. In this review, we discuss the types, characteristics, antiviral mechanisms, and shortcomings of recommended candidate medicines for SARS-CoV-2 infection, as well as perspectives of the drugs for the disease treatment, which may provide a theoretical basis for drug screening and application.
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Affiliation(s)
- Chang Li
- Research Unit of Key Technologies for Prevention and Control of Virus Zoonoses, Chinese Academy of Medical Sciences, Military Veterinary Institute, Academy of Military Medical Sciences, Changchun, 130122, China
| | - Lin Wang
- Key Lab for Zoonoses Research, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun 130062, China
| | - Linzhu Ren
- Key Lab for Zoonoses Research, Ministry of Education, Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Jilin University, Changchun 130062, China.
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Osborne V, Davies M, Lane S, Evans A, Denyer J, Dhanda S, Roy D, Shakir S. Lopinavir-Ritonavir in the Treatment of COVID-19: A Dynamic Systematic Benefit-Risk Assessment. Drug Saf 2020; 43:809-821. [PMID: 32578156 PMCID: PMC7309686 DOI: 10.1007/s40264-020-00966-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND OBJECTIVE COVID-19 is an ongoing, global public health crisis for which safe and effective treatments need to be identified. The benefit-risk balance for the use of lopinavir-ritonavir in COVID-19 needs to be monitored on an ongoing basis, therefore a systematic benefit-risk assessment was designed and conducted. A key objective of this study was to provide a platform for a dynamic systematic benefit-risk evaluation; although initially this evaluation is likely to contain limited information, it is required because of the urgent unmet public need. Importantly, it allows additional data to be incorporated as they become available, and re-evaluation of the benefit-risk profile. METHODS A systematic benefit-risk assessment was conducted using the Benefit-Risk Action Team (BRAT) framework. The exposure of interest was lopinavir-ritonavir treatment in severe COVID-19 compared to standard of care, placebo or other treatments. A literature search was conducted in PubMed and Embase to identify peer-reviewed papers reporting clinical outcomes. Two clinicians constructed a value tree and ranked key benefits and risks in order of considered clinical importance. RESULTS We screened 143 papers from PubMed and 264 papers from Embase for lopinavir-ritonavir; seven papers were included in the final benefit-risk assessment. In comparison to standard of care, data for several key benefits and risks were identified for lopinavir-ritonavir. Time to clinical improvement was not significantly different for lopinavir-ritonavir in comparison to standard of care (hazard ratio 1.31, 95% confidence interval 0.95-1.80). From one study, there were fewer cases of acute respiratory distress syndrome with lopinavir-ritonavir compared with standard of care (13% vs 27%). There also appeared to be fewer serious adverse events with lopinavir-ritonavir (20%) vs standard of care (32%). Limited data were available for comparison of lopinavir-ritonavir to other treatments. CONCLUSIONS Based on currently available data, there was no clear benefit for the use of lopinavir-ritonavir compared to standard of care in severe COVID-19. Risk data suggested a possible decrease in serious adverse events. There was a reduction in acute respiratory distress syndrome with lopinavir-ritonavir in one study. Overall, the benefit-risk profile for lopinavir-ritonavir in severe COVID-19 cannot be considered positive until further efficacy and effectiveness data become available.
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Affiliation(s)
- Vicki Osborne
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK.
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
| | - Miranda Davies
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Samantha Lane
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Alison Evans
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Jacqueline Denyer
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK
| | - Sandeep Dhanda
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Debabrata Roy
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Saad Shakir
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, SO31 1AA, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Benani A, Ben Mkaddem S. Mechanisms Underlying Potential Therapeutic Approaches for COVID-19. Front Immunol 2020; 11:1841. [PMID: 32793246 PMCID: PMC7385230 DOI: 10.3389/fimmu.2020.01841] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022] Open
Abstract
Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is a betacoronavirus, and is associated with cytokine storm inflammation and lung injury, leading to respiratory distress. The transmission of the virus is mediated by human contact. To control and prevent the spread of this virus, the majority of people worldwide are facing quarantine; patients are being subjected to non-specific treatments under isolation. To prevent and stop the COVID-19 pandemic, several clinical trials are in the pipeline. The current clinical trials either target the intracellular replication and spread of the virus or the cytokine storm inflammation seen in COVID-19 cases during the later stages of the disease. Since both targeting strategies are different, the window drug administration plays a crucial role in the efficacy of the treatment. Here, we review the mechanism underlying SARS-CoV-2 cell infection and potential future therapeutic approaches.
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Affiliation(s)
- Abdelouaheb Benani
- Unité de Biologie Moléculaire, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Sanae Ben Mkaddem
- U978 Institut National de la Santé et de la Recherche Médicale, Bobigny, France.,UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
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Benefit-risk assessment for remdesivir in COVID-19. REACTIONS WEEKLY 2020. [PMCID: PMC7290138 DOI: 10.1007/s40278-020-79483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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