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Alshamrani AA, Assiri AM, Almohammed OA. Comprehensive evaluation of six interventions for hospitalized patients with COVID-19: A propensity score matching study. Saudi Pharm J 2023; 31:517-525. [PMID: 36819112 PMCID: PMC9930407 DOI: 10.1016/j.jsps.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the effectiveness of either hydroxychloroquine, triple combination therapy (TCT), favipiravir, dexamethasone, remdesivir, or COVID-19 convalescent plasma (CCP) in comparison with standard-of-care for hospitalized patients with COVID-19 using real-world data from Saudi Arabia. Patients and methods A secondary database analysis was conducted using the Saudi Ministry of Health database for patients with COVID-19. Adult (≥ 18 years) hospitalized patients with COVID-19 between March 2020 and January 2021 were included in the analysis. A propensity score matching technique was used to establish comparable groups for each therapeutic approach. Lastly, an independent t-test and chi-square test were used to compare the matching groups in the aspects of the duration of hospitalization, length of stay (LOS) in intensive care units (ICU), in-hospital mortality, and composite poor outcome. Multilevel logistic regression model was used to assess the association between the severity stage of COVID-19 and the outcomes while using the medication or intervention used as a grouping variable in the model. Results The mean duration of hospitalization was significantly longer for patients who received TCT, favipiravir, dexamethasone, or CCP compared to patients who did not receive these therapies, with a mean difference ranging between 2.2 and 4.9 days for dexamethasone and CCP, respectively. Furthermore, the use of favipiravir or CCP was associated with a longer stay in ICU. Remdesivir was the only agent associated with in-hospital mortality benefit. A higher risk of mortality and poorer composite outcome were associated with the use of favipiravir or dexamethasone. However, the logistic regression model reveled that the difference between the two matched cohorts was due to the severity stage not the medication. Additionally, the use of hydroxychloroquine, TCT, or CCP had no impact on the incidence of in-hospital mortality or composite poor outcomes. Conclusion Remdesivir was the only agent associated with in-hospital mortality benefit. The observed worsened treatment outcomes associated with the use of dexamethasone or FPV shall be attributed to the severity stage rather than the medication use. In light of these varied results, additional studies are needed to continue evaluating the actual benefits of these therapies.
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Affiliation(s)
- Ali A Alshamrani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed M Assiri
- Health Volunteering Center, Ministry of Health, Riyadh, Saudi Arabia
| | - Omar A Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Maziarz M, Stencel A. The failure of drug repurposing for COVID-19 as an effect of excessive hypothesis testing and weak mechanistic evidence. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:47. [PMID: 36258007 PMCID: PMC9579070 DOI: 10.1007/s40656-022-00532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 03/16/2022] [Indexed: 05/26/2023]
Abstract
The current strategy of searching for an effective treatment for COVID-19 relies mainly on repurposing existing therapies developed to target other diseases. Conflicting results have emerged in regard to the efficacy of several tested compounds but later results were negative. The number of conducted and ongoing trials and the urgent need for a treatment pose the risk that false-positive results will be incorrectly interpreted as evidence for treatments' efficacy and a ground for drug approval. Our purpose is twofold. First, we show that the number of drug-repurposing trials can explain the false-positive results. Second, we assess the evidence for treatments' efficacy from the perspective of evidential pluralism and argue that considering mechanistic evidence is particularly needed in cases when the evidence from clinical trials is conflicting or of low quality. Our analysis is an application of the program of Evidence Based Medicine Plus (EBM+) to the drug repurposing trials for COVID. Our study shows that if decision-makers applied EBM+, authorizing the use of ineffective treatments would be less likely. We analyze the example of trials assessing the efficacy of hydroxychloroquine as a treatment for COVID-19 and mechanistic evidence in favor of and against its therapeutic power to draw a lesson for decision-makers and drug agencies on how excessive hypothesis testing can lead to spurious findings and how studying negative mechanistic evidence can be helpful in discriminating genuine from spurious results.
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Affiliation(s)
- Mariusz Maziarz
- Interdisciplinary Centre for Ethics, Jagiellonian University, Grodzka 52, Kraków, Poland
- Institute of Philosophy, Jagiellonian University, Grodzka 52, Kraków, Poland
| | - Adrian Stencel
- Institute of Philosophy, Jagiellonian University, Grodzka 52, Kraków, Poland
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Hydroxychloroquine blocks SARS-CoV-2 entry into the endocytic pathway in mammalian cell culture. Commun Biol 2022; 5:958. [PMID: 36104427 PMCID: PMC9472185 DOI: 10.1038/s42003-022-03841-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Hydroxychloroquine (HCQ), a drug used to treat lupus and malaria, was proposed as a treatment for SARS-coronavirus-2 (SARS-CoV-2) infection, albeit with controversy. In vitro, HCQ effectively inhibits viral entry, but its use in the clinic has been hampered by conflicting results. A better understanding of HCQ’s mechanism of actions in vitro is needed. Recently, anesthetics were shown to disrupt ordered clusters of monosialotetrahexosylganglioside1 (GM1) lipid. These same lipid clusters recruit the SARS-CoV-2 surface receptor angiotensin converting enzyme 2 (ACE2) to endocytic lipids, away from phosphatidylinositol 4,5 bisphosphate (PIP2) clusters. Here we employed super-resolution imaging of cultured mammalian cells (VeroE6, A549, H1793, and HEK293T) to show HCQ directly perturbs clustering of ACE2 receptor with both endocytic lipids and PIP2 clusters. In elevated (high) cholesterol, HCQ moves ACE2 nanoscopic distances away from endocytic lipids. In cells with resting (low) cholesterol, ACE2 primarily associates with PIP2 clusters, and HCQ moves ACE2 away from PIP2 clusters—erythromycin has a similar effect. We conclude HCQ inhibits viral entry through two distinct mechanisms in high and low tissue cholesterol and does so prior to inhibiting cathepsin-L. HCQ clinical trials and animal studies will need to account for tissue cholesterol levels when evaluating dosing and efficacy. Super-resolution microscopy in cultured cells is employed to dissect the effect of hydroxychloroquine (HCQ) at the plasma membrane and HCQ directly perturbs clustering of the SARS-CoV-2 receptor ACE2 with endocytic lipids and PIP2 clusters.
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Grant JM, Chan J, Lother SA, Barrett L, Bonnar PE, Findlater AR, Kassim SS, Lam JC, Vinh DC. AMMI Canada Practice Point: Treatments for adults with COVID-19 in 2021-2022. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:163-169. [PMID: 36337603 PMCID: PMC9629725 DOI: 10.3138/jammi-2022-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer M Grant
- Division of Medical Microbiology and Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Chan
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States
| | - Sylvain A Lother
- Divisions of Critical Care and Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Barrett
- Division of Infectious Diseases, Department of Medicine, Department of Microbiology and Immunology, Queen Elizabeth II Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul E Bonnar
- Division of Infectious Diseases, Queen Elizabeth II Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Aidan R Findlater
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sameer S Kassim
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba
| | - John C Lam
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donald C Vinh
- Division of Infectious Diseases, Department of Medicine; Division of Medical Microbiology, Department of Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Locher C, Moher D, Cristea IA, Naudet F. Publication by association: how the COVID-19 pandemic has shown relationships between authors and editorial board members in the field of infectious diseases. BMJ Evid Based Med 2022; 27:133-136. [PMID: 33785512 DOI: 10.1136/bmjebm-2021-111670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 12/29/2022]
Abstract
During the COVID-19 pandemic, the rush to scientific and political judgements on the merits of hydroxychloroquine was fuelled by dubious papers which may have been published because the authors were not independent from the practices of the journals in which they appeared. This example leads us to consider a new type of illegitimate publishing entity, 'self-promotion journals' which could be deployed to serve the instrumentalisation of productivity-based metrics, with a ripple effect on decisions about promotion, tenure and grant funding, but also on the quality of manuscripts that are disseminated to the medical community and form the foundation of evidence-based medicine.
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Affiliation(s)
- Clara Locher
- CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de 14 Rennes)], Rennes 1 University, Rennes, Bretagne, France
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
| | | | - Florian Naudet
- CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de 14 Rennes)], Rennes 1 University, Rennes, Bretagne, France
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Baracaldo-Santamaría D, Pabón-Londoño S, Rojas-Rodriguez LC. Drug safety of frequently used drugs and substances for self-medication in COVID-19. Ther Adv Drug Saf 2022; 13:20420986221094141. [PMID: 35493401 PMCID: PMC9039440 DOI: 10.1177/20420986221094141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
During the COVID-19 pandemic, the behavior of self-medication has increased. The dissemination of misleading information regarding the efficacy of certain drugs or substances for the prevention and treatment of COVID-19 has been the major contributing factor for this phenomenon. Alongside with the increase in self-medication behavior, the inherent risks to this act such as drug-drug interactions, adverse events, drug toxicity, and masking of symptoms have also increased. Self-medication in the context of COVID-19 has led to drug misuse leading in some cases to the development of fatal adverse drug reactions. It is important that during this ongoing pandemic drugs with potential clinical efficacy against COVID-19 are adequately analyzed regarding their efficacy, safety, and monitoring. The aim of this review is to describe the available evidence regarding the efficacy, safety, and monitoring of the drugs and substances that have been shown to be frequently used for self-medication in patients with COVID-19 (hydroxychloroquine, non-steroidal anti-inflammatory drugs, ivermectin, azithromycin, vitamins, aspirin, and chlorine dioxide) to adequately characterize their risks, safe use, monitoring strategies, and to reinforce the concept that these substances should not be used for self-medication and require a medical prescription. Plain Language Summary Drug safety of frequently used drugs and substances for self-medication in COVID-19 Dissemination of information about potential COVID-19 treatments has led individuals to self-medicate and expose themselves to risks such as drug-drug interactions, side effects, antibiotic resistance, and misdiagnosis. There is a need to review the medical literature to evaluate the safety and efficacy of the drugs and substances commonly used by the population for the treatment and prevention of SARS CoV-2 infection. In this review, we included drugs that are frequently used for self-medication and commonly advertised such as ivermectin, hydroxychloroquine, chlorine dioxide, azithromycin, and non-steroidal anti-inflammatory drugs, among others. A brief introduction of the drug and its mechanism of action, followed by a summary of the efficacy in COVID-19 and safety, will be described for each drug in order to promote their responsible use.
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Affiliation(s)
- Daniela Baracaldo-Santamaría
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | - Luis Carlos Rojas-Rodriguez
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
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Gupta T, Thakkar P, Kalra B, Kannan S. Hydroxychloroquine in the treatment of coronavirus disease 2019: Rapid updated systematic review and meta-analysis. Rev Med Virol 2022; 32:e2276. [PMID: 34245622 PMCID: PMC8420202 DOI: 10.1002/rmv.2276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 continues to grow and spread throughout the world since being declared a pandemic. Despite extensive scientific research globally including repurposing of several existing drugs, there is no effective or proven therapy for this enigmatic disease which is still largely managed empirically This systematic review evaluated the role of hydroxychloroquine (HCQ) in the treatment of COVID-19 infection and was conducted using Cochrane methodology for systematic reviews of interventional studies including risk of bias assessment and grading of the quality of evidence. Only prospective clinical trials randomly assigning COVID-19 patients to HCQ plus standard of care therapy (test arm) versus placebo/standard of care (control arm) were included. Data were pooled using the random-effects model and expressed as risk ratio (RR) with 95% confidence interval (CI). A total of 10,492 patients from 19 randomised controlled trials were included. The use of HCQ was not associated with higher rates of clinical improvement (RR = 1.00, 95% CI: 0.96-1.03, p = 0.79) or reduction in all-cause mortality by Day14 (RR = 1.07, 95% CI: 0.97-1.19, p = 0.19) or Day28 (RR = 1.08, 95% CI: 0.99-1.19, p = 0.09) compared to placebo/standard of care. There was no significant difference in serious adverse events between the two arms (RR = 1.01, 95% CI: 0.85-1.19, p = 0.95). There is low-to-moderate certainty evidence that HCQ therapy is generally safe but does not reduce mortality or enhance recovery in patients with COVID-19 infection.
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Affiliation(s)
- Tejpal Gupta
- Department of Radiation OncologyClinical Research CentreAdvanced Centre for Treatment Research & Education in Cancer (ACTREC)Tata Memorial CentreHomi Bhabha National Institute (HBNI)KhargharNavi MumbaiIndia
| | - Prafulla Thakkar
- Division of Internal MedicineClinical Research CentreAdvanced Centre for Treatment Research & Education in Cancer (ACTREC)Tata Memorial CentreHomi Bhabha National Institute (HBNI)KhargharNavi MumbaiIndia
| | - Babusha Kalra
- Department of Radiation OncologyClinical Research CentreAdvanced Centre for Treatment Research & Education in Cancer (ACTREC)Tata Memorial CentreHomi Bhabha National Institute (HBNI)KhargharNavi MumbaiIndia
| | - Sadhana Kannan
- Clinical Research SecretariatClinical Research CentreAdvanced Centre for Treatment Research & Education in Cancer (ACTREC)Tata Memorial CentreHomi Bhabha National Institute (HBNI)KhargharNavi MumbaiIndia
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Kountouras J, Gialamprinou D, Kotronis G, Papaefthymiou A, Economidou E, Soteriades ES, Vardaka E, Chatzopoulos D, Tzitiridou-Chatzopoulou M, Papazoglou DD, Doulberis M. Ofeleein i mi Vlaptin-Volume II: Immunity Following Infection or mRNA Vaccination, Drug Therapies and Non-Pharmacological Management at Post-Two Years SARS-CoV-2 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:309. [PMID: 35208631 PMCID: PMC8874934 DOI: 10.3390/medicina58020309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/06/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022]
Abstract
The persistence of the coronavirus disease 2019 (COVID-19) pandemic has triggered research into limiting transmission, morbidity and mortality, thus warranting a comprehensive approach to guide balanced healthcare policies with respect to people's physical and mental health. The mainstay priority during COVID-19 is to achieve widespread immunity, which could be established through natural contact or vaccination. Deep knowledge of the immune response combined with recent specific data indicates the potential inferiority of induced immunity against infection. Moreover, the prevention of transmission has been founded on general non-pharmacological measures of protection, albeit debate exists considering their efficacy and, among other issues, their socio-psychological burden. The second line of defense is engaged after infection and is supported by a plethora of studied agents, such as antibiotics, steroids and non-steroid anti-inflammatory drugs, antiviral medications and other biological agents that have been proposed, though variability in terms of benefits and adverse events has not allowed distinct solutions, albeit certain treatments might have a role in prevention and/or treatment of the disease. This narrative review summarizes the existing literature on the advantages and weaknesses of current COVID-19 management measures, thus underlining the necessity of acting based on the classical principle of "ofeleein i mi vlaptin", that is, to help or not to harm.
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Affiliation(s)
- Jannis Kountouras
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
| | - Dimitra Gialamprinou
- Second Neonatal Department and NICU, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Central Macedonia, Greece;
| | - Georgios Kotronis
- Department of Internal Medicine, General Hospital Aghios Pavlos of Thessaloniki, 55134 Thessaloniki, Central Macedonia, Greece;
| | - Apostolis Papaefthymiou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Department of Gastroenterology, University Hospital of Larisa, Mezourlo, 41110 Larisa, Thessaly, Greece
| | - Eleftheria Economidou
- School of Economics and Management, Healthcare Management Program, Open University of Cyprus, Nicosia 12794, Cyprus; (E.E.); (E.S.S.)
| | - Elpidoforos S. Soteriades
- School of Economics and Management, Healthcare Management Program, Open University of Cyprus, Nicosia 12794, Cyprus; (E.E.); (E.S.S.)
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA 02115, USA
| | - Elisabeth Vardaka
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Central Macedonia, Greece
| | - Dimitrios Chatzopoulos
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
| | - Maria Tzitiridou-Chatzopoulou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Midwifery Department, School of Healthcare Sciences, University of West Macedonia, Koila, 50100 Kozani, Central Macedonia, Greece
| | - Dimitrios David Papazoglou
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Michael Doulberis
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
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10
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McKinnon JE, Wang DD, Zervos M, Saval M, Marshall-Nightengale L, Kilgore P, Pabla P, Szandzik E, Maksimowicz-McKinnon K, O'Neill WW. Safety and Tolerability of Hydroxychloroquine in healthcare workers and first responders for the prevention of COVID-19: WHIP COVID-19 Study. Int J Infect Dis 2021; 116:167-173. [PMID: 34954095 PMCID: PMC8695310 DOI: 10.1016/j.ijid.2021.12.343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Abstract
Hydroxychloroquine chemoprophylaxis is safe in high-risk populations for COVID-19. No increased cardiovascular risks were observed with hydroxychloroquine chemoprophylaxis. Adverse events were similar between placebo and hydroxychloroquine treatment arms.
Background Health care workers (HCW) are among the highest risk groups for acquisition of COVID-19 because of occupational exposures. The WHIP COVID-19 Study aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) as chemoprophylaxis for SARS-CoV-2 infection in this population. Methods HCW, first responders, and other occupationally high-risk participants were enrolled in a randomized, placebo-controlled clinical study of HCQ from April to October 2020. The trial compared daily versus weekly HCQ with placebo and with a prospective cohort on HCQ for autoimmune diseases. Participants were followed for 8 weeks. Serology or a positive polymerase chain reaction test was used to determine laboratory confirmed clinical cases. Results A total of 624 participants were randomized to placebo (n = 200), weekly HCQ (n = 201), daily HCQ (n = 197). For the primary safety end point, 279 (44.7%) participants experienced adverse event (AE) level II or lower (total AEs n = 589), similar rates in all randomized groups (P = .188) with no hospitalizations or interventions required. Only 4 laboratory confirmed COVID-19 cases occurred, with 2 in the placebo arm and one in each HCQ randomized arm. Conclusions This randomized placebo-controlled trial was able to demonstrate the safety of HCQ outpatient chemoprophylaxis in high-risk groups against COVID-19. Future studies of chemoprophylaxis for SARS-CoV-2 are needed as the epidemic continues worldwide.
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Affiliation(s)
- J E McKinnon
- Infectious Disease, Henry Ford Hospital, Detroit, Michigan.
| | - D D Wang
- Division of Cardiovascular Disease, Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - M Zervos
- Infectious Disease, Henry Ford Hospital, Detroit, Michigan
| | - M Saval
- Division of Cardiovascular Disease, Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - L Marshall-Nightengale
- Division of Cardiovascular Disease, Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan; Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - P Kilgore
- Infectious Disease, Henry Ford Hospital, Detroit, Michigan
| | - P Pabla
- Pharmacy, Henry Ford Hospital, Detroit, Michigan
| | - E Szandzik
- Pharmacy, Henry Ford Hospital, Detroit, Michigan
| | | | - W W O'Neill
- Division of Cardiovascular Disease, Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
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Abstract
The COVID-19 pandemic has frightened people worldwide, and coronavirus has become the most commonly used phrase in recent years. Therefore, there is a need for a systematic literature review (SLR) related to Big Data applications in the COVID-19 pandemic crisis. The objective is to highlight recent technological advancements. Many studies emphasize the area of the COVID-19 pandemic crisis. Our study categorizes the many applications used to manage and control the pandemic. There is a very limited SLR prospective of COVID-19 with Big Data. Our SLR study picked five databases: Science direct, IEEE Xplore, Springer, ACM, and MDPI. Before the screening, following the recommendation, Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) were reported for 893 studies from 2019, 2020 and until September 2021. After screening, 60 studies met the inclusion criteria through COVID-19 data statistics, and Big Data analysis was used as the search string. Our research’s findings successfully dealt with COVID-19 healthcare with risk diagnosis, estimation or prevention, decision making, and drug Big Data applications problems. We believe that this review study will motivate the research community to perform expandable and transparent research against the pandemic crisis of COVID-19.
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12
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Wen X, Yang Y, Klionsky DJ. Moments in autophagy and disease: Past and present. Mol Aspects Med 2021; 82:100966. [PMID: 33931245 PMCID: PMC8548407 DOI: 10.1016/j.mam.2021.100966] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 01/18/2023]
Abstract
Over the past several decades, research on autophagy, a highly conserved lysosomal degradation pathway, has been advanced by studies in different model organisms, especially in the field of its molecular mechanism and regulation. The malfunction of autophagy is linked to various diseases, among which cancer and neurodegenerative diseases are the major focus. In this review, we cover some other important diseases, including cardiovascular diseases, infectious and inflammatory diseases, and metabolic disorders, as well as rare diseases, with a hope of providing a more complete understanding of the spectrum of autophagy's role in human health.
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Affiliation(s)
- Xin Wen
- Life Sciences Institute, Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Ying Yang
- Life Sciences Institute, Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Klionsky
- Life Sciences Institute, Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA.
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Ferreira G, Santander A, Savio F, Guirado M, Sobrevia L, Nicolson GL. SARS-CoV-2, Zika viruses and mycoplasma: Structure, pathogenesis and some treatment options in these emerging viral and bacterial infectious diseases. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166264. [PMID: 34481867 PMCID: PMC8413106 DOI: 10.1016/j.bbadis.2021.166264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/22/2021] [Accepted: 08/30/2021] [Indexed: 01/28/2023]
Abstract
The molecular evolution of life on earth along with changing environmental, conditions has rendered mankind susceptible to endemic and pandemic emerging infectious diseases. The effects of certain systemic viral and bacterial infections on morbidity and mortality are considered as examples of recent emerging infections. Here we will focus on three examples of infections that are important in pregnancy and early childhood: SARS-CoV-2 virus, Zika virus, and Mycoplasma species. The basic structural characteristics of these infectious agents will be examined, along with their general pathogenic mechanisms. Coronavirus infections, such as caused by the SARS-CoV-2 virus, likely evolved from zoonotic bat viruses to infect humans and cause a pandemic that has been the biggest challenge for humanity since the Spanish Flu pandemic of the early 20th century. In contrast, Zika Virus infections represent an expanding infectious threat in the context of global climate change. The relationship of these infections to pregnancy, the vertical transmission and neurological sequels make these viruses highly relevant to the topics of this special issue. Finally, mycoplasmal infections have been present before mankind evolved, but they were rarely identified as human pathogens until recently, and they are now recognized as important coinfections that are able to modify the course and prognosis of various infectious diseases and other chronic illnesses. The infectious processes caused by these intracellular microorganisms are examined as well as some general aspects of their pathogeneses, clinical presentations, and diagnoses. We will finally consider examples of treatments that have been used to reduce morbidity and mortality of these infections and discuss briefly the current status of vaccines, in particular, against the SARS-CoV-2 virus. It is important to understand some of the basic features of these emerging infectious diseases and the pathogens involved in order to better appreciate the contributions of this special issue on how infectious diseases can affect human pregnancy, fetuses and neonates.
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Affiliation(s)
- Gonzalo Ferreira
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling, Department of Biophysics, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay.
| | - Axel Santander
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling, Department of Biophysics, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - Florencia Savio
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling, Department of Biophysics, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - Mariana Guirado
- Department of Infectious Diseases, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaeology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; Medical School (Faculty of Medicine), São Paulo State University (UNESP), Brazil; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston QLD 4029, Queensland, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands
| | - Garth L Nicolson
- Department of Molecular Pathology, The Institute for Molecular Medicine, Huntington Beach, CA, USA
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14
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Deng J, Zhou F, Heybati K, Ali S, Zuo QK, Hou W, Dhivagaran T, Ramaraju HB, Chang O, Wong CY, Silver Z. Efficacy of chloroquine and hydroxychloroquine for the treatment of hospitalized COVID-19 patients: a meta-analysis. Future Virol 2021; 17:10.2217/fvl-2021-0119. [PMID: 34887938 PMCID: PMC8647998 DOI: 10.2217/fvl-2021-0119] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023]
Abstract
Aims: To evaluate the efficacy and safety of hydroxychloroquine/chloroquine, with or without azithromycin, in treating hospitalized COVID-19 patients. Materials & methods: Data from randomized and observational studies were included in a random-effects meta-analysis. Primary outcomes included time to negative conversion of SARS-CoV-2 tests, length of stay, mortality, incidence of mechanical ventilation, time to normalization of body temperature, incidence of adverse events and incidence of QT prolongations. Results: Fifty-one studies (n = 61,221) were included. Hydroxychloroquine/chloroquine showed no efficacy in all primary efficacy outcomes, but was associated with increased odds of QT prolongations. Conclusion: Due to a lack of efficacy and increased odds of cardiac adverse events, hydroxychloroquine/chloroquine should not be used for treating hospitalized COVID-19 patients.
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Affiliation(s)
- Jiawen Deng
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Fangwen Zhou
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Kiyan Heybati
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Saif Ali
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Qi Kang Zuo
- Department of Anesthesiology, Rutgers, New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G5, Canada
| | - Wenteng Hou
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Thanansayan Dhivagaran
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Integrated Biomedical Engineering & Health Sciences Program (iBioMed), McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | | | - Oswin Chang
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Chi Yi Wong
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Zachary Silver
- Faculty of Science, Carleton University, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada
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15
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Boudesseul J, Zerhouni O, Harbert A, Rubinos C. Keeping Meta-Analyses Hygienic During the COVID-19 Pandemic. Front Public Health 2021; 9:722458. [PMID: 34660516 PMCID: PMC8511714 DOI: 10.3389/fpubh.2021.722458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/01/2021] [Indexed: 12/27/2022] Open
Abstract
Despite the massive distribution of different vaccines globally, the current pandemic has revealed the crucial need for an efficient treatment against COVID-19. Meta-analyses have historically been extremely useful to determine treatment efficacy but recent debates about the use of hydroxychloroquine for COVID-19 patients resulted in contradictory meta-analytical results. Different factors during the COVID-19 pandemic have impacted key features of conducting a good meta-analysis. Some meta-analyses did not evaluate or treat substantial heterogeneity (I2 > 75%); others did not include additional analysis for publication bias; none checked for evidence of p–hacking in the primary studies nor used recent methods (i.e., p-curve or p-uniform) to estimate the average population-size effect. These inconsistencies may contribute to contradictory results in the research evaluating COVID-19 treatments. A prominent example of this is the use of hydroxychloroquine, where some studies reported a large positive effect, whereas others indicated no significant effect or even increased mortality when hydroxychloroquine was used with the antibiotic azithromycin. In this paper, we first recall the benefits and fundamental steps of good quality meta-analysis. Then, we examine various meta-analyses on hydroxychloroquine treatments for COVID-19 patients that led to contradictory results and causes for this discrepancy. We then highlight recent tools that contribute to evaluate publication bias and p-hacking (i.e., p-curve, p-uniform) and conclude by making technical recommendations that meta-analyses should follow even during extreme global events such as a pandemic.
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Affiliation(s)
- Jordane Boudesseul
- Facultad de Psicología, Instituto de Investigación Científica, Universidad de Lima, Lima, Peru
| | | | - Allie Harbert
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Clio Rubinos
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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16
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Martins-Filho PR, Ferreira LC, Heimfarth L, Araújo AADS, Quintans-Júnior LJ. Efficacy and safety of hydroxychloroquine as pre-and post-exposure prophylaxis and treatment of COVID-19: A systematic review and meta-analysis of blinded, placebo-controlled, randomized clinical trials. LANCET REGIONAL HEALTH. AMERICAS 2021; 2:100062. [PMID: 34485970 PMCID: PMC8403035 DOI: 10.1016/j.lana.2021.100062] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hydroxychloroquine (HCQ) is an anti-malarial and immunomodulatory drug considered a potential candidate for drug repurposing in COVID-19 due to their in vitro antiviral activity against SARS-CoV-2. Despite the potential antiviral effects and anti-inflammatory profile, the results based on clinical studies are contradictory. Therefore, the quality of the decision-making process from meta-analyses summarizing the available evidence selecting studies with different designs and unblinded trials is limited. The aim of this study was to synthesize the best evidence on the efficacy and safety of HCQ as pre-and post-exposure prophylaxis and treatment of non-hospitalized and hospitalized patients with COVID-19. METHODS Searches were performed in PubMed, Web of Science, Embase, Lilacs, the website ClinicalTrials.gov and the preprint server medRxiv from January 1, 2020 to May 17, 2021. The following elements were used to define eligibility criteria: (1) Population: individuals at high-risk of exposure to SARS-CoV-2 (pre-exposure), individuals who had close contact with a positive or probable case of COVID-19 (post-exposure), non-hospitalized patients with COVID-19 and hospitalized patients with COVID-19; (2) Intervention: HCQ; (3) Comparison: placebo; (4) Outcomes: incidence of SARS-CoV-2 infection, need for hospitalization, length of hospital stay, need for invasive mechanical ventilation (MV), death, and adverse events; and (5) Study type: blinded, placebo-controlled, randomized clinical trials (RCTs). Risk of bias was judged according to the Cochrane guidelines for RCTs. Treatment effects were reported as relative risk (RR) for dichotomous variables and mean difference (MD) for continuous variables with 95% confidence intervals (CI). We used either a fixed or random-effects model to pool the results of individual studies depending on the presence of heterogeneity. The GRADE system was used to evaluate the strength of evidence between use of HCQ and the outcomes of interest. FINDINGS Fourteen blinded, placebo-controlled RCTs were included in this meta-analysis. Four trials (1942 patients: HCQ = 1271; placebo = 671) used HCQ as a prophylactic medication pre-exposure to COVID-19, two (1650 patients: HCQ = 821; placebo = 829) as a prophylactic medication post-exposure to COVID-19, three (1018 patients: HCQ = 497; placebo = 521) as treatment for non-hospitalized patients, and five (1138 patients: HCQ = 572; placebo = 566) as treatment for hospitalized patients with COVID-19. We found no decreased risk of SARS-CoV-2 infection among individuals receiving HCQ as pre-exposure (RR = 0.90; 95% CI 0.46 to 1.77) or post-exposure (RR = 0.96; 95% CI 0.72 to 1.29) prophylaxis to prevent COVID-19. There was no significant decreased risk of hospitalization for outpatients with SARS-CoV-2 infection (RR = 0.64; 95% CI 0.33 to 1.23) and no decreased risk of MV (RR = 0.81; 95% CI 0.49 to 1.34) and death (RR = 1.05; 95% CI 0.62 to 1.78) among hospitalized patients with COVID-19 receiving HCQ. The certainty of the results on the lack of clinical benefit for HCQ was rated as moderate. Moreover, our results demonstrated an increased risk for any adverse events and gastrointestinal symptoms among those using HCQ. INTERPRETATION Available evidence based on the results of blinded, placebo-controlled RCTs showed no clinical benefits of HCQ as pre-and post-exposure prophylaxis and treatment of non-hospitalized and hospitalized patients with COVID-19. FUNDING There was no funding source.
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Affiliation(s)
- Paulo Ricardo Martins-Filho
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil,Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil,Corresponding author. Prof. Paulo Ricardo Martins-Filho. Universidade Federal de Sergipe, Hospital Universitário, Laboratório de Patologia Investigativa. Rua Cláudio Batista, s/n. Bairro Sanatório. Aracaju, Sergipe, Brasil. CEP
| | - Lis Campos Ferreira
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil,Department of Medicine, Tiradentes University, Aracaju, Sergipe, Brazil
| | - Luana Heimfarth
- Laboratory of Neuroscience and Pharmacological Assays, Department of Physiology, Federal University of Sergipe, São Cristovão, Sergipe, Brazil
| | - Adriano Antunes de Souza Araújo
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil,Laboratory of Pharmaceutical Assays and Toxicity, Department of Pharmacy, Federal University of Sergipe, São Cristovão, Sergipe, Brazil
| | - Lucindo José Quintans-Júnior
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil,Laboratory of Neuroscience and Pharmacological Assays, Department of Physiology, Federal University of Sergipe, São Cristovão, Sergipe, Brazil
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17
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Big Data Research in Fighting COVID-19: Contributions and Techniques. BIG DATA AND COGNITIVE COMPUTING 2021. [DOI: 10.3390/bdcc5030030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has induced many problems in various sectors of human life. After more than one year of the pandemic, many studies have been conducted to discover various technological innovations and applications to combat the virus that has claimed many lives. The use of Big Data technology to mitigate the threats of the pandemic has been accelerated. Therefore, this survey aims to explore Big Data technology research in fighting the pandemic. Furthermore, the relevance of Big Data technology was analyzed while technological contributions to five main areas were highlighted. These include healthcare, social life, government policy, business and management, and the environment. The analytical techniques of machine learning, deep learning, statistics, and mathematics were discussed to solve issues regarding the pandemic. The data sources used in previous studies were also presented and they consist of government officials, institutional service, IoT generated, online media, and open data. Therefore, this study presents the role of Big Data technologies in enhancing the research relative to COVID-19 and provides insights into the current state of knowledge within the domain and references for further development or starting new studies are provided.
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18
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Hydroxychloroquine and Azithromycin Treatment of Hospitalized Patients Infected with SARS-CoV-2 in Senegal from March to October 2020. J Clin Med 2021; 10:jcm10132954. [PMID: 34209237 PMCID: PMC8269162 DOI: 10.3390/jcm10132954] [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: 05/01/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
As of today, little data is available on COVID-19 in African countries, where the case management relied mainly on a treatment by association between hydroxychloroquine (HCQ) and azithromycin (AZM). This study aimed to understand the main clinical outcomes of COVID-19 hospitalized patients in Senegal from March to October 20202. We described the clinical characteristics of patients and analysed clinical status (alive and discharged versus hospitalized or died) at 15 days after Isolation and Treatment Centres (ITC) admission among adult patients who received HCQ plus AZM and those who did not receive this combination. A total of 926 patients were included in this analysis. Six hundred seventy-four (674) (72.8%) patients received a combination of HCQ and AZM. Results showed that the proportion of patient discharge at D15 was significantly higher for patients receiving HCQ plus AZM (OR: 1.63, IC 95% (1.09-2.43)). Factors associated with a lower proportion of patients discharged alive were: age ≥ 60 years (OR: 0.55, IC 95% (0.36-0.83)), having of at least one pre-existing disorder (OR: 0.61, IC 95% (0.42-0.90)), and a high clinical risk at admission following NEWS score (OR: 0.49, IC 95% (0.28-0.83)). Few side effects were reported including 2 cases of cardiac rhythmic disorders in the HCQ and AZM group versus 13 in without HCQ + AZM. An improvement of clinical status at 15 days was found for patients exposed to HCQ plus AZM combination.
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19
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Khodajou-Masouleh H, Shahangian SS, Rasti B. Reinforcing our defense or weakening the enemy? A comparative overview of defensive and offensive strategies developed to confront COVID-19. Drug Metab Rev 2021; 53:508-541. [PMID: 33980089 DOI: 10.1080/03602532.2021.1928686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Developing effective strategies to confront coronavirus disease 2019 (COVID-19) has become one of the greatest concerns of the scientific community. In addition to the vast number of global mortalities due to COVID-19, since its outbreak, almost every aspect of human lives has changed one way or another. In the present review, various defensive and offensive strategies developed to confront COVID-19 are illustrated. The Administration of immune-boosting micronutrients/agents, as well as the inhibition of the activity of incompetent gatekeepers, including some host cell receptors (e.g. ACE2) and proteases (e.g. TMPRSS2), are some efficient defensive strategies. Antibody/phage therapies and specifically vaccines also play a prominent role in the enhancement of host defense against COVID-19. Nanotechnology, however, can considerably weaken the virulence of SARS-CoV-2, utilizing fake cellular locks (compounds mimicking cell receptors) to block the viral keys (spike proteins). Generally, two strategies are developed to interfere with the binding of spike proteins to the host cell receptors, either utilizing fake cellular locks to block the viral keys or utilizing fake viral keys to block the cellular locks. Due to their evolutionary conserved nature, viral enzymes, including 3CLpro, PLpro, RdRp, and helicase are highly potential targets for drug repurposing strategy. Thus, various steps of viral replication/transcription can effectively be blocked by their inhibition, leading to the elimination of SARS-CoV-2. Moreover, RNA decoy and CRISPR technologies likely offer the best offensive strategies after viral entry into the host cells, inhibiting the viral replication/assembly in the infected cells and substantially reducing the quantity of viral progeny.
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Affiliation(s)
| | - S Shirin Shahangian
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
| | - Behnam Rasti
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University (IAU), Lahijan, Guilan, Iran
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20
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Maity S, Saha A. Therapeutic Potential of Exploiting Autophagy Cascade Against Coronavirus Infection. Front Microbiol 2021; 12:675419. [PMID: 34054782 PMCID: PMC8160449 DOI: 10.3389/fmicb.2021.675419] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022] Open
Abstract
Since its emergence in December 2019 in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) created a worldwide pandemic of coronavirus disease (COVID-19) with nearly 136 million cases and approximately 3 million deaths. Recent studies indicate that like other coronaviruses, SARS-CoV-2 also hijacks or usurps various host cell machineries including autophagy for its replication and disease pathogenesis. Double membrane vesicles generated during initiation of autophagy cascade act as a scaffold for the assembly of viral replication complexes and facilitate RNA synthesis. The use of autophagy inhibitors - chloroquine and hydroxychloroquine initially appeared to be as a potential treatment strategy of COVID-19 patients but later remained at the center of debate due to high cytotoxic effects. In the absence of a specific drug or vaccine, there is an urgent need for a safe, potent as well as affordable drug to control the disease spread. Given the intricate connection between autophagy machinery and viral pathogenesis, the question arises whether targeting autophagy pathway might show a path to fight against SARS-CoV-2 infection. In this review we will discuss about our current knowledge linking autophagy to coronaviruses and how that is being utilized to repurpose autophagy modulators as potential COVID-19 treatment.
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Affiliation(s)
| | - Abhik Saha
- School of Biotechnology, Presidency University, Kolkata, India
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21
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Grine G, Fournier PE, Drancourt M. NMNI editorial report, 2020. New Microbes New Infect 2021; 41:100859. [PMID: 33889414 PMCID: PMC8050769 DOI: 10.1016/j.nmni.2021.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- G Grine
- Aix-Marseille Université, IRD, MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France.,Aix-Marseille Université, UFR Odontologie, Marseille, France
| | - P-E Fournier
- Aix-Marseille Université, IRD, VITROME, Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France
| | - M Drancourt
- Aix-Marseille Université, IRD, MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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22
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Lv Y, Ma C, Li X, Wu M. Big data driven COVID-19 pandemic crisis management: potential approach for global health. Arch Med Sci 2021; 17:829-837. [PMID: 34025856 PMCID: PMC8130465 DOI: 10.5114/aoms/133522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/21/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Information has the power to protect against unexpected events and control any crisis such as the COVID-19 pandemic. Since COVID-19 has already rapidly spread all over the world, only technology-driven data management can provide accurate information to manage the crisis. This study aims to explore the potential of big data technologies for controlling COVID-19 transmission and managing it effectively. METHODS A systematic review guided by PRISMA guidelines has been performed to obtain the key elements. RESULTS This study identified the thirty-two most relevant documents for qualitative analysis. This study also reveals 10 possible sources and 8 key applications of big data for analyzing the virus infection trend, transmission pattern, virus association, and differences of genetic modifications. It also explores several limitations of big data usage including unethical use, privacy, and exploitative use of data. CONCLUSIONS The findings of the study will provide new insight and help policymakers and administrators to develop data-driven initiatives to tackle and manage the COVID-19 crisis.
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Affiliation(s)
- Yang Lv
- School of Public Administration, Sichuan University, China
| | - Chenwei Ma
- School of Public Administration, Sichuan University, China
| | - Xiaohan Li
- School of Public Administration, Sichuan University, China
| | - Min Wu
- School of Public Administration, Sichuan University, China
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23
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De Vito A, Fiore V, Princic E, Geremia N, Panu Napodano CM, Muredda AA, Maida I, Madeddu G, Babudieri S. Predictors of infection, symptoms development, and mortality in people with SARS-CoV-2 living in retirement nursing homes. PLoS One 2021; 16:e0248009. [PMID: 33724987 PMCID: PMC7963051 DOI: 10.1371/journal.pone.0248009] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death. Methods and findings We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student’s t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables’ influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab’s positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients’ autonomy and early heparin treatment were related to lower mortality risk. Conclusions We evidenced factors associated with infection’s risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.
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Affiliation(s)
- Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- * E-mail:
| | - Vito Fiore
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Elija Princic
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Nicholas Geremia
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Catello Mario Panu Napodano
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alberto Augusto Muredda
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ivana Maida
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Mediterranean Center for Disease Control, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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24
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Hache G, Rolain JM, Gautret P, Deharo JC, Brouqui P, Raoult D, Honoré S. Combination of Hydroxychloroquine Plus Azithromycin As Potential Treatment for COVID-19 Patients: Safety Profile, Drug Interactions, and Management of Toxicity. Microb Drug Resist 2021; 27:281-290. [PMID: 33729874 PMCID: PMC7987362 DOI: 10.1089/mdr.2020.0232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2, has recently emerged worldwide. In this context, there is an urgent need to identify safe and effective therapeutic strategies for treatment of such highly contagious disease. We recently reported promising results of combining hydroxychloroquine and azithromycin as an early treatment option. Although ongoing clinical trials are challenging the efficacy of this combination, many clinicians claim the authorization to or have already begun to use it to treat COVID-19 patients worldwide. The aim of this article is to share pharmacology considerations contributing to the rationale of this combination, and to provide safety information to prevent toxicity and drug-drug interactions, based on available evidence.
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Affiliation(s)
- Guillaume Hache
- Service de Pharmacie, Hôpital de la Timone, APHM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Jean Marc Rolain
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Philippe Gautret
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Jean-Claude Deharo
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- Service de Cardiologie, Hôpital de la Timone, APHM, Marseille, France
| | - Philippe Brouqui
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Stéphane Honoré
- Service de Pharmacie, Hôpital de la Timone, APHM, Marseille, France
- Aix Marseille Univ, Laboratoire de Pharmacie Clinique, Marseille, France
- Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
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25
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Eze P, Mezue KN, Nduka CU, Obianyo I, Egbuche O. Efficacy and safety of chloroquine and hydroxychloroquine for treatment of COVID-19 patients-a systematic review and meta-analysis of randomized controlled trials. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:93-107. [PMID: 33815925 PMCID: PMC8012280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
The coronavirus disease 19 (COVID-19) pandemic has caused significant morbidity and mortality worldwide and an effective treatment is needed. Chloroquine (CQ) and hydroxychloroquine (HCQ) have shown in vitro antiviral activity against SARS-CoV-2 which causes the disease, but the evidence from in vivo studies so far has been inconclusive. OBJECTIVE To evaluate the efficacy and safety of CQ and HCQ in the treatment of COVID-19. DATA SOURCES We systematically searched the PubMed, Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Scopus, Joanna Briggs Institute Database, ClinicalTrials.gov, and Chinese Clinical Trial Registry (ChiCTR) for all articles published between 01 January 2020 to 15 September 2020 on CQ/HCQ and COVID-19 using a predefined search protocol; without any language restrictions. A search of grey literature repositories (New York Academy of Medicine Grey Literature and Open Grey), and pre-publication server deposits (medRxIV and bioRxIV) was also performed. STUDY SELECTION Randomized clinical trials (RCT) which compared CQ/HCQ to standard supportive therapy in treating COVID-19 were included. DATA EXTRACTION AND SYNTHESIS Data were extracted from original publications by four independent reviewers. Risk of bias was assessed using the Cochrane Collaboration's assessment tool. Data were meta-analyzed using a random-effect models. Results are reported according to PRISMA guidelines. Main Outcome(s) and Measure(s): The primary prespecified efficacy outcome was all-cause mortality. The primary safety outcome was any adverse effect attributed to use of CQ/HCQ. RESULTS Eight RCTs were included and pooled in the mortality meta-analysis (6,592 unique participants; mean age = 59.4 years; 42% women). CQ/HCQ did not show any mortality benefit when compared to standard supportive therapy (Pooled Relative Risk [RR] 1.07; 95% CI = 0.97-1.18; I2 statistic = 0.00%). Sensitivity and sub-group analyses showed similar findings. Any adverse event was significantly higher in patients randomized to CQ/HCQ (RR = 2.51; 95% CI = 1.53-4.12; n = 1,818 patients), but the risk of developing severe adverse event was not statistically significant (RR = 0.99, 95% CI = 0.53-1.86; n = 6,456 patients). CONCLUSIONS AND RELEVANCE Evidence from currently published RCTs do not demonstrate any added benefit for the use of CQ or HCQ in the treatment of COVID-19 patients.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State UniversityUniversity Park, PA 16802, USA
| | - Kenechukwu N Mezue
- Division of Nuclear Cardiology, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA 02114, USA
| | - Chidozie U Nduka
- Population Evidence and Technologies, Warwick Medical School, University of WarwickCoventry, CV4 7AL, UK
| | - Ijeoma Obianyo
- Department of Surgery, University of Nigeria Teaching HospitalItuku-Ozalla, Enugu, Nigeria
| | - Obiora Egbuche
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA 30310, USA
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26
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Ortega-Peña M, González-Cuevas R. Familiar Dermatologic Drugs as Therapies for COVID-19. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:118-126. [PMID: 33045209 PMCID: PMC7546972 DOI: 10.1016/j.ad.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022] Open
Abstract
Researchers the world over are working to find the treatments needed to reduce the negative effects of coronavirus disease 2019 (COVID-19) and improve the current prognosis of patients. Several drugs that are often used in dermatology are among the potentially useful treatments: ivermectin, antiandrogenic agents, melatonin, and the antimalarial drugs chloroquine and hydroxychloroquine. These and other agents, some of which have proven controversial, are being scrutinized by the scientific community. We briefly review the aforementioned dermatologic drugs and describe the most recent findings relevant to their use against COVID-19.
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Affiliation(s)
- M Ortega-Peña
- Escuela de Medicina, Universidad Mayor, Santiago, Chile
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27
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Abstract
Researchers the world over are working to find the treatments needed to reduce the negative effects of coronavirus disease 2019 (COVID-19) and improve the current prognosis of patients. Several drugs that are often used in dermatology are among the potentially useful treatments: ivermectin, antiandrogenic agents, melatonin, and the antimalarial drugs chloroquine and hydroxychloroquine. These and other agents, some of which have proven controversial, are being scrutinized by the scientific community. We briefly review the aforementioned dermatologic drugs and describe the most recent findings relevant to their use against COVID-19.
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28
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Ratre YK, Kahar N, Bhaskar LVKS, Bhattacharya A, Verma HK. Molecular mechanism, diagnosis, and potential treatment for novel coronavirus (COVID-19): a current literature review and perspective. 3 Biotech 2021; 11:94. [PMID: 33520580 PMCID: PMC7832422 DOI: 10.1007/s13205-021-02657-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Novel coronavirus disease 2019 (COVID-19) is a positive-sense single-stranded RNA virus which belongs to the Coronaviridae family. COVID-19 outbreak became evident after the severe acute respiratory syndrome coronavirus and the Middle East respiratory syndrome coronavirus in the twenty-first century as the start of the third deadly coronavirus. Currently, research is at an early stage, and the exact etiological dimensions of COVID-19 are unknown. Several candidate drugs and plasma therapy have been considered and evaluated for the treatment of severe COVID-19 patients. These include clinically available drugs such as chloroquine, hydroxychloroquine, and lopinavir/ritonavir. However, understanding the pathogenic mechanisms of this virus is critical for predicting interaction with humans. Based on recent evidence, we have summarized the current virus biology in terms of the possible understanding of the various pathophysiologies, molecular mechanisms, recent efficient diagnostics, and therapeutic approaches to control the disease. In addition, we briefly reviewed the biochemistry of leading candidates for novel therapies and their current status in clinical trials. As information from COVID-19 is evolving rapidly, this review will help the researcher to consider new insights and potential therapeutic approaches based on up-to-date knowledge. Finally, this review illustrates a list of alternative therapeutic solutions for a viral infection.
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Affiliation(s)
| | - Namrata Kahar
- Department of Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | | | - Antaripa Bhattacharya
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | - Henu Kumar Verma
- Developmental and Stem Cell Biology Lab, Institute of Experimental Endocrinology and Oncology CNR, Naples, Italy
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29
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Romeo I, Mesiti F, Lupia A, Alcaro S. Current Updates on Naturally Occurring Compounds Recognizing SARS-CoV-2 Druggable Targets. Molecules 2021; 26:632. [PMID: 33530467 PMCID: PMC7865633 DOI: 10.3390/molecules26030632] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified in China as the etiologic agent of the recent COVID-19 pandemic outbreak. Due to its high transmissibility, this virus quickly spread throughout the world, causing considerable health issues. The scientific community exerted noteworthy efforts to obtain therapeutic solutions for COVID-19, and new scientific networks were constituted. No certified drugs to efficiently inhibit the virus were identified, and the development of de-novo medicines requires approximately ten years of research. Therefore, the repurposing of natural products could be an effective strategy to handle SARS-CoV-2 infection. This review aims to update on current status of the natural occurring compounds recognizing SARS-CoV-2 druggable targets. Among the clinical trials actually recruited, some natural compounds are ongoing to examine their potential role to prevent and to treat the COVID-19 infection. Many natural scaffolds, including alkaloids, terpenes, flavonoids, and benzoquinones, were investigated by in-silico, in-vitro, and in-vivo approaches. Despite the large data set obtained by a computational approach, experimental evidences in most cases are not available. To fill this gap, further efforts to validate these results are required. We believe that an accurate investigation of naturally occurring compounds may provide insights for the potential treatment of COVID-19 patients.
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Affiliation(s)
- Isabella Romeo
- Dipartimento di Scienze della Salute, Università “Magna Græcia” di Catanzaro, Campus “S. Venuta”, Viale Europa, 88100 Catanzaro, Italy;
- Net4Science Academic Spin-Off, Università “Magna Græcia” di Catanzaro, Campus “S. Venuta”, Viale Europa, 88100 Catanzaro, Italy; (F.M.); (A.L.)
| | - Francesco Mesiti
- Net4Science Academic Spin-Off, Università “Magna Græcia” di Catanzaro, Campus “S. Venuta”, Viale Europa, 88100 Catanzaro, Italy; (F.M.); (A.L.)
| | - Antonio Lupia
- Net4Science Academic Spin-Off, Università “Magna Græcia” di Catanzaro, Campus “S. Venuta”, Viale Europa, 88100 Catanzaro, Italy; (F.M.); (A.L.)
| | - Stefano Alcaro
- Dipartimento di Scienze della Salute, Università “Magna Græcia” di Catanzaro, Campus “S. Venuta”, Viale Europa, 88100 Catanzaro, Italy;
- Net4Science Academic Spin-Off, Università “Magna Græcia” di Catanzaro, Campus “S. Venuta”, Viale Europa, 88100 Catanzaro, Italy; (F.M.); (A.L.)
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30
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Diallo A, Carlos-Bolumbu M, Traoré M, Diallo MH, Jedrecy C. An updated systematic review and network meta-analysis of 25 randomized trials assessing the efficacy and safety of treatments in COVID-19 disease. J Public Health Res 2021; 10:1945. [PMID: 33634043 PMCID: PMC7883016 DOI: 10.4081/jphr.2021.1945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022] Open
Abstract
To date, there is no definite effective treatment for the COVID- 19 pandemic. We performed an update network meta-analysis to compare and rank COVID-19 treatments according to their efficacy and safety. Literature search was performed from MEDLINE and CENTRAL databases from inception to September 5, 2020. Randomized clinical trials (RCTs) which compared the effect of any pharmacological drugs versus standard care or placebo 28-day after hospitalization in adult patients with COVID-19 disease were included. Risk ratio (RR) and 95% CI were calculated for 28-day all-cause mortality, clinical improvement, any adverse event (AEs), and viral clearance. A total of 25 RCTs, evaluating 17 different treatments, and 11,597 participants were analyzed. Remdesivir for 10- day compared to standard care (RR 0.69, 95% CI [0.48-0.99]), and a low dose compared to a high dose of HCQ (0.38, [0.17-0.89]) were associated with a lower risk of death. A total of 2,766 patients experienced clinical improvement, a 5-day course of remdesivir was associated with a higher frequency of clinical improvement compared to standard care (RR 1.21, 95% CI [1.00-1.47]). Compared to standard care, remdesivir for both 5 and 10 days, lopinavir/ritonavir, and dexamethasone reduced the risk of any severe AEs by 52% (0.48, 0.34-0.67), 24% (0.77, 0.63-0.92), 40% (0.60, 0.37-0.98), and 50% (0.50, 0.25-0.98) respectively. In this study of hospitalized patients with COVID-19, administration of remdesivir for 10-day compared to standard care was associated with lower 28-day all-cause mortality and serious AEs, and higher clinical improvement rate.
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Affiliation(s)
- Alhassane Diallo
- INSERM, CIC 1411, CHU of Montpellier, St Eloi Hospital, University of Montpellier
| | | | - Marie Traoré
- Service de Rhumatologie, APHP Henry Mondor, Paris
| | - Mamadou Hassimiou Diallo
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Unité de Recherche Clinique Salpêtrière - Charles Foix, Paris, France
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31
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Gautret P, Hoang VT, Honoré S, Roussel Y, Million M, Lagier JC, Raoult D. Response to the use of hydroxychloroquine in combination with azithromycin for patients with COVID-19 is not supported by recent literature. Int J Antimicrob Agents 2021; 57:106241. [PMID: 33408031 PMCID: PMC7779257 DOI: 10.1016/j.ijantimicag.2020.106241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Philippe Gautret
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Van Thuan Hoang
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Stéphane Honoré
- Service Pharmacie, Hôpital Timone, AP-HM, Marseille, France; Laboratoire de Pharmacie Clinique, Aix Marseille Université, Marseille, France
| | - Yanis Roussel
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Matthieu Million
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France.
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32
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Fedorowski JJ. Could amantadine interfere with COVID-19 vaccines based on the LNP-mRNA platform? Arch Med Sci 2021; 17:827-828. [PMID: 34025855 PMCID: PMC8130463 DOI: 10.5114/aoms/134716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Amantadine is a well-known medication with indications in neurology and infectious diseases. It is currently FDA approved for Parkinson's disease, drug-induced extrapyramidal symptoms, and influenza. METHODS The article is the author's original research hypothesis. RESULTS Because more people are going to be vaccinated and additional similar vaccines are going to be introduced, we should take into consideration the potential of amantadine to interfere with LNP-mRNA COVID-19 vaccine delivery into the target cells. CONCLUSIONS A more cautious approach to the patients taking amantadine as far as vaccination utilizing LNP-mRNA platform should be considered.
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Affiliation(s)
- Jaroslaw J. Fedorowski
- Polish Hospital Federation, Poland
- Collegium Humanum Warsaw Management University, Warsaw, Poland
- College of Medicine and Health Network, University of Vermont, Vermont, United States
- Warsaw Maria Curie-Sklodowska Medical University, Warsaw, Poland
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33
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Fiolet T, Guihur A, Rebeaud ME, Mulot M, Peiffer-Smadja N, Mahamat-Saleh Y. Effect of hydroxychloroquine with or without azithromycin on the mortality of COVID-19 patients: authors' response. Clin Microbiol Infect 2021; 27:138-140. [PMID: 33080383 PMCID: PMC7568487 DOI: 10.1016/j.cmi.2020.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Thibault Fiolet
- CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, 94 805, Villejuif, France; Gustave Roussy, F-94805, Villejuif, France.
| | - Anthony Guihur
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Mathieu Edouard Rebeaud
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Matthieu Mulot
- Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchâtel, Switzerland
| | - Nathan Peiffer-Smadja
- Université de Paris, IAME, INSERM, F-75018 Paris, France; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, 75018, France
| | - Yahya Mahamat-Saleh
- CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, 94 805, Villejuif, France; Gustave Roussy, F-94805, Villejuif, France
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34
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Raoult D. Rational for meta-analysis and randomized treatment: the COVID-19 example. Clin Microbiol Infect 2021; 27:6-8. [PMID: 33098998 PMCID: PMC7577218 DOI: 10.1016/j.cmi.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Didier Raoult
- MEPHI, IRD, Aix Marseille Univ, AP-HM, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
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35
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Emani VR, Goswami S, Nandanoor D, Emani SR, Reddy NK, Reddy R. Randomised controlled trials for COVID-19: evaluation of optimal randomisation methodologies-need for data validation of the completed trials and to improve ongoing and future randomised trial designs. Int J Antimicrob Agents 2021; 57:106222. [PMID: 33189891 PMCID: PMC7659806 DOI: 10.1016/j.ijantimicag.2020.106222] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 12/15/2022]
Abstract
During the emerging COVID-19 (coronavirus disease 2019) pandemic, initially there were no proven treatment options. With the release of randomised controlled trial (RCT) results, we are beginning to see possible treatment options for COVID-19. The RECOVERY trial showed an absolute risk reduction in mortality by 2.8% with dexamethasone, and the ACTT-1 trial showed that treatment with remdesivir reduced the time to recovery by 4 days. Treatment with hydroxychloroquine (HCQ) and lopinavir/ritonavir did not show any mortality benefit in either the RECOVERY or World Health Organization (WHO) Solidarity trials. The National Institutes of Health (NIH) and Brazilian HCQ trials did not show any benefit for HCQ based on the seven-point ordinal scale outcomes. The randomisation methodologies utilised in these controlled trials and the quality of published data were reviewed to examine their adaptability to treat patients. We found that the randomisation methodologies of these trials were suboptimal for matching the studied groups based on disease severity among critically-ill hospitalised COVID-19 patients with high mortality rates. The published literature is very limited regarding the disease severity metrics among the compared groups and failed to show that the data are without fatal sampling errors and sampling biases. We also found that there is a definite need for the validation of data in these trials along with additional important disease severity metrics to ensure that the trials' conclusions are accurate. We also propose proper randomisation methodologies for the design of RCTs for COVID-19 as well as guidance for the publication of COVID-19 trial results.
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Affiliation(s)
- Venkata R Emani
- Central Valley Cardiovascular Associates, Inc., 1148 Norman Drive, Suite #2, Manteca, CA 95336, USA.
| | - Sanjeev Goswami
- San Joaquin Critical Care Medical Group, 1801 E March Ln c300, Stockton, CA 95210, USA
| | | | - Shaila R Emani
- Central Valley Cardiovascular Associates, Inc., 1148 Norman Drive, Suite #2, Manteca, CA 95336, USA
| | - Nidhi K Reddy
- Stockton Primary Care, 805 N California St #102, Stockton, CA 95204, USA
| | - Raghunath Reddy
- Stockton Primary Care, 805 N California St #102, Stockton, CA 95204, USA
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36
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Gautret P, Million M, Jarrot PA, Camoin-Jau L, Colson P, Fenollar F, Leone M, La Scola B, Devaux C, Gaubert JY, Mege JL, Vitte J, Melenotte C, Rolain JM, Parola P, Lagier JC, Brouqui P, Raoult D. Natural history of COVID-19 and therapeutic options. Expert Rev Clin Immunol 2020; 16:1159-1184. [PMID: 33356661 DOI: 10.1080/1744666x.2021.1847640] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: COVID-19 presents benign forms in young patients who frequently present with anosmia. Infants are rarely infected, while severe forms occur in patients over 65 years of age with comorbidities, including hypertension and diabetes. Lymphopenia, eosinopenia, thrombopenia, increased lactate dehydrogenase, troponin, C-reactive protein, D-dimers and low zinc levels are associated with severity.Areas covered: The authors review the literature and provide an overview of the current state of knowledge regarding the natural history of and therapeutic options for COVID-19. Expert opinion: Diagnosis should rely on PCR and not on clinical presumption. Because of discrepancies between clinical symptoms, oxygen saturation or radiological signs on CT scans, pulse oximetry, and radiological investigation should be systematic. The disease evolves in successive phases: an acute virological phase, and, in some patients, a cytokine storm phase; an uncontrolled coagulopathy; and an acute respiratory distress syndrome. Therapeutic options include antivirals, oxygen therapy, immunomodulators, anticoagulants and prolonged mechanical treatment. Early diagnosis, care, and implementation of an antiviral treatment; the use of immunomodulators at a later stage; and the quality of intensive care are critical regarding mortality rates. The higher mortality observed in Western countries remains unexplained. Pulmonary fibrosis may occur in some patients. Its future is unpredictable.
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Affiliation(s)
- Philippe Gautret
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Ssa, Vitrome, Aix Marseille Univ , Marseille, France
| | - Matthieu Million
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | | | - Laurence Camoin-Jau
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France.,Laboratoire d'Hématologie, Hôpital De La Timone, APHM, Boulevard Jean- Moulin , Marseille, France
| | - Philippe Colson
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | - Florence Fenollar
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Ssa, Vitrome, Aix Marseille Univ , Marseille, France
| | - Marc Leone
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France.,Service d'Anesthésie Et De Réanimation, Hôpital Nord, APHM , Marseille, France
| | - Bernard La Scola
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | - Christian Devaux
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France.,CNRS , Marseille, France
| | - Jean Yves Gaubert
- Department of Radiology and Cardiovascular Imaging, Aix Marseille Univ, LIIE , Marseille, France
| | - Jean-Louis Mege
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | - Joana Vitte
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | - Cléa Melenotte
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | - Jean-Marc Rolain
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | - Philippe Parola
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Ssa, Vitrome, Aix Marseille Univ , Marseille, France
| | - Jean-Christophe Lagier
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | - Philippe Brouqui
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
| | - Didier Raoult
- Institut Hospitalo-Universitaire Méditerranée Infection , Marseille, France.,Ird, Ap-hm, Mephi, Aix Marseille Univ , Marseille, France
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Shamshirian A, Hessami A, Heydari K, Alizadeh-Navaei R, Ebrahimzadeh MA, Yip GW, Ghasemian R, Sedaghat M, Baradaran H, Mohammadi Yazdii S, Aboufazeli E, Jafarpour H, Dadgostar E, Tirandazi B, Sadeghnezhad R, Karimifar K, Eftekhari A, Shamshirian D. The Role of Hydroxychloroquine in COVID-19 Treatment: A Systematic Review and Meta-Analysis. ANNALS ACADEMY OF MEDICINE SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2020370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: A systematic review and meta-analysis was carried out to examine the role of hydroxychloroquine (HCQ) in the treatment of COVID-19. Methods: We performed a systematic search in PubMed, Scopus, Embase, Cochrane- Library, Web of Science, Google Scholar, and medRxiv pre-print databases using available MeSH terms for COVID-19 and hydroxychloroquine. Data from all studies that focused on the effectiveness of HCQ with or without the addition of azithromycin (AZM) in confirmed COVID-19 patients, which were published up to 12 September 2020, were collated for analysis using CMA v.2.2.064. Results: Our systematic review retrieved 41 studies. Among these, 37 studies including 45,913 participants fulfilled the criteria for subsequent meta-analysis. The data showed no significant difference in treatment efficacy between the HCQ and control groups (RR: 1.02, 95% CI, 0.81–1.27). Combination of HCQ with AZM also did not lead to improved treatment outcomes (RR: 1.26, 95% CI, 0.91–1.74). Furthermore, the mortality difference was not significant, neither in HCQ treatment group (RR: 0.86, 95% CI, 0.71–1.03) nor in HCQ plus AZM treatment group (RR: 1.28, 95% CI, 0.76–2.14) in comparison to controls. Meta-regression analysis showed that age was the factor that significantly affected mortality (P<0.00001). Conclusion: The meta-analysis found that there was no clinical benefit of using either HCQ by itself or in combination with AZM for the treatment of COVID-19 patients. Hence, it may be prudent for clinicians and researchers to focus on other therapeutic options that may show greater promise in this disease. Keywords: Azithromycin, coronavirus outbreaks, pandemic, SARS-CoV-2 disease
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ehsan Dadgostar
- Halal research center of Islamic Republic of Iran, FDA, Tehran, Iran
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Elavarasi A, Prasad M, Seth T, Sahoo RK, Madan K, Nischal N, Soneja M, Sharma A, Maulik SK, Shalimar, Garg P. Chloroquine and Hydroxychloroquine for the Treatment of COVID-19: a Systematic Review and Meta-analysis. J Gen Intern Med 2020; 35:3308-3314. [PMID: 32885373 PMCID: PMC7471562 DOI: 10.1007/s11606-020-06146-w] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/12/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is no effective therapy for COVID-19. Hydroxychloroquine (HCQ) and chloroquine (CQ) have been used for its treatment but their safety and efficacy remain uncertain. OBJECTIVE We performed a systematic review to synthesize the available data on the efficacy and safety of CQ and HCQ for the treatment of COVID-19. METHODS Two reviewers searched for published and pre-published relevant articles between December 2019 and 8 June 2020. The data from the selected studies were abstracted and analyzed for efficacy and safety outcomes. Critical appraisal of the evidence was done by Cochrane risk of bias tool and Newcastle Ottawa Scale. The quality of evidence was graded as per the GRADE approach. RESULTS We reviewed 12 observational and 3 randomized trials which included 10,659 patients of whom 5713 received CQ/HCQ and 4966 received only standard of care. The efficacy of CQ/HCQ for COVID-19 was inconsistent across the studies. Meta-analysis of included studies revealed no significant reduction in mortality with HCQ use [RR 0.98 95% CI 0.66-1.46], time to fever resolution (mean difference - 0.54 days (- 1.19-011)) or clinical deterioration/development of ARDS with HCQ [RR 0.90 95% CI 0.47-1.71]. There was a higher risk of ECG abnormalities/arrhythmia with HCQ/CQ [RR 1.46 95% CI 1.04 to 2.06]. The quality of evidence was graded as very low for these outcomes. AUTHORS' CONCLUSION The available evidence suggests that CQ or HCQ does not improve clinical outcomes in COVID-19. Well-designed randomized trials are required for assessing the efficacy and safety of HCQ and CQ for COVID-19.
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Affiliation(s)
| | - Manya Prasad
- Department of Community Medicine, NDMC Medical College, New Delhi, India
| | - Tulika Seth
- Clinical Hematology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ranjit Kumar Sahoo
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Karan Madan
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Neeraj Nischal
- Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manish Soneja
- Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Atul Sharma
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Subir Kumar Maulik
- Pharmacology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shalimar
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Pramod Garg
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029, India.
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39
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Khan Z, Ghafoor D, Khan A, Ualiyeva D, Khan S, Bilal H, Khan B, Khan A, Sajjad W. Diagnostic approaches and potential therapeutic options for coronavirus disease 2019. New Microbes New Infect 2020; 38:100770. [PMID: 33014380 PMCID: PMC7525249 DOI: 10.1016/j.nmni.2020.100770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan city of China in late December 2019 and identified as a novel coronavirus. Due to its contagious nature, the virus spreads rapidly and causes coronavirus disease 2019 (COVID-19). The global tally of COVID-19 was 28 million in early September 2020. The fears and stress associated with SARS-CoV-2 has demolished the socio-economic status worldwide. Researchers are trying to identify treatments, especially antiviral drugs and/or vaccines, that could potentially control the viral spread and manage the ongoing unprecedented global crisis. To date, more than 300 clinical trials have been conducted on various antiviral drugs, and immunomodulators are being evaluated at various stages of COVID-19. This review aims to collect and summarize a list of drugs used to treat COVID-19, including dexamethasone, chloroquine, hydroxychloroquine, lopinavir/ritonavir, favipiravir, remdesivir, tociluzimab, nitazoxanide and ivermectin. However, some of these drugs are not effective and their use has been suspended by WHO.
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Affiliation(s)
- Z. Khan
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
- University of Chinese Academy of Sciences, Beijing, China
| | - D. Ghafoor
- University of Chinese Academy of Sciences, Beijing, China
- Wuhan Institute of Virology, Chinese Academy of Sciences Xiao Hong Shan No.44, Wuhan, Hubei, China
| | - A. Khan
- Department of Microbiology, School of Life Sciences, Lanzhou University, China
| | - D. Ualiyeva
- University of Chinese Academy of Sciences, Beijing, China
- Laboratory of Molecular Biology and Evolution, Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, China
| | - S.A. Khan
- Department of Pathobiology, University of Poonch Rawalakot Azad Kashmir, Rawalakot, Azad Kashmir, Pakistan
| | - H. Bilal
- Centre for Management and Commerce, University of Swat, Mingora, Pakistan
| | - B. Khan
- Department of Optometry, Isra University Islamabad, Islamabad, Pakistan
| | - A. Khan
- Department of Computer and Software Technology, University of Swat, Mingora, Pakistan
| | - W. Sajjad
- State Key Laboratory of Cryospheric Science, Northwest Institute of Eco-Environment and Resources, Chinese Academy of Sciences, Lanzhou, China
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Raoult D. Lancet gate: a matter of fact or a matter of concern. New Microbes New Infect 2020; 38:100758. [PMID: 32983540 PMCID: PMC7508049 DOI: 10.1016/j.nmni.2020.100758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
I am adopting an epistemological point of view to decrypt the recent Lancet gate, revealing current weaknesses in Sciences and its production in western countries, giving an unique opportunity to refound both.
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Affiliation(s)
- D. Raoult
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Université, IRD, APHM, MEPHI, Marseille, France
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41
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Ayerbe L, Risco-Risco C, Ayis S. The association of treatment with hydroxychloroquine and hospital mortality in COVID-19 patients. Intern Emerg Med 2020; 15:1501-1506. [PMID: 32997237 PMCID: PMC7526068 DOI: 10.1007/s11739-020-02505-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/12/2020] [Indexed: 02/07/2023]
Abstract
This study investigates the association between the treatment with hydroxychloroquine and mortality in patients admitted with COVID-19. Routinely recorded, clinical data, up to the 24th of April 2020, from the 2075 patients with COVID-19, admitted in 17 hospitals in Spain between the 1st of March and the 20th of April 2020 were used. The following variables were extracted for this study: age, gender, temperature, and saturation of oxygen on admission, treatment with hydroxychloroquine, azithromycin, heparin, steroids, tocilizumab, a combination of lopinavir with ritonavir, and oseltamivir, together with data on mortality. Multivariable logistic regression models were used to investigate the associations. At the time of collecting the data, 301 patients had died, 1449 had been discharged home from the hospitals, 240 were still admitted, and 85 had been transferred to hospitals not included in the study. Median follow-up time was 8 (IQR 5-12) days. Hydroxychloroquine had been used in 1857 patients. Hydroxychloroquine was associated with lower mortality when the model was adjusted for age and gender, with OR (95% CI): 0.44 (0.29-0.67). This association remained significant when saturation of oxygen < 90% and temperature > 37 °C were added to de model with OR 0.45 (0.30-0.68) p < 0.001, and also when all the other drugs, and time of admission, were included as covariates. The association between hydroxychloroquine and lower mortality observed in this study can be acknowledged by clinicians in hospitals and in the community. Randomized-controlled trials to assess the causal effects of hydroxychloroquine in different therapeutic regimes are required.
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Affiliation(s)
- Luis Ayerbe
- Centre of Primary Care and Public Health Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
- Carnarvon Medical Centre, Southend-on-Sea, UK.
| | - Carlos Risco-Risco
- Service of Internal Medicine. Hospital, Universitario HM Sanchinarro, Madrid, Spain
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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42
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Yuan Z, Pavel MA, Wang H, Hansen SB. Hydroxychloroquine: mechanism of action inhibiting SARS-CoV2 entry. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.08.13.250217. [PMID: 32817933 PMCID: PMC7430563 DOI: 10.1101/2020.08.13.250217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hydroxychloroquine (HCQ) has been proposed in the treatment of SARS-coronavirus 2 (SARS-CoV-2) infection, albeit with much controversy. In vitro, HCQ effectively inhibits viral entry, but its use in the clinic has been hampered by conflicting results. A better understanding of HCQ's mechanism of actions in vitro is needed to resolve these conflicts. Recently, anesthetics were shown to disrupt ordered monosialotetrahexosylganglioside1 (GM1) lipid rafts. These same lipid rafts recruit the SARS-CoV-2 surface receptor angiotensin converting enzyme 2 (ACE2) to an endocytic entry point, away from phosphatidylinositol 4,5 bisphosphate (PIP2) domains. Here we employed super resolution imaging of cultured mammalian cells to show HCQ directly perturbs GM1 lipid rafts and inhibits the ability of ACE2 receptor to associate with the endocytic pathway. HCQ also disrupts PIP2 domains and their ability to cluster and sequester ACE2. Similarly, the antibiotic erythromycin inhibits viral entry and both HCQ and erythromycin decrease the antimicrobial host defense peptide amyloid beta in cultured cells. We conclude HCQ is an anesthetic-like compound that disrupts GM1 lipid rafts similar to anesthetics. The disruption likely decreases viral clustering at both endocytic and putative PIP2 entry points.
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Affiliation(s)
- Zixuan Yuan
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, Florida, 33458, USA
- Department of Neuroscience, The Scripps Research Institute, Jupiter, Florida, 33458, USA
- Skaggs Graduate School of Chemical and Biological Sciences, The Scripps Research Institute, Jupiter, Florida, 33458, USA
| | - Mahmud Arif Pavel
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, Florida, 33458, USA
- Department of Neuroscience, The Scripps Research Institute, Jupiter, Florida, 33458, USA
| | - Hao Wang
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, Florida, 33458, USA
- Department of Neuroscience, The Scripps Research Institute, Jupiter, Florida, 33458, USA
- Skaggs Graduate School of Chemical and Biological Sciences, The Scripps Research Institute, Jupiter, Florida, 33458, USA
| | - Scott B. Hansen
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, Florida, 33458, USA
- Department of Neuroscience, The Scripps Research Institute, Jupiter, Florida, 33458, USA
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COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study. Int J Antimicrob Agents 2020; 56:106214. [PMID: 33122096 PMCID: PMC7587171 DOI: 10.1016/j.ijantimicag.2020.106214] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/13/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3–6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40–67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06–0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03–1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.
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Bonnechère B. Preprints in Medicine: Useful or Harmful? Front Med (Lausanne) 2020; 7:579100. [PMID: 33072789 PMCID: PMC7536293 DOI: 10.3389/fmed.2020.579100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Bruno Bonnechère
- Department of Psychiatry and Behavioral and Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Public Health School, Université Libre de Bruxelles, Brussels, Belgium
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45
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Wu J, Wang J, Nicholas S, Maitland E, Fan Q. Application of Big Data Technology for COVID-19 Prevention and Control in China: Lessons and Recommendations. J Med Internet Res 2020; 22:e21980. [PMID: 33001836 PMCID: PMC7561444 DOI: 10.2196/21980] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/28/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the prevention and control of infectious diseases, previous research on the application of big data technology has mainly focused on the early warning and early monitoring of infectious diseases. Although the application of big data technology for COVID-19 warning and monitoring remain important tasks, prevention of the disease's rapid spread and reduction of its impact on society are currently the most pressing challenges for the application of big data technology during the COVID-19 pandemic. After the outbreak of COVID-19 in Wuhan, the Chinese government and nongovernmental organizations actively used big data technology to prevent, contain, and control the spread of COVID-19. OBJECTIVE The aim of this study is to discuss the application of big data technology to prevent, contain, and control COVID-19 in China; draw lessons; and make recommendations. METHODS We discuss the data collection methods and key data information that existed in China before the outbreak of COVID-19 and how these data contributed to the prevention and control of COVID-19. Next, we discuss China's new data collection methods and new information assembled after the outbreak of COVID-19. Based on the data and information collected in China, we analyzed the application of big data technology from the perspectives of data sources, data application logic, data application level, and application results. In addition, we analyzed the issues, challenges, and responses encountered by China in the application of big data technology from four perspectives: data access, data use, data sharing, and data protection. Suggestions for improvements are made for data collection, data circulation, data innovation, and data security to help understand China's response to the epidemic and to provide lessons for other countries' prevention and control of COVID-19. RESULTS In the process of the prevention and control of COVID-19 in China, big data technology has played an important role in personal tracking, surveillance and early warning, tracking of the virus's sources, drug screening, medical treatment, resource allocation, and production recovery. The data used included location and travel data, medical and health data, news media data, government data, online consumption data, data collected by intelligent equipment, and epidemic prevention data. We identified a number of big data problems including low efficiency of data collection, difficulty in guaranteeing data quality, low efficiency of data use, lack of timely data sharing, and data privacy protection issues. To address these problems, we suggest unified data collection standards, innovative use of data, accelerated exchange and circulation of data, and a detailed and rigorous data protection system. CONCLUSIONS China has used big data technology to prevent and control COVID-19 in a timely manner. To prevent and control infectious diseases, countries must collect, clean, and integrate data from a wide range of sources; use big data technology to analyze a wide range of big data; create platforms for data analyses and sharing; and address privacy issues in the collection and use of big data.
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Affiliation(s)
- Jun Wu
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, Australia
- Newcastle Business School, University of Newcastle, Newcastle, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Qiuyan Fan
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
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46
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Million M, Roussel Y, Lagier JC, Raoult D. Re: 'Effect of hydroxychloroquine with or without azithromycin on the mortality of COVID-19 patients' by Fiolet et al. Clin Microbiol Infect 2020; 27:132-133. [PMID: 32980527 PMCID: PMC7832561 DOI: 10.1016/j.cmi.2020.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Matthieu Million
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Yanis Roussel
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.
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47
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Ong WY, Go ML, Wang DY, Cheah IKM, Halliwell B. Effects of Antimalarial Drugs on Neuroinflammation-Potential Use for Treatment of COVID-19-Related Neurologic Complications. Mol Neurobiol 2020; 58:106-117. [PMID: 32897518 PMCID: PMC7477069 DOI: 10.1007/s12035-020-02093-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
The SARS-CoV-2 virus that is the cause of coronavirus disease 2019 (COVID-19) affects not only peripheral organs such as the lungs and blood vessels, but also the central nervous system (CNS)—as seen by effects on smell, taste, seizures, stroke, neuropathological findings and possibly, loss of control of respiration resulting in silent hypoxemia. COVID-19 induces an inflammatory response and, in severe cases, a cytokine storm that can damage the CNS. Antimalarials have unique properties that distinguish them from other anti-inflammatory drugs. (A) They are very lipophilic, which enhances their ability to cross the blood-brain barrier (BBB). Hence, they have the potential to act not only in the periphery but also in the CNS, and could be a useful addition to our limited armamentarium against the SARS-CoV-2 virus. (B) They are non-selective inhibitors of phospholipase A2 isoforms, including cytosolic phospholipase A2 (cPLA2). The latter is not only activated by cytokines but itself generates arachidonic acid, which is metabolized by cyclooxygenase (COX) to pro-inflammatory eicosanoids. Free radicals are produced in this process, which can lead to oxidative damage to the CNS. There are at least 4 ways that antimalarials could be useful in combating COVID-19. (1) They inhibit PLA2. (2) They are basic molecules capable of affecting the pH of lysosomes and inhibiting the activity of lysosomal enzymes. (3) They may affect the expression and Fe2+/H+ symporter activity of iron transporters such as divalent metal transporter 1 (DMT1), hence reducing iron accumulation in tissues and iron-catalysed free radical formation. (4) They could affect viral replication. The latter may be related to their effect on inhibition of PLA2 isoforms. Inhibition of cPLA2 impairs an early step of coronavirus replication in cell culture. In addition, a secretory PLA2 (sPLA2) isoform, PLA2G2D, has been shown to be essential for the lethality of SARS-CoV in mice. It is important to take note of what ongoing clinical trials on chloroquine and hydroxychloroquine can eventually tell us about the use of antimalarials and other anti-inflammatory agents, not only for the treatment of COVID-19, but also for neurovascular disorders such as stroke and vascular dementia.
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Affiliation(s)
- Wei-Yi Ong
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore.
- Neurobiology Programme, Life Sciences Institute, National University of Singapore, Singapore, 119260, Singapore.
| | - Mei-Lin Go
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, 119260, Singapore
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore
| | - Irwin Kee-Mun Cheah
- Neurobiology Programme, Life Sciences Institute, National University of Singapore, Singapore, 119260, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore
| | - Barry Halliwell
- Neurobiology Programme, Life Sciences Institute, National University of Singapore, Singapore, 119260, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore.
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48
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Million M, Roussel Y, Raoult D. Chloroquine and COVID-19: A western medical and scientific drift? Eur J Intern Med 2020; 78:4-5. [PMID: 32600860 PMCID: PMC7309807 DOI: 10.1016/j.ejim.2020.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Matthieu Million
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Yanis Roussel
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
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49
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Lagier JC, Million M, Gautret P, Colson P, Cortaredona S, Giraud-Gatineau A, Honoré S, Gaubert JY, Fournier PE, Tissot-Dupont H, Chabrière E, Stein A, Deharo JC, Fenollar F, Rolain JM, Obadia Y, Jacquier A, La Scola B, Brouqui P, Drancourt M, Parola P, Raoult D. Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis. Travel Med Infect Dis 2020; 36:101791. [PMID: 32593867 PMCID: PMC7315163 DOI: 10.1016/j.tmaid.2020.101791] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In our institute in Marseille, France, we initiated early and massive screening for coronavirus disease 2019 (COVID-19). Hospitalization and early treatment with hydroxychloroquine and azithromycin (HCQ-AZ) was proposed for the positive cases. METHODS We retrospectively report the clinical management of 3,737 screened patients, including 3,119 (83.5%) treated with HCQ-AZ (200 mg of oral HCQ, three times daily for ten days and 500 mg of oral AZ on day 1 followed by 250 mg daily for the next four days, respectively) for at least three days and 618 (16.5%) patients treated with other regimen ("others"). Outcomes were death, transfer to the intensive care unit (ICU), ≥10 days of hospitalization and viral shedding. RESULTS The patients' mean age was 45 (sd 17) years, 45% were male, and the case fatality rate was 0.9%. We performed 2,065 low-dose computed tomography (CT) scans highlighting lung lesions in 592 of the 991 (59.7%) patients with minimal clinical symptoms (NEWS score = 0). A discrepancy between spontaneous dyspnoea, hypoxemia and lung lesions was observed. Clinical factors (age, comorbidities, NEWS-2 score), biological factors (lymphocytopenia; eosinopenia; decrease in blood zinc; and increase in D-dimers, lactate dehydrogenase, creatinine phosphokinase, troponin and C-reactive protein) and moderate and severe lesions detected in low-dose CT scans were associated with poor clinical outcome. Treatment with HCQ-AZ was associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11-0.27), decreased risk of hospitalization ≥10 days (odds ratios 95% CI 0.38 0.27-0.54) and shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17-1.42). QTc prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 12 cases including 3 cases with QTc> 500 ms. No cases of torsade de pointe or sudden death were observed. CONCLUSION Although this is a retrospective analysis, results suggest that early diagnosis, early isolation and early treatment of COVID-19 patients, with at least 3 days of HCQ-AZ lead to a significantly better clinical outcome and a faster viral load reduction than other treatments.
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Affiliation(s)
- Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Matthieu Million
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Gautret
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Philippe Colson
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Sébastien Cortaredona
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Audrey Giraud-Gatineau
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France; Centre d'Epidémiologie et de Santé Publique des Armées (CESPA), Marseille, France; AP-HM, Marseille, France
| | - Stéphane Honoré
- Aix Marseille University, Laboratoire de Pharmacie Clinique, Marseille, France; AP-HM, Hôpital Timone, Service Pharmacie, Marseille, France
| | - Jean-Yves Gaubert
- Department of Radiology and Cardiovascular Imaging, Aix Marseille Univ, LIIE, Marseille, France
| | - Pierre-Edouard Fournier
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Hervé Tissot-Dupont
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Eric Chabrière
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Andreas Stein
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Jean-Claude Deharo
- AP-HM, Aix Marseille University, Hôpital Timone, Cardiologie, Rythmologie, Marseille, France
| | - Florence Fenollar
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Jean-Marc Rolain
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | | | - Alexis Jacquier
- Department of Radiology and Cardiovascular Imaging, Aix-Marseille Univ., UMR 7339, CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale-Centre d'Exploration Métaboliques Par Résonance Magnétique), Marseille, France
| | - Bernard La Scola
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Brouqui
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Michel Drancourt
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Parola
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France.
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